Need some help.

December 27, 2006

Mike,

Contact on Hospital Emergency Department, . Manager is Blas

Meza, R.N., EMT-P.

Randy

R. (Randy) Loflin, M.D., FACEP

Associate Professor

Medical Director, City of El Paso EMSS

Need some help.

Good Morning,

I am needing a little help. I am doing some research for my wife, her

nurse manager questioned the possibility of using paramedics in the

ER. I was looking for any hospital that uses paramedics in the ER and

what tasks they perform.

I am not necessarily looking for specifics, but any info will help,

just hospitals that utilize paramedics. We will contact them directly

for further information.

Thanks,

Mike Shown

December 27, 2006

In a message dated 12/27/2006 3:13:07 P.M. Central Standard Time,

asclapius@... writes:

If paramedics aren't functioning to the standard scope of

practice and are instead functioning similarly to nurses aides, then

wouldn't the RN be " in charge " somewhat of the paramedic's actions?

And might that not be dependent upon the job description or job title they

are working under?

For example could a hospital allow and EMT-I to be a staff phlebotomist?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 27, 2006

Greetings everyone,

I'm in Europe and haven't read every listing so I'm not sure if you all have

seen or discussed the paper in this link.

_http://www.tdh.state.tx.us/hcqs/ems/EMSinFacilities.htm_

(http://www.tdh.state.tx.us/hcqs/ems/EMSinFacilities.htm)

I hope each of you had a very nice Christmas with your biological and/or EMS

families for those who where on duty. I look forward to continue working

with you all in 2007 and when this legislative session is over I hope to get

out of Austin in order to visit your schools and work sites. In the meantime

if I can assist you please send me an e-mail and I will contact you as soon as

possible.

Happy New Year to each of you EMS Professionals and thanks for everything

you do for the citizen and visitors of our great state.

Maxie

December 27, 2006

In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

asclapius@... writes:

Precisely. That's why I'm of the opinion that it would depend on the

specific situation. I know of a few hospitals that hire paramedics as

" ER Techs " or " Patient Care Techs, " thus the charge nurse directing

the care and subsequently being responsible for said care performed by

these personnel, regardless of their certification with DSHS OEMS/TS.

-Alfonso R. Ochoa

Exactly, I know that in NJ, PA and DE it is common practice to have a job

description where one of the Chinese menu approaches to being qualified for the

job is to have a B or P card (none of these states have I's). The

phlebotomists is likely the best example. A few of the Medics I know that

worked for ALS

services that had some cutbacks were offered phlebotomist jobs as a way to

keep them in the system till those short term issues were worked out (albeit

at a lower pay grade then Medic).

Given the numbers of Legal beagles that hospitals have I'm sure that if the

facility wanted to do this they cod do so.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 27, 2006

Gene,

Your response was most informative, however it left me somewhat

confused. I got the impression from the BNE website that RNs were

responsible for the care of the patient and delegated care to LVNs and

UAPs. If paramedics aren't functioning to the standard scope of

practice and are instead functioning similarly to nurses aides, then

wouldn't the RN be " in charge " somewhat of the paramedic's actions?

-Alfonso R. Ochoa

>

> Andy is correct. Nurses cannot delegate any practice to an EMT or

paramdic.

> However, the physician can.

>

> Paramedics in Texas work under the delegated practice of a physician.

> Nurses have no place in the process. They have neither the power to

delegate

> practice to an EMT or to deny the EMT the right to practice under

the physician's

> orders. They are totally superfluous to the practice of EMTs and

Paramedics.

>

> Nurses have fought to the death in other states to keep paramedics

out of

> the ER and other places in the hospital. This has, so far, not

happened in

> Texas, but don't hold your breath.

>

> It is purely an economic battle, a turf battle, and it has nothing

> whatsoever to do with competency to perform the delegated skills.

>

> In Texas, Paramedics or EMTs can work in a hospital if they are

working

> under the delegated orders of a physician. Nurses have no role in

either

> approving or disapproving what medics do in the hospital if they're

working under

> the physician's license.

>

> However, if a nurse were to decide to delegate to a medic, it would be

> illegal.

>

> So, medics in a hospital work under a physician's license or not at

all.

