Re: Scope of Practice Questions

[Guest guest]

We've covered this question before, but I will repeat it. Two words:

University Degree. And accredited at that, no less. The more pieces

of paper we have, the better we look to other professions. Not saying

the SLAM courses are a waste of time of course, which I know they are

not.

-aro

> >> In my Opinion there are skills such as surgical airway

> technequics, Chest decompression and the addition of a 4 year degree

> to be able to preform them would put our service back to a basic

> level service. <<

>

>

>

>

>

[Guest guest]

I agree with you. At the company I work for, we're cleared to do

surgical crics and chest decompressions. But in a year's time I have

done exactly 0 of both.

-aro

> I keep seeing arguments for RSI and/or surgical trachs - I have to

> wonder just how many of these are done by an individual medic in a

> year's time. . .

> Also, I would much rather have someone who has formal training in

an

> advanced procedure performing that procedure on me, as opposed to

> someone who merely has his medical director's permission.

>

>

> Rick LaChance

[Guest guest]

Knowing what to do is one thing, knowing why is a totally different

story. Why do we need doctors when PA's can do the majority of their

work?

-aro

> > Why go to a 4 year degree whebn I can take a S.L.A.M. (steet level

> airway maintenance) course and get the same knowledge and skill. <<

>

>

>

>

>

[Guest guest]

I'm not arguing to do away with Medical Directors. In fact, some of

my best friends are Medical Directors!

Currently certified paramedics are not routinely trained to operate

ventilators other than of the rate and volume ATV variety.

Currently certified paramedics are not routinely trained in

hemodynamic, ICP, or arterial line monitoring. Nor are they

routinely trained in central line insertion, dislocation reduction,

or wound closure.

You DON'T need another level of paramedic to do what you are already

trained to do. A new level of paramedic is being created to do the

things you are NOT trained to do.

Kenny Navarro

>> Let me express that another way. Why do we need another level of

paramedic to do the things that we are already trained to do and

approved by our Medical Director? Just to take the Medical Director

out of the Picture? <<

[Guest guest]

>

> And believe me, RSI and surgical crichs are well enough

established as

> being within the expertise of paramedics to perform, that if your

patient could

> have been saved through such a procedure and you didn't do it,

you'll be taking

> a long journey through the legal system.

>

'tis why when the time comes, I can point out it's beyond my Scope of

Practice so I didn't do it for risk of being arrested. :-)

-aro

[Guest guest]

>

> And believe me, RSI and surgical crichs are well enough

established as

> being within the expertise of paramedics to perform, that if your

patient could

> have been saved through such a procedure and you didn't do it,

you'll be taking

> a long journey through the legal system.

>

'tis why when the time comes, I can point out it's beyond my Scope of

Practice so I didn't do it for risk of being arrested. :-)

-aro

[Guest guest]

>

> And believe me, RSI and surgical crichs are well enough

established as

> being within the expertise of paramedics to perform, that if your

patient could

> have been saved through such a procedure and you didn't do it,

you'll be taking

> a long journey through the legal system.

>

'tis why when the time comes, I can point out it's beyond my Scope of

Practice so I didn't do it for risk of being arrested. :-)

-aro

[Guest guest]

You're right. That won't change for us either. However, there will

be a provider with greater autonomy than we have now, just like a PA,

but without the prescription abilities.

-aro

> > > Why go to a 4 year degree whebn I can take a S.L.A.M. (steet level

> > airway maintenance) course and get the same knowledge and skill. <<

> >

> >

> >

> >

> >

[Guest guest]

You're right. That won't change for us either. However, there will

be a provider with greater autonomy than we have now, just like a PA,

but without the prescription abilities.

-aro

> > > Why go to a 4 year degree whebn I can take a S.L.A.M. (steet level

> > airway maintenance) course and get the same knowledge and skill. <<

> >

> >

> >

> >

> >

[Guest guest]

You're right. That won't change for us either. However, there will

be a provider with greater autonomy than we have now, just like a PA,

but without the prescription abilities.

