Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Ours states to not take advice from an on-scene physician. Therefore, I would interpret that as including PAs or NPs. D. Stone > Most EMS protocols address what to do when a physician is on the scene of a > medical emergency. Does anyone have any guidance for when an advanced practice > nurse (nurse practitioner) or physician's assistant is on scene? > > Thanks, > Wes Ogilvie, MPA, JD, EMT-B > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Ours states to not take advice from an on-scene physician. Therefore, I would interpret that as including PAs or NPs. D. Stone > Most EMS protocols address what to do when a physician is on the scene of a > medical emergency. Does anyone have any guidance for when an advanced practice > nurse (nurse practitioner) or physician's assistant is on scene? > > Thanks, > Wes Ogilvie, MPA, JD, EMT-B > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Ours states to not take advice from an on-scene physician. Therefore, I would interpret that as including PAs or NPs. D. Stone > Most EMS protocols address what to do when a physician is on the scene of a > medical emergency. Does anyone have any guidance for when an advanced practice > nurse (nurse practitioner) or physician's assistant is on scene? > > Thanks, > Wes Ogilvie, MPA, JD, EMT-B > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Nurse practitioners and PAs have to have a protocol or set of guidelines to practice under just like we do. They are usually designed to be used in an office setting and probably do not extend to any location or situation. Nurse practitioners and PAs cannot give orders on their own and therefore (and this may sound cocky) can't tell us what to do or issue orders. Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. Chambers, AAS, LP -- Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Nurse practitioners and PAs have to have a protocol or set of guidelines to practice under just like we do. They are usually designed to be used in an office setting and probably do not extend to any location or situation. Nurse practitioners and PAs cannot give orders on their own and therefore (and this may sound cocky) can't tell us what to do or issue orders. Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. Chambers, AAS, LP -- Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Nurse practitioners and PAs have to have a protocol or set of guidelines to practice under just like we do. They are usually designed to be used in an office setting and probably do not extend to any location or situation. Nurse practitioners and PAs cannot give orders on their own and therefore (and this may sound cocky) can't tell us what to do or issue orders. Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. Chambers, AAS, LP -- Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 -- Chambers wrote: " Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. " I'll do the Good Samaritan thing, but you won't find any ALS equipment in my kit. Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 -- Chambers wrote: " Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. " I'll do the Good Samaritan thing, but you won't find any ALS equipment in my kit. Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 -- Chambers wrote: " Same as nurses on scene, accept basic assistance if offered but here we don't even let them start IVs. And we have some first responders who are nurses. " I'll do the Good Samaritan thing, but you won't find any ALS equipment in my kit. Larry RN LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Hello Wes, This is our statement in our protocol and policy manual at Hopkins County EMS. Unknown Physician or Allied Healthcare Practitioners On-Scene The EMS personnel should not take orders from unknown physicians or healthcare practitioners on scene. This includes physicians who clearly identify themselves, but have no affiliation with the patient. This does not apply to a patient in a physician's office. Any allied healthcare practitioners, including unknown EMS persons are allowed to assist with basic therapies, if the EMS personnel feel they are not hindering patient care. The EMS personnel should have any person on scene removed if they are hindering patient care. All Hopkins County EMS personnel should have an official identification noting their name and level of authorization. Hopkins County EMS will be in charge of patient care under the medical direction of Hopkins County Memorial Hospital. Allied Healthcare Practitioners Any allied healthcare practitioners that accompanies a patient either from a facility or a scene must be affiliated with Hopkins County Memorial Hospital and either be a TDH certified or licensed EMS personnel or have written orders from the patient's personal physician in order to render care. VanBibber Hopkins County EMS Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Hello Wes, This is our statement in our protocol and policy manual at Hopkins County EMS. Unknown Physician or Allied Healthcare Practitioners On-Scene The EMS personnel should not take orders from unknown physicians or healthcare practitioners on scene. This includes physicians who clearly identify themselves, but have no affiliation with the patient. This does not apply to a patient in a physician's office. Any allied healthcare practitioners, including unknown EMS