>

> Gene G.

>

December 27, 2006

In a message dated 12/27/2006 5:47:56 P.M. Central Standard Time,

asclapius@... writes:

This is how I understand it.

Me too, but I have been wrong once or twice in the past

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 27, 2006

In a message dated 12/27/2006 8:09:13 P.M. Central Standard Time,

jkaymdc@... writes:

Paramedics did the actual running of a code, just like in the field,

except you had more people and someone was actually writing down what

was done, when it was done/time drug was administered, etc...;-)

Keeping a record of a code what a novel concept

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

December 27, 2006

Have her contact Yates at Methodist Health Systems in Dallas,

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Mike

Sent: Tuesday, December 26, 2006 8:15 AM

To: texasems-l

Subject: Need some help.

Good Morning,

I am needing a little help. I am doing some research for my wife, her

nurse manager questioned the possibility of using paramedics in the

ER. I was looking for any hospital that uses paramedics in the ER and

what tasks they perform.

I am not necessarily looking for specifics, but any info will help,

just hospitals that utilize paramedics. We will contact them directly

for further information.

Thanks,

Mike Shown-

December 27, 2006

Precisely. That's why I'm of the opinion that it would depend on the

specific situation. I know of a few hospitals that hire paramedics as

" ER Techs " or " Patient Care Techs, " thus the charge nurse directing

the care and subsequently being responsible for said care performed by

these personnel, regardless of their certification with DSHS OEMS/TS.

-Alfonso R. Ochoa

>

> In a message dated 12/27/2006 3:13:07 P.M. Central Standard Time,

> asclapius@... writes:

>

> If paramedics aren't functioning to the standard scope of

> practice and are instead functioning similarly to nurses aides, then

> wouldn't the RN be " in charge " somewhat of the paramedic's actions?

>

> And might that not be dependent upon the job description or job

title they

> are working under?

>

> For example could a hospital allow and EMT-I to be a staff

phlebotomist?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

1962)

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated

with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

December 27, 2006

So in Texas, at least in theory, a hospital could hire a paramedic and

have him/her work under a RN's license as a UAP so long as they have a

job description of performing specific tasks and not to the fullest

potential of paramedic training. This is how I understand it.

-Alfonso R. Ochoa

>

> In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> asclapius@... writes:

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> Exactly, I know that in NJ, PA and DE it is common practice to have

a job

> description where one of the Chinese menu approaches to being

qualified for the

> job is to have a B or P card (none of these states have I's). The

> phlebotomists is likely the best example. A few of the Medics I

know that worked for ALS

> services that had some cutbacks were offered phlebotomist jobs as a

way to

> keep them in the system till those short term issues were worked

out (albeit

> at a lower pay grade then Medic).

>

> Given the numbers of Legal beagles that hospitals have I'm sure that

if the

> facility wanted to do this they cod do so.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

1962)

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated

with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

December 27, 2006

I have seen it a couple of different ways.

When I was in Arizona, Paramedics were used in the ER and were able to use

their entire skill set. They worked under the ER Doc's license but under

the direction of the charge nurse. It was basically a 4 tier system...ER

Doc, RN, Medic, and Tech. Most of the Medics were firefighter/medics

moonlighting so they were already familiar with the ED and the Doc.

Here in Texas I have seen medics used as ER techs. On paper they were

allowed to do first aid, bandaging and other tech skills. The only evasive

procedure they did was blood draws. I have heard 'rumors' of medics doing

IVs and passing meds for the RN but if you look at the job description this

was outside their scope.

As far as working under a RNs license...I have never heard of that. Because

of the differences in skill sets, I am not sure how this would work. It

would make more sense to me to work under the ER Doctors license the same

way we do in the field.

Quinten

EMT-LP/Firefighter

Re: Need some help.

So in Texas, at least in theory, a hospital could hire a paramedic and

have him/her work under a RN's license as a UAP so long as they have a

job description of performing specific tasks and not to the fullest

potential of paramedic training. This is how I understand it.