-aro

> > > Why go to a 4 year degree whebn I can take a S.L.A.M. (steet level

> > airway maintenance) course and get the same knowledge and skill. <<

> >

> >

> >

> >

> >

[Guest guest]

Sorry Gene, I don't think I am missing the point. The patient only

cares about being ventilated, as you have stated (and I thought I

said that as well).

With any technique, device, or medication, the potential benefits

must always be weighed against the known risks. If percutaneous

cricothyrotomy and surgical cricothyrotomy have the same potential

benefits but one has more known risks, isn't it prudent to choose

the less risky device?

Kenny Navarro

>> Kenny, you are missing the point...What the patient really cares

about is being ventilated. Ventilation is the standard, not the use

of any one device or technique. <<

[Guest guest]

Sorry Gene, I don't think I am missing the point. The patient only

cares about being ventilated, as you have stated (and I thought I

said that as well).

With any technique, device, or medication, the potential benefits

must always be weighed against the known risks. If percutaneous

cricothyrotomy and surgical cricothyrotomy have the same potential

benefits but one has more known risks, isn't it prudent to choose

the less risky device?

Kenny Navarro

>> Kenny, you are missing the point...What the patient really cares

about is being ventilated. Ventilation is the standard, not the use

of any one device or technique. <<

[Guest guest]

Sorry Gene, I don't think I am missing the point. The patient only

cares about being ventilated, as you have stated (and I thought I

said that as well).

With any technique, device, or medication, the potential benefits

must always be weighed against the known risks. If percutaneous

cricothyrotomy and surgical cricothyrotomy have the same potential

benefits but one has more known risks, isn't it prudent to choose

the less risky device?

Kenny Navarro

>> Kenny, you are missing the point...What the patient really cares

about is being ventilated. Ventilation is the standard, not the use

of any one device or technique. <<

[Guest guest]

So you're saying, if I'm interpreting this correctly, is if I work for

a service that only has 3-lead EKG capabilities and the prevailing

standard of care is 12-lead EKG capability, the company,

administration, and medical director can be held liable?

-aro

> Writes Alphonso:

>

> " tis why when the time comes, I can point out it's beyond my Scope of

> Practice so I didn't do it for risk of being arrested. :-) "

>

> That's an interesting argument and one that would surely be set forth;

> however, since scope or practice and standard of care are two

different things, a

> service that chooses to limit scope of practice may in fact be

guilty of failing

> to provide the prevailing standard of care. The persons who will

be liable

> for that failure will be the administrators, owners, managers, and

medical

> directors.

>

> Further, the SoP is sure to be attacked as an impermissible

restriction on a

> physician's medical practice, as interfering with the patient's 5th

and 14th

> Amendment rights, and so forth. The service that is chosen to be the

> defendant in one of these cases will lose even if it wins.

>

> GG

> GG

> In a message dated 12/6/04 16:44:08, asclapius@a... writes:

>

>

> >

> >

> >

> > >

> > > And believe me, RSI and surgical crichs are well enough

> > established as

> > > being within the expertise of paramedics to perform, that if your

> > patient could

> > > have been saved through such a procedure and you didn't do it,

> > you'll be taking

> > > a long journey through the legal system.

> > >

> >

> > '

> >

> > -aro

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

So you're saying, if I'm interpreting this correctly, is if I work for

a service that only has 3-lead EKG capabilities and the prevailing

standard of care is 12-lead EKG capability, the company,

administration, and medical director can be held liable?

-aro

> Writes Alphonso:

>

> " tis why when the time comes, I can point out it's beyond my Scope of

> Practice so I didn't do it for risk of being arrested. :-) "

>

> That's an interesting argument and one that would surely be set forth;

> however, since scope or practice and standard of care are two

different things, a

> service that chooses to limit scope of practice may in fact be

guilty of failing

> to provide the prevailing standard of care. The persons who will

be liable

> for that failure will be the administrators, owners, managers, and

medical

> directors.