persons are allowed to assist with basic therapies, if the EMS personnel feel they are not hindering patient care. The EMS personnel should have any person on scene removed if they are hindering patient care. All Hopkins County EMS personnel should have an official identification noting their name and level of authorization. Hopkins County EMS will be in charge of patient care under the medical direction of Hopkins County Memorial Hospital. Allied Healthcare Practitioners Any allied healthcare practitioners that accompanies a patient either from a facility or a scene must be affiliated with Hopkins County Memorial Hospital and either be a TDH certified or licensed EMS personnel or have written orders from the patient's personal physician in order to render care. VanBibber Hopkins County EMS Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Hello Wes, This is our statement in our protocol and policy manual at Hopkins County EMS. Unknown Physician or Allied Healthcare Practitioners On-Scene The EMS personnel should not take orders from unknown physicians or healthcare practitioners on scene. This includes physicians who clearly identify themselves, but have no affiliation with the patient. This does not apply to a patient in a physician's office. Any allied healthcare practitioners, including unknown EMS persons are allowed to assist with basic therapies, if the EMS personnel feel they are not hindering patient care. The EMS personnel should have any person on scene removed if they are hindering patient care. All Hopkins County EMS personnel should have an official identification noting their name and level of authorization. Hopkins County EMS will be in charge of patient care under the medical direction of Hopkins County Memorial Hospital. Allied Healthcare Practitioners Any allied healthcare practitioners that accompanies a patient either from a facility or a scene must be affiliated with Hopkins County Memorial Hospital and either be a TDH certified or licensed EMS personnel or have written orders from the patient's personal physician in order to render care. VanBibber Hopkins County EMS Health Care Providers Most EMS protocols address what to do when a physician is on the scene of a medical emergency. Does anyone have any guidance for when an advanced practice nurse (nurse practitioner) or physician's assistant is on scene? Thanks, Wes Ogilvie, MPA, JD, EMT-B Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 How exactly is that accomplished? From what I've read, a physician licensed to practice medicine in the state where the incident occured can assume responsibility for the patient and/or render patient care under his/her license. Therefore, since paramedics are physician-extenders and not independent practioners, they would have to step back and let the physician do his/her thing. Another angle is a physician on the scene is, in theory, a higher level of care than a paramedic. Any thoughts? -Alfonso R. Ochoa > > Ours states to not take advice from an on-scene physician. > Therefore, I would interpret that as including PAs or NPs. > > D. Stone > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 How exactly is that accomplished? From what I've read, a physician licensed to practice medicine in the state where the incident occured can assume responsibility for the patient and/or render patient care under his/her license. Therefore, since paramedics are physician-extenders and not independent practioners, they would have to step back and let the physician do his/her thing. Another angle is a physician on the scene is, in theory, a higher level of care than a paramedic. Any thoughts? -Alfonso R. Ochoa > > Ours states to not take advice from an on-scene physician. > Therefore, I would interpret that as including PAs or NPs. > > D. Stone > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 How exactly is that accomplished? From what I've read, a physician licensed to practice medicine in the state where the incident occured can assume responsibility for the patient and/or render patient care under his/her license. Therefore, since paramedics are physician-extenders and not independent practioners, they would have to step back and let the physician do his/her thing. Another angle is a physician on the scene is, in theory, a higher level of care than a paramedic. Any thoughts? -Alfonso R. Ochoa > > Ours states to not take advice from an on-scene physician. > Therefore, I would interpret that as including PAs or NPs. > > D. Stone > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 But isn't it your Medical Director's license to practice medicine that grants the paramedic the ability to do his/her job? With the standing orders and online direction, you're operating under him. I mean...I see what you're saying. A doctor's a doctor. But an on-scene doctor wouldn't necessarily know your service's protocols and could potentially tell you to do something you can't. So, if he were to " take command, " shouldn't it be cleared with your medical director/supervisor/etc? - > How exactly is that accomplished? From what I've read, a physician > licensed to practice medicine in the state where the incident occured > can assume responsibility for the patient and/or render patient care > under his/her license. Therefore, since paramedics are > physician-extenders and not independent practioners, they would have > to step back and