-Alfonso R. Ochoa

>

> In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> asclapius@... writes:

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> Exactly, I know that in NJ, PA and DE it is common practice to have

a job

> description where one of the Chinese menu approaches to being

qualified for the

> job is to have a B or P card (none of these states have I's). The

> phlebotomists is likely the best example. A few of the Medics I

know that worked for ALS

> services that had some cutbacks were offered phlebotomist jobs as a

way to

> keep them in the system till those short term issues were worked

out (albeit

> at a lower pay grade then Medic).

>

> Given the numbers of Legal beagles that hospitals have I'm sure that

if the

> facility wanted to do this they cod do so.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

1962)

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated

with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

December 27, 2006

Alfonso,

The only way that nurses can exert control over paramedics is by assigning

rooms, and so forth, but they CANNOT delegate patient assessment or any other

nursing task. Nor can they order a paramedic to do anything else other than

to empty a bedpan and such. Delegation of nursing skills and duties cannot

be delegated, under Texas law.

A nurse cannot even delegate patient assessment to an LVN. However, the

doctor can delegate patient assessment to a paramedic, but the nurse cannot.

Questions come up when paramedics work triage. Is triage patient assessment

that must be done be a nurse unless delegated to a paramedic by doctor's

orders? I think so.

Now, once the physician issues protocols for paramedics, they are working for

the doctor, not the nurse.

I worked on a case where a Paramedic was working as a tech, and was allowed

to give drugs. He followed a physician's order and gave the wrong drug. He,

the doc, the nurse, and the hospital got sued. Unfortunately there were no

written protocols or job descriptions for the medic. The outcome of the case

was not pretty. It's imperative, as others have said, that there be written

protocols for the hospital paramedics just as there are for street medics.

The physician is not bound by nursing rules as to what he can delegate to

paramedics. So, for example, he can allow paramedics to intubate if he wants

to.

The only qualification is that he is responsible for their actions, and he

obviously should not delegate something beyond the paramedic's training and

skills level.

Hospital administration has an obvious role in determining what it wants

paramedics to do. But it does that through the physician, not the nursing

staff,

although at times nursing staff is involved in the decision making process.

So, like it or not, nurses do not have the power to delegate duties to

paramedics that involve medical care. It's the law. They do have the power to

delegate administrative duties, such as which patient you're assigned to, but

that's about it.

Paramedics working in a hospital work for the physician, not the nurse, in

terms of patient care. They may work for the nurse in terms of when and where

they work, but the nurse does not determine the skills they perform.

Ideally, nurses and paramedics would work together as a part of a team. My

experience with places that have paramedics working in the ER is that everyone

gets along well, and the nurses and paramedics respect each other and

complement each other. I have seen places where there is no rivalry at all

between

them, and that's as it should be. Each has a role to play, and each brings a

different perspective to the job.

Paramedics cannot replace nurses, and nurses do not necessarily have the

skills that paramedics do, although that is quite possible, especially when

paramedics later become nurses.

Both have a legitimate roll to play in the hospital environment, in my

judgment. Others will differ, I fully realize.

What we do not need is a rivalry between the two professions. And we do not

need to have hospitals hiring medics to save money. Medics who work in the

ED under full doctors' orders do basically the same things that nurses do.

And they should be paid accordingly.

I hope this helps to clarify.

GG

>

> Gene,

>

> Your response was most informative, however it left me somewhat

> confused. I got the impression from the BNE website that RNs were

> responsible for the care of the patient and delegated care to LVNs and

> UAPs. If paramedics aren't functioning to the standard scope of

> practice and are instead functioning similarly to nurses aides, then

> wouldn't the RN be " in charge " somewhat of the paramedic's actions?

>

> -Alfonso R. Ochoa

>

> --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> >

> > Andy is correct. Nurses cannot delegate any practice to an EMT or

> paramdic.

> > However, the physician can.

> >

> > Paramedics in Texas work under the delegated practice of a physician.

> > Nurses have no place in the process. They have neither the power to

> delegate

> > practice to an EMT or to deny the EMT the right to practice under

> the physician's

> > orders. They are totally superfluous to the practice of EMTs and

> Paramedics.

> >

> > Nurses have fought to the death in other states to keep paramedics

> out of

> > the ER and other places in the hospital. This has, so far, not

> happened in

> > Texas, but don't hold your breath.