>

> Further, the SoP is sure to be attacked as an impermissible

restriction on a

> physician's medical practice, as interfering with the patient's 5th

and 14th

> Amendment rights, and so forth. The service that is chosen to be the

> defendant in one of these cases will lose even if it wins.

>

> GG

> GG

> In a message dated 12/6/04 16:44:08, asclapius@a... writes:

>

>

> >

> >

> >

> > >

> > > And believe me, RSI and surgical crichs are well enough

> > established as

> > > being within the expertise of paramedics to perform, that if your

> > patient could

> > > have been saved through such a procedure and you didn't do it,

> > you'll be taking

> > > a long journey through the legal system.

> > >

> >

> > '

> >

> > -aro

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

So you're saying, if I'm interpreting this correctly, is if I work for

a service that only has 3-lead EKG capabilities and the prevailing

standard of care is 12-lead EKG capability, the company,

administration, and medical director can be held liable?

-aro

> Writes Alphonso:

>

> " tis why when the time comes, I can point out it's beyond my Scope of

> Practice so I didn't do it for risk of being arrested. :-) "

>

> That's an interesting argument and one that would surely be set forth;

> however, since scope or practice and standard of care are two

different things, a

> service that chooses to limit scope of practice may in fact be

guilty of failing

> to provide the prevailing standard of care. The persons who will

be liable

> for that failure will be the administrators, owners, managers, and

medical

> directors.

>

> Further, the SoP is sure to be attacked as an impermissible

restriction on a

> physician's medical practice, as interfering with the patient's 5th

and 14th

> Amendment rights, and so forth. The service that is chosen to be the

> defendant in one of these cases will lose even if it wins.

>

> GG

> GG

> In a message dated 12/6/04 16:44:08, asclapius@a... writes:

>

>

> >

> >

> >

> > >

> > > And believe me, RSI and surgical crichs are well enough

> > established as

> > > being within the expertise of paramedics to perform, that if your

> > patient could

> > > have been saved through such a procedure and you didn't do it,

> > you'll be taking

> > > a long journey through the legal system.

> > >

> >

> > '

> >

> > -aro

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Well said .

-aro

> Sorry I haven't been around to respond to all of the fear-mongering

that has

> taken place.

>

> Someone made a comment, and it really represents the crux of the

argument

> from my perspective. They said, " Why go to a 4 year degree whebn I

can take

> a S.L.A.M. (steet level airway maintenance) course and get the same

> knowledge and skill. "

>

> I have heard people refer to themselves as " professionals " several times

> while this issue was being discussed. It seems that we want to be

> considered professionals, but on the other hand, we don't want to do the

> things that professionals do. Namely, we don't want to require

education

> instead of " training " . Right now, EMS is NOT a profession. It is a

> vocation. There have been many arguments about the effect that this

would

> have on rural EMS, essentially saying that instituting real professional

> standards would have a detrimental effect on their ability to continue

> providing the level of care that they require. I am not

unsympathetic to

> this (even though I believe some of the claims have been

exaggerated), but I

> think the problem is circular. There is no incentive for the county

> commissioners to fork over more money as long as rural systems

continue to

> scrape by. Rural systems will continue to suffer shortages of qualified

> people because there is no money. And the cycle continues.

>

> I am also beginning to question how much we really value education. Of

> course, everyone says they are in favor of it. Yet the comments

always go

> something like this, " I am all for more education, BUT... " , " I am not

> against more education, BUT " . Everybody thinks it's a great idea as

long as

> they don't have to put their money where their mouth is, and there

is always

> some caveat. And then you see comments like the one I quoted above.

When

> you have EMSAT opposing anything that requires even an Associate

degree for

> future Paramedics, we need to quit expecting salaries comparable to

RN's and

> RT's and just be happy with our Wal-Mart Associate wage.

>

> - Lancaster

[Guest guest]

Well said .

-aro

> Sorry I haven't been around to respond to all of the fear-mongering

that has

> taken place.

