PAs and Nurse Practicioners as medical control?

[somedic]

Do any of you work in a system where Physician Assistants and/or Nurse Practicioners give or approve orders to Paramedics?

In my state the regulations are clear that a Paramedic does not request or follow orders from any PA, NP or physician designee. Only licenced physicians are allowed to order or approve paramedic interventions in the field.

I'd be interested in how things work in your system if PAs and NPs do approve or give orders to Paramedics .

Thanks for any information.

SOMEDIC

[Ridryder 911]

Many states only recognizes that EMS medical directors should be only medical licensed physicians. NP & P.A. are recognized physician extenders and are licensed as such. They should be able to give orders (direct and written) in their expertise field as a direct physician extender, but should not be even considered as the main EMS medical control for overseeing operations.

Many areas do not have physician coverage, and are staffed by such physician extenders. I to question if an EMS has to do a specialty transport and the P.A. or NP wrote specific orders and they were not followed what the legality would be?... i.e. increase Pitocin drip etc...Since NP's are considered licensed practitioners and have authority in the state as such.

R/r 911

[JPINFV]

Online medical control in my county has a tiered approach for online medical control. Paramedics make base hospital contact to Mobile Intesive Care nurses (MICN) at the base hospital. Some procedures/drugs can be approved by the MICN while others are passed by the MICN to the base hospital physican.

[Dustdevil]

I've never worked any civilian EMS position where physician extenders were in a position of medical control. I can't say that I am totally opposed to the concept. I currently rely quite a bit on PAs for medical advice in my clinical practice. I run into some PAs that honestly don't seem to know anymore than I do. But I also deal with quite a few PAs that are extremely knowledgeable and are outstanding in a particular specialty. Let's face it. Pre-hospital EMS is not rocket surgery. I can think of damn few situations where a reasonably competent and experienced PA would not be capable of providing quality medical control to EMS. In fact, I can think of damn few situations where a reasonably competent and experienced paramedic should even need medical control in the first place.

But, as Rid stated, a Medical Director is, by definition, only a physician.

[somedic]

Dust: I couldnt agree more with your last post. My first contact with PAs was in the military and I've come to the conclusion that they are of one extreme or the other...either very good or really-really bad. And like you ,I have met some PAs that knew very little of anything. Here in the south PAs are not very well recieved by patients wanting to be seen by a real doctor.

I love the comment about reasonably competent and experienced paramedics not needing any medical control to begin..excellent !

NPs..Im not going there...I guess they have their place too some where far removed from prehospital medicine

Good work!

SOMEDIC

[Ridryder 911]

NPs..Im not going there...I guess they have their place too some where far removed from prehospital medicine

SOMEDIC

Sorry you feel that way, since they have a equal to higher diagnostic ratio than physicians and as well prescribe and order less than half the med.'s, procedures and tests to give them that diagnostic rating.

What I have found out is most health care workers are ignorant of NP requirements and their capabilities. I was enrolled in a P.A. program at one time and dropped out due to the philosophy of being too closely to the medical model of treating the symptoms not the patient. Most as well are not aware that NP's are specialized.. they are not generic and cannot function as such, unless one would consider a family NP being generic. For example, neonate, pediatric, adult, geriatric NP's have specialized education in only those areas and then take a board certification test in that specific area. Like EMS, they are specialized and cannot crossover to another health care profession.

I would find the NP being more closely to prehospital since they at least are required to have some form of medical education prior to applying to graduate school (most P.A.'s schools do not require) and most require a minimal of 2-5 years of patient contact experience. P.A. are a great asset and by no means, am I belittling them. But, in comparison a P.A. is similar to general medicine and after graduation the diversify into any area of medicine, where as a NP is only in that specialty.

As well, I guess or assume a Trauma NP, Acute Care, Flight Nurse NP, Emergency NP that only studied in those speciality areas with an additional 2 to 2 1/2 years on top of their undergrad not to be qualified enough to be in the field right? ....NOT!.. since Paramedics training is so in detailed.....with all that 10 months of nighttime classes...LOL

R/r 911

[tinman694]

We can give a patient report to the nurse at the recieving, but have to talk to the doc for anything related to intervention...which is the way it should be. As a medic, you are the "smart hands" for the doctor who will (hopefully) be treating the pt. you are bringing in.

Guess this is why I am considered a gray beard in the field...still remember the "mother may I" and the telemetry phone days.

Sorry, but a PA and NP do not have any more credentials (or education for that matter) than I do when it comes to the decision making....the system is set up to be run by a qualified physician.

Alles Klar?

[PRPGfirerescuetech]

Does an NP still qualify as a physician extender, considering their diagnostic ability and specialized practice?

[Ridryder 911]

Sorry, but a PA and NP do not have any more credentials (or education for that matter) than I do when it comes to the decision making....the system is set up to be run by a qualified physician.

Unless you have a graduate degree in EMS and are board certified, that it is not true. Many P.A.'s and NP's started out as Paramedics. In the rule of hierarchy of medicine, P.A.'s & N.P."s are just below physician level, hence the reason they are given privileges and are considered professionals at hospitals. As well, why the average salary is at least a 6 figure.

Yes, NP's and P.A. are both still considered physician extenders.

The reason I chose the NP over P.A. is because of autonomy; in some states (11 and growing) at this time, NP do NOT have to be associated with a physician and can have independent clinics and perform their practice on their own license, and can bill medicare/HMO on their own account. Where as P.A.'s has to be directly associated and supervised by a physician (most within a 60 minute response or telephone coverage).

As well, many of the ER's are now converting to NP' in lieu of P.A.'s since they are working on their own license. Again nothing derogatory to P.A.'s but since N.P.'s work on their own license, malpractice is on the NP license not the physician. As well NP's have prescriptive rights (limited to their specialty). Most are placed in the ER setting in fast track, minor emergencies etc..and knows their limits; as well some are placed in the acute side, and in rural ER's for stabilization.

Remember, P.A.'s basically go through the medical model like medical school in 2 -2 1/2 years, after undergrad. They sit in the same classes side by side with medical students and attend a lot of the same course, the main difference is clinical and residency time. P.A.'s as well have to have CEU's and re-test the board every 6 years.. and you think EMT's have it bad.

Where as NP's require to have a BSN and nursing experience. One then chooses their specialty, for example neonate, psych, geriatric, emergency, acute care, etc...for additional 2 1/2 yrs. Within this license each state, specifically allows the NP according to their State Nursing Practice Act to fulfill specific roles. For example a pediatric NP can not work on an adult... pysch cannot work on neonate, etc... This limit's their scope, but as well studies are directly where they are at a specialty only. One can re-attend course and then become diverse... and become board eligible and be multispecialty. By the year 2015 NP's will have to have a Doctorate level.

As I stated, M.D./ D.O. should only hold the title of Medical Director of EMS. I don't believe you would find most P.A.'s or N.P.'s in disagreement with that at all, or any that would feel comfortable or would want that role. This is definitely for physician level and responsibility.

R/r 911

[Spock]

I couldn't agree more with Rid except about the 6 figure salaries. My wife was in the psych NP program and switched to a clinical nurse specialist because she didn't want to write prescriptions and psych NP's mostly just did intake physicals while the CNS could do therapy. Salaries were no where near 6 figures. The PA's I work with in the OR are always complaining of low salaries. Maybe that is just my area.

Medical control of EMS means just that--a doctor.

Live long and prosper.

Spock