> >

> > It is purely an economic battle, a turf battle, and it has nothing

> > whatsoever to do with competency to perform the delegated skills.

> >

> > In Texas, Paramedics or EMTs can work in a hospital if they are

> working

> > under the delegated orders of a physician. Nurses have no role in

> either

> > approving or disapproving what medics do in the hospital if they're

> working under

> > the physician's license.

> >

> > However, if a nurse were to decide to delegate to a medic, it would be

> > illegal.

> >

> > So, medics in a hospital work under a physician's license or not at

> all.

> >

> > Gene G.

> >

December 27, 2006

A hospital could hire an EMT-I to be a staff phlebotomist. Anybody can be a

phlebotomist. The training program is usually about 2-3 days. All the

hospital has to do is to decide that the person is capable of doing the job and

have some staff physician certify them. Actually, I'm not sure that's even

required.

Private physicians routinely have office " nurses " which have little or no

actual nursing training to draw blood, labs hire folks who have a " certificate "

from the Vampire School of Phlebotomy, blood donor and plasma centers do the

same, and hospitals can hire anybody they want.

In Texas, there is no Texas Board of Phlebotomy.

I did a Google search for " phlebotomy Texas " and " phlebotomist Texas " and

found no returns.

If I have missed something, please let me know.

Gene G.

>

> In a message dated 12/27/2006 3:13:07 P.M. Central Standard Time,

> asclapius@... writes:

>

> If paramedics aren't functioning to the standard scope of

> practice and are instead functioning similarly to nurses aides, then

> wouldn't the RN be " in charge " somewhat of the paramedic's actions?

>

> And might that not be dependent upon the job description or job title they

> are working under?

>

> For example could a hospital allow and EMT-I to be a staff phlebotomist?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/ FF/

> Freelance Consultant/Trainer/ Freelance Cons Freelance Consultant/Traine

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

>

> The comments contained in this E-mail are the opinions of the author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated with

> unless I

> specifically state that I am doing so. Further this E-mail is intended only

> for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public domain by

> the

> original author.

>

December 27, 2006

I disagree. I cannot find any law that authorizes a " charge nurse " to

direct the care by a paramedic or mandates the nurse being responsible for care

rendered by persons that the Nursing Practice Act prohibits them from delegating

duties to.

As I said earlier, the Charge Nurse can assign duties in terms of what

patients the paramedic will be working with, but he or she cannot order them to

do

anything beyond what the Nursing Practice Act allows.

A physician, however, can.

Now, on the subject of responsibility for acts of paramedics, will a nurse be

held responsible for the acts of a paramedic who is acting under a

physician's standing orders? It would seem not, but if the same act could be

performed

by the nurse, whose judgment prevails? And who has the power to control the

situation? That is a thorny question, and it is one that I haven't found

any case law on. The statutes do not address this situation. I would suggest

that the hospital ought to have clearly stated policies addressing this

issue.

It is possible for the hospital to write policies saying who has the ultimate

authority in a given situation, so long as the policy recognizes the legal

rights and responsibilities of each member of the team.

My experience is that few hospitals have gone to the trouble of enacting

policies that are clear and definitive regarding these problems. That's the

job

of the risk manager, but too often the risk manager is not familiar with the

nuances of these problems.

And so we sow a fertile plain for litigation.

Gene G.

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> >

> > In a message dated 12/27/2006 3:13:07 P.M. Central Standard Time,

> > asclapius@.. asclapiu

> >

> > If paramedics aren't functioning to the standard scope of

> > practice and are instead functioning similarly to nurses aides, then

> > wouldn't the RN be " in charge " somewhat of the paramedic's actions?

> >

> > And might that not be dependent upon the job description or job

> title they

> > are working under?

> >

> > For example could a hospital allow and EMT-I to be a staff

> phlebotomist?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/ FF/

> > Freelance Consultant/Trainer/ Freelance Cons Freelance Consul

> Consultant

> >

> > LNMolino@...