>

> Someone made a comment, and it really represents the crux of the

argument

> from my perspective. They said, " Why go to a 4 year degree whebn I

can take

> a S.L.A.M. (steet level airway maintenance) course and get the same

> knowledge and skill. "

>

> I have heard people refer to themselves as " professionals " several times

> while this issue was being discussed. It seems that we want to be

> considered professionals, but on the other hand, we don't want to do the

> things that professionals do. Namely, we don't want to require

education

> instead of " training " . Right now, EMS is NOT a profession. It is a

> vocation. There have been many arguments about the effect that this

would

> have on rural EMS, essentially saying that instituting real professional

> standards would have a detrimental effect on their ability to continue

> providing the level of care that they require. I am not

unsympathetic to

> this (even though I believe some of the claims have been

exaggerated), but I

> think the problem is circular. There is no incentive for the county

> commissioners to fork over more money as long as rural systems

continue to

> scrape by. Rural systems will continue to suffer shortages of qualified

> people because there is no money. And the cycle continues.

>

> I am also beginning to question how much we really value education. Of

> course, everyone says they are in favor of it. Yet the comments

always go

> something like this, " I am all for more education, BUT... " , " I am not

> against more education, BUT " . Everybody thinks it's a great idea as

long as

> they don't have to put their money where their mouth is, and there

is always

> some caveat. And then you see comments like the one I quoted above.

When

> you have EMSAT opposing anything that requires even an Associate

degree for

> future Paramedics, we need to quit expecting salaries comparable to

RN's and

> RT's and just be happy with our Wal-Mart Associate wage.

>

> - Lancaster

[Guest guest]

Well said .

-aro

> Sorry I haven't been around to respond to all of the fear-mongering

that has

> taken place.

>

> Someone made a comment, and it really represents the crux of the

argument

> from my perspective. They said, " Why go to a 4 year degree whebn I

can take

> a S.L.A.M. (steet level airway maintenance) course and get the same

> knowledge and skill. "

>

> I have heard people refer to themselves as " professionals " several times

> while this issue was being discussed. It seems that we want to be

> considered professionals, but on the other hand, we don't want to do the

> things that professionals do. Namely, we don't want to require

education

> instead of " training " . Right now, EMS is NOT a profession. It is a

> vocation. There have been many arguments about the effect that this

would

> have on rural EMS, essentially saying that instituting real professional

> standards would have a detrimental effect on their ability to continue

> providing the level of care that they require. I am not

unsympathetic to

> this (even though I believe some of the claims have been

exaggerated), but I

> think the problem is circular. There is no incentive for the county

> commissioners to fork over more money as long as rural systems

continue to

> scrape by. Rural systems will continue to suffer shortages of qualified

> people because there is no money. And the cycle continues.

>

> I am also beginning to question how much we really value education. Of

> course, everyone says they are in favor of it. Yet the comments

always go

> something like this, " I am all for more education, BUT... " , " I am not

> against more education, BUT " . Everybody thinks it's a great idea as

long as

> they don't have to put their money where their mouth is, and there

is always

> some caveat. And then you see comments like the one I quoted above.

When

> you have EMSAT opposing anything that requires even an Associate

degree for

> future Paramedics, we need to quit expecting salaries comparable to

RN's and

> RT's and just be happy with our Wal-Mart Associate wage.

>

> - Lancaster

[Guest guest]

> Mr. Lancaster,

>

> I can say without any hesitation,I feel

> education is not the issue. I can say that we all need

> more training{12 lead, Rsi, Surg. Airway, CCEMT-P].

> And all of those should be standard curriculum

> Nationwide. And can be obtained through secondary

I couldn't disagree more. The issue is education, whether you see it

or not.

> classes. But to force a Nationwide Scope Of

> Practice,when the folks whom are pushing this,have no

> idea what is like to have a seemingly stable LDT from

> Fort Worth To Sealy in Galveston blow up in your

> face. And you are in Madisonville, and the hospital

> is,well abit primitive. [Yes, I ran that call]Or,you

> are on scene of a 63 y/o m whom is entrapped in his

> PTO

> of the tractor he was plowing his land with,and his

> tractor tipped over.Or a bull rider was thrown and

> stomped on and you are 30 min.from a Trauma Center,

> and CareFlite is grounded due to low cloud cover.These

> are folks with a solid political agenda with regards

> to Homeland Security Funding.