let the physician do his/her thing. Another angle is > a physician on the scene is, in theory, a higher level of care than a > paramedic. > > Any thoughts? > > -Alfonso R. Ochoa > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 But isn't it your Medical Director's license to practice medicine that grants the paramedic the ability to do his/her job? With the standing orders and online direction, you're operating under him. I mean...I see what you're saying. A doctor's a doctor. But an on-scene doctor wouldn't necessarily know your service's protocols and could potentially tell you to do something you can't. So, if he were to " take command, " shouldn't it be cleared with your medical director/supervisor/etc? - > How exactly is that accomplished? From what I've read, a physician > licensed to practice medicine in the state where the incident occured > can assume responsibility for the patient and/or render patient care > under his/her license. Therefore, since paramedics are > physician-extenders and not independent practioners, they would have > to step back and let the physician do his/her thing. Another angle is > a physician on the scene is, in theory, a higher level of care than a > paramedic. > > Any thoughts? > > -Alfonso R. Ochoa > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 But isn't it your Medical Director's license to practice medicine that grants the paramedic the ability to do his/her job? With the standing orders and online direction, you're operating under him. I mean...I see what you're saying. A doctor's a doctor. But an on-scene doctor wouldn't necessarily know your service's protocols and could potentially tell you to do something you can't. So, if he were to " take command, " shouldn't it be cleared with your medical director/supervisor/etc? - > How exactly is that accomplished? From what I've read, a physician > licensed to practice medicine in the state where the incident occured > can assume responsibility for the patient and/or render patient care > under his/her license. Therefore, since paramedics are > physician-extenders and not independent practioners, they would have > to step back and let the physician do his/her thing. Another angle is > a physician on the scene is, in theory, a higher level of care than a > paramedic. > > Any thoughts? > > -Alfonso R. Ochoa > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 I'm not sure exactly how it works here, but I know how my sister, who has been a medic in CA for 23 years handles it. She informs the doctor that if she turns the care over to him, he is responsible for the patient both at the scene and during transport. Then she asks if he really wants to have to ride in the back with the patient while she enjoys the front seat. She's never had one insist on treating. Carol > > > But isn't it your Medical Director's license to practice medicine that > grants the paramedic the ability to do his/her job? With the standing > orders and online direction, you're operating under him. > > I mean...I see what you're saying. A doctor's a doctor. But an > on-scene doctor wouldn't necessarily know your service's protocols and > could potentially tell you to do something you can't. So, if he were > to " take command, " shouldn't it be cleared with your medical > director/supervisor/etc? > > - > > > > How exactly is that accomplished? From what I've read, a physician > > licensed to practice medicine in the state where the incident occured > > can assume responsibility for the patient and/or render patient care > > under his/her license. Therefore, since paramedics are > > physician-extenders and not independent practioners, they would have > > to step back and let the physician do his/her thing. Another angle is > > a physician on the scene is, in theory, a higher level of care than a > > paramedic. > > > > Any thoughts? > > > > -Alfonso R. Ochoa > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 I'm not sure exactly how it works here, but I know how my sister, who has been a medic in CA for 23 years handles it. She informs the doctor that if she turns the care over to him, he is responsible for the patient both at the scene and during transport. Then she asks if he really wants to have to ride in the back with the patient while she enjoys the front seat. She's never had one insist on treating. Carol > > > But isn't it your Medical Director's license to practice medicine that > grants the paramedic the ability to do his/her job? With the standing > orders and online direction, you're operating under him. > > I mean...I see what you're saying. A doctor's a doctor. But an > on-scene doctor wouldn't necessarily know your service's protocols and > could potentially tell you to do something you can't. So, if he were > to " take command, " shouldn't it be cleared with your medical > director/supervisor/etc? > > - > > > > How exactly is that accomplished? From what I've read, a physician > > licensed to practice medicine in the state where the incident occured > > can assume responsibility for the patient and/or render patient care > > under his/her license. Therefore, since paramedics are > > physician-extenders and not independent practioners, they would have > > to step back and let the physician do his/her thing. Another angle is > > a physician on the scene is, in theory, a higher level of care than a > > paramedic. > > > > Any thoughts? > > > > -Alfonso