> >

> > (Cell Phone)

> > (Home Phone)

> > (IFW/TFW/FSS Office)

> > (IFW/TFW/FSS Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > " Great minds discuss ideas; Average minds discuss events; Small minds

> > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

> >

> > The comments contained in this E-mail are the opinions of the

> author and the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated

> with unless I

> > specifically state that I am doing so. Further this E-mail is

> intended only for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public

> domain by the

> > original author.

> >

December 27, 2006

No. I don't think that's possible under Texas law. A paramedic cannot

work under an RN's license. The Nursing Practice Act simply does not permit

it.

GG

>

> So in Texas, at least in theory, a hospital could hire a paramedic and

> have him/her work under a RN's license as a UAP so long as they have a

> job description of performing specific tasks and not to the fullest

> potential of paramedic training. This is how I understand it.

>

> -Alfonso R. Ochoa

>

> >

> > In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> > asclapius@.. asclapiu

> >

> > Precisely. That's why I'm of the opinion that it would depend on the

> > specific situation. I know of a few hospitals that hire paramedics as

> > " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> > the care and subsequently being responsible for said care performed by

> > these personnel, regardless of their certification with DSHS OEMS/TS.

> >

> > -Alfonso R. Ochoa

> >

> > Exactly, I know that in NJ, PA and DE it is common practice to have

> a job

> > description where one of the Chinese menu approaches to being

> qualified for the

> > job is to have a B or P card (none of these states have I's). The

> > phlebotomists is likely the best example. A few of the Medics I

> know that worked for ALS

> > services that had some cutbacks were offered phlebotomist jobs as a

> way to

> > keep them in the system till those short term issues were worked

> out (albeit

> > at a lower pay grade then Medic).

> >

> > Given the numbers of Legal beagles that hospitals have I'm sure that

> if the

> > facility wanted to do this they cod do so.

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/ FF/

> > Freelance Consultant/Trainer/ Freelance Cons Freelance Consul

> Consultant

> >

> > LNMolino@...

> >

> > (Cell Phone)

> > (Home Phone)

> > (IFW/TFW/FSS Office)

> > (IFW/TFW/FSS Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > " Great minds discuss ideas; Average minds discuss events; Small minds

> > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

> >

> > The comments contained in this E-mail are the opinions of the

> author and the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated

> with unless I

> > specifically state that I am doing so. Further this E-mail is

> intended only for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public

> domain by the

> > original author.

> >

December 27, 2006

In Iowa, EMS personnel can function in a clinical or hospital setting

and treat within their scope of practice. Here, and I worked on a

hospital based service, we did whatever we were directed to do,

including passing meds and IVs, etc as long as they fell into our scope

of practice or we could document Med Director approval, education and

competencies.

Paramedics did the actual running of a code, just like in the field,

except you had more people and someone was actually writing down what

was done, when it was done/time drug was administered, etc...;-)

Jules

Re: Need some help.

So in Texas, at least in theory, a hospital could hire a paramedic and

have him/her work under a RN's license as a UAP so long as they have a

job description of performing specific tasks and not to the fullest

potential of paramedic training. This is how I understand it.

-Alfonso R. Ochoa

>

> In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> asclapius@... writes:

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed

by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> Exactly, I know that in NJ, PA and DE it is common practice to have

a job

> description where one of the Chinese menu approaches to being

qualified for the

> job is to have a B or P card (none of these states have I's). The

> phlebotomists is likely the best example. A few of the Medics I

know that worked for ALS

> services that had some cutbacks were offered phlebotomist jobs as a

way to

> keep them in the system till those short term issues were worked

out (albeit

> at a lower pay grade then Medic).

>

> Given the numbers of Legal beagles that hospitals have I'm sure that

if the

> facility wanted to do this they cod do so.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

1962)

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated

with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

December 27, 2006

I have not seen medics working like that here in Texas but I am only

familiar with the Emergency Departments here in San .

Re: Need some help.

So in Texas, at least in theory, a hospital could hire a paramedic and

have him/her work under a RN's license as a UAP so long as they have a

job description of performing specific tasks and not to the fullest

potential of paramedic training. This is how I understand it.