Those are great war stories, but are a bit misguided. The fact of the

matter is, yes, you could do certain interventions at the I assume

paramedic level, but with this new level, advanced paramedics will be

able to do certain procedures that have not been taught to paramedics

in general. In essence, better patient care. Why would anyone not

want that?

-aro

[Guest guest]

> Mr. Lancaster,

>

> I can say without any hesitation,I feel

> education is not the issue. I can say that we all need

> more training{12 lead, Rsi, Surg. Airway, CCEMT-P].

> And all of those should be standard curriculum

> Nationwide. And can be obtained through secondary

I couldn't disagree more. The issue is education, whether you see it

or not.

> classes. But to force a Nationwide Scope Of

> Practice,when the folks whom are pushing this,have no

> idea what is like to have a seemingly stable LDT from

> Fort Worth To Sealy in Galveston blow up in your

> face. And you are in Madisonville, and the hospital

> is,well abit primitive. [Yes, I ran that call]Or,you

> are on scene of a 63 y/o m whom is entrapped in his

> PTO

> of the tractor he was plowing his land with,and his

> tractor tipped over.Or a bull rider was thrown and

> stomped on and you are 30 min.from a Trauma Center,

> and CareFlite is grounded due to low cloud cover.These

> are folks with a solid political agenda with regards

> to Homeland Security Funding.

Those are great war stories, but are a bit misguided. The fact of the

matter is, yes, you could do certain interventions at the I assume

paramedic level, but with this new level, advanced paramedics will be

able to do certain procedures that have not been taught to paramedics

in general. In essence, better patient care. Why would anyone not

want that?

-aro

[Guest guest]

> Mr. Lancaster,

>

> I can say without any hesitation,I feel

> education is not the issue. I can say that we all need

> more training{12 lead, Rsi, Surg. Airway, CCEMT-P].

> And all of those should be standard curriculum

> Nationwide. And can be obtained through secondary

I couldn't disagree more. The issue is education, whether you see it

or not.

> classes. But to force a Nationwide Scope Of

> Practice,when the folks whom are pushing this,have no

> idea what is like to have a seemingly stable LDT from

> Fort Worth To Sealy in Galveston blow up in your

> face. And you are in Madisonville, and the hospital

> is,well abit primitive. [Yes, I ran that call]Or,you

> are on scene of a 63 y/o m whom is entrapped in his

> PTO

> of the tractor he was plowing his land with,and his

> tractor tipped over.Or a bull rider was thrown and

> stomped on and you are 30 min.from a Trauma Center,

> and CareFlite is grounded due to low cloud cover.These

> are folks with a solid political agenda with regards

> to Homeland Security Funding.

Those are great war stories, but are a bit misguided. The fact of the

matter is, yes, you could do certain interventions at the I assume

paramedic level, but with this new level, advanced paramedics will be

able to do certain procedures that have not been taught to paramedics

in general. In essence, better patient care. Why would anyone not

want that?

-aro

[Guest guest]

>

> " EMSAT opposes the imposition of any requirement that limits

advanced paramedic practice to those persons with a college degree in

EMS. "

>

Now why would EMSAT hold such a position? It's mind boggling to say

the least.

-aro

[Guest guest]

>

> " EMSAT opposes the imposition of any requirement that limits

advanced paramedic practice to those persons with a college degree in

EMS. "

>

Now why would EMSAT hold such a position? It's mind boggling to say

the least.

-aro

[Guest guest]

>

> " EMSAT opposes the imposition of any requirement that limits

advanced paramedic practice to those persons with a college degree in

EMS. "

>

Now why would EMSAT hold such a position? It's mind boggling to say

the least.

-aro