R. Ochoa > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 I'm not sure exactly how it works here, but I know how my sister, who has been a medic in CA for 23 years handles it. She informs the doctor that if she turns the care over to him, he is responsible for the patient both at the scene and during transport. Then she asks if he really wants to have to ride in the back with the patient while she enjoys the front seat. She's never had one insist on treating. Carol > > > But isn't it your Medical Director's license to practice medicine that > grants the paramedic the ability to do his/her job? With the standing > orders and online direction, you're operating under him. > > I mean...I see what you're saying. A doctor's a doctor. But an > on-scene doctor wouldn't necessarily know your service's protocols and > could potentially tell you to do something you can't. So, if he were > to " take command, " shouldn't it be cleared with your medical > director/supervisor/etc? > > - > > > > How exactly is that accomplished? From what I've read, a physician > > licensed to practice medicine in the state where the incident occured > > can assume responsibility for the patient and/or render patient care > > under his/her license. Therefore, since paramedics are > > physician-extenders and not independent practioners, they would have > > to step back and let the physician do his/her thing. Another angle is > > a physician on the scene is, in theory, a higher level of care than a > > paramedic. > > > > Any thoughts? > > > > -Alfonso R. Ochoa > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 Just to muddy the water a little bit. Does anybody have anything written in their protocols for integrating volunteer physicians and health care providers at MCI scenes? Seems like it would be a bit of a different situation if one showed up at an MCI and offered to pitch in. It's not like he would be taking over a patient you were already working on. He'd just be utilizing your supplies. Anybody addressed this eventuality on paper? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 I understand what you are saying, but we have some rather unique protocols. We have been on scenes and while we were working the pts per our protocol, and we had to almost stop and explain or " justify " what we were doing. For example, trying to explain why we perform chest-abdominal counter compressions, obtain either IV or IO access, administer Aminophylline, , and intubate prior to defibrillation (at 360 joules) for someone who is in V-fib with a down time greater than 4 minutes is rather difficult. Once the call is over, we can offer loads of literature that backs our protocols, but most physicians want complete control of the scene and per our medical director...that won't happen. It causes conflict and the pt is the one who will suffer. D. Stone > > > > Ours states to not take advice from an on-scene physician. > > Therefore, I would interpret that as including PAs or NPs. > > > > D. Stone > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2005 Report Share Posted February 25, 2005 I understand what you are saying, but we have some rather unique protocols. We have been on scenes and while we were working the pts per our protocol, and we had to almost stop and explain or " justify " what we were doing. For example, trying to explain why we perform chest-abdominal counter compressions, obtain either IV or IO access, administer Aminophylline, , and intubate prior to defibrillation (at 360 joules) for someone who is in V-fib with a down time greater than 4 minutes is rather difficult. Once the call is over, we can offer loads of literature that backs our protocols, but most physicians want complete control of the scene and per our medical director...that won't happen. It causes conflict and the pt is the one who will suffer. D. Stone > > > > Ours states to not take advice from an on-scene physician. > > Therefore, I would interpret that as including PAs or NPs. > > > > D. Stone > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2005 Report Share Posted February 26, 2005 Chapter 197 of the Board of Medical Examiners Rules of Medical Practice states the conditions under which an intervenor physician may direct the care of the patient. In short, the intervenor physician may assume care of the patient only with the permission of on-line medical control. Even then, he/she may not order EMS personnel to do anything outside their protocols. And medical control may require the intervenor physician to accompany the patient to the hospital if he/she wishes to assume control of the care of the patient. Randy >How exactly is that accomplished? From what I've read, a physician >licensed to practice medicine in the state where the incident occured >can assume responsibility for the patient and/or render patient care >under his/her license. Therefore, since paramedics are >physician-extenders and not independent practioners, they would have >to step back and let the physician do his/her thing. Another angle is >a physician on the scene is, in theory, a higher level of care than a >paramedic. > >Any thoughts? R. Loflin, M.D., FAAEM, FACEP Associate Professor Medical Director, City of El Paso EMSS Medical Director, ACLS Program james.loflin@... Quote Link to comment Share on other sites More sharing options...
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