-Alfonso R. Ochoa

>

> In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> asclapius@... writes:

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed

by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> Exactly, I know that in NJ, PA and DE it is common practice to have

a job

> description where one of the Chinese menu approaches to being

qualified for the

> job is to have a B or P card (none of these states have I's). The

> phlebotomists is likely the best example. A few of the Medics I

know that worked for ALS

> services that had some cutbacks were offered phlebotomist jobs as a

way to

> keep them in the system till those short term issues were worked

out (albeit

> at a lower pay grade then Medic).

>

> Given the numbers of Legal beagles that hospitals have I'm sure that

if the

> facility wanted to do this they cod do so.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

>

> LNMolino@...

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

1962)

>

> The comments contained in this E-mail are the opinions of the

author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated

with unless I

> specifically state that I am doing so. Further this E-mail is

intended only for its

> stated recipient and may contain private and or confidential

materials

> retransmission is strictly prohibited unless placed in the public

domain by the

> original author.

>

December 27, 2006

I believe Gene is right. In order for you to " practice " you need to

be under a physicians orders/protocols. You cannot work under an

RN's license. While an RN can designate things for you to do in the

ER you still have to have either physicians orders OR be working

under physician approved protocols. Either way you are NOT working

under the RN's license. It is the physician's license that covers

you. But that's just the way I understand it.

> >

> > Andy is correct. Nurses cannot delegate any practice to an EMT

or

> paramdic.

> > However, the physician can.

> >

> > Paramedics in Texas work under the delegated practice of a

physician.

> > Nurses have no place in the process. They have neither the

power to

> delegate

> > practice to an EMT or to deny the EMT the right to practice under

> the physician's

> > orders. They are totally superfluous to the practice of EMTs

and

> Paramedics.

> >

> > Nurses have fought to the death in other states to keep

paramedics

> out of

> > the ER and other places in the hospital. This has, so far, not

> happened in

> > Texas, but don't hold your breath.

> >

> > It is purely an economic battle, a turf battle, and it has

nothing

> > whatsoever to do with competency to perform the delegated skills.

> >

> > In Texas, Paramedics or EMTs can work in a hospital if they are

> working

> > under the delegated orders of a physician. Nurses have no role

in

> either

> > approving or disapproving what medics do in the hospital if

they're

> working under

> > the physician's license.

> >

> > However, if a nurse were to decide to delegate to a medic, it

would be

> > illegal.

> >

> > So, medics in a hospital work under a physician's license or not

at

> all.

> >

> > Gene G.

> >

December 27, 2006

Gene,

You would be on my dreams team. You are correct I just want to make sure

they understand that if the nurse is the supervisor and if she ask you do do

something within the scope of practice the doctor has delegated to the EMS

person then she is acting as the supervisor and not medical director, for

example

the Nurse/Supervisor says the patient in room 5 needs an IV and a breating

treatment. She/He is asking you to do it as the supervisor, but the

authorization to perform those skills comes from the Medical director.

Gene is absolutely correct when he say there should be written protocols in

place, it is important that everyone knows and agrees what an EMS worker can

or can not do within the scope of practice the Medical Director has

delegated. I also agree EMS personel should not be hired as cheap labor to

replace

nurses rather they should work as part of the team as Gene states.

I hope this helps too.

Maxie

December 27, 2006

Gene writes:

>>A hospital could hire an EMT-I to be a staff phlebotomist.

Anybody can be a

>>phlebotomist. The training program is usually about 2-3 days. All

the

>>hospital has to do is to decide that the person is capable of doing

the job and

>>have some staff physician certify them. Actually, I'm not sure

that's even

>>required.

Nope...not much is needed...in the hospital where I use to work, two

housekeeper moved into the lab as phlegotomists....better money...less

training...;-)

Jules

________________________________________________________________________

Check Out the new free AIM® Mail -- 2 GB of storage and

industry-leading spam and email virus protection.

December 27, 2006

Gene,

Thanks again. Now the difficult task begins of back-peddling to

figure out exactly where I went wrong in my logic and/or reasoning.

-Alfonso R. Ochoa

>

> Alfonso,

>

> The only way that nurses can exert control over paramedics is by

assigning

> rooms, and so forth, but they CANNOT delegate patient assessment

or any other

> nursing task. Nor can they order a paramedic to do anything else

other than

> to empty a bedpan and such. Delegation of nursing skills and

duties cannot

> be delegated, under Texas law.

>

> A nurse cannot even delegate patient assessment to an LVN.

However, the

> doctor can delegate patient assessment to a paramedic, but the nurse

cannot.

>

> Questions come up when paramedics work triage. Is triage patient

assessment

> that must be done be a nurse unless delegated to a paramedic by

doctor's

> orders? I think so.

>

> Now, once the physician issues protocols for paramedics, they are

working for

> the doctor, not the nurse.

>

> I worked on a case where a Paramedic was working as a tech, and was

allowed

> to give drugs. He followed a physician's order and gave the wrong

drug. He,

> the doc, the nurse, and the hospital got sued. Unfortunately there

were no

> written protocols or job descriptions for the medic. The outcome

of the case

> was not pretty. It's imperative, as others have said, that there be

written

> protocols for the hospital paramedics just as there are for street

medics.

> The physician is not bound by nursing rules as to what he can

delegate to

> paramedics. So, for example, he can allow paramedics to intubate

if he wants to.

> The only qualification is that he is responsible for their actions,

and he

> obviously should not delegate something beyond the paramedic's

training and

> skills level.

>

> Hospital administration has an obvious role in determining what it

wants

> paramedics to do. But it does that through the physician, not the

nursing staff,

> although at times nursing staff is involved in the decision making

process.

>

> So, like it or not, nurses do not have the power to delegate duties to

> paramedics that involve medical care. It's the law. They do have

the power to

> delegate administrative duties, such as which patient you're

assigned to, but

> that's about it.

>

> Paramedics working in a hospital work for the physician, not the

nurse, in

> terms of patient care. They may work for the nurse in terms of

when and where

> they work, but the nurse does not determine the skills they perform.

>

> Ideally, nurses and paramedics would work together as a part of a

team. My

> experience with places that have paramedics working in the ER is

that everyone

> gets along well, and the nurses and paramedics respect each other and

> complement each other. I have seen places where there is no

rivalry at all between

> them, and that's as it should be. Each has a role to play, and

each brings a

> different perspective to the job.

>

> Paramedics cannot replace nurses, and nurses do not necessarily have

the

> skills that paramedics do, although that is quite possible,

especially when

> paramedics later become nurses.

>

> Both have a legitimate roll to play in the hospital environment, in my

> judgment. Others will differ, I fully realize.

>

> What we do not need is a rivalry between the two professions. And

we do not

> need to have hospitals hiring medics to save money. Medics who

work in the

> ED under full doctors' orders do basically the same things that

nurses do.

> And they should be paid accordingly.

>

> I hope this helps to clarify.

>

> GG

>

> >

> > Gene,

> >

> > Your response was most informative, however it left me somewhat

> > confused. I got the impression from the BNE website that RNs were

> > responsible for the care of the patient and delegated care to LVNs and

> > UAPs. If paramedics aren't functioning to the standard scope of

> > practice and are instead functioning similarly to nurses aides, then

> > wouldn't the RN be " in charge " somewhat of the paramedic's actions?

> >

> > -Alfonso R. Ochoa

> >

> > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> > >

> > > Andy is correct. Nurses cannot delegate any practice to an EMT or

> > paramdic.

> > > However, the physician can.

> > >

> > > Paramedics in Texas work under the delegated practice of a

physician.

> > > Nurses have no place in the process. They have neither the power to

> > delegate

> > > practice to an EMT or to deny the EMT the right to practice under

> > the physician's

> > > orders. They are totally superfluous to the practice of EMTs and

> > Paramedics.

> > >

> > > Nurses have fought to the death in other states to keep paramedics

> > out of

> > > the ER and other places in the hospital. This has, so far, not

> > happened in

> > > Texas, but don't hold your breath.

> > >

> > > It is purely an economic battle, a turf battle, and it has nothing

> > > whatsoever to do with competency to perform the delegated skills.

> > >

> > > In Texas, Paramedics or EMTs can work in a hospital if they are

> > working

> > > under the delegated orders of a physician. Nurses have no role in

> > either

> > > approving or disapproving what medics do in the hospital if they're

> > working under

> > > the physician's license.

> > >

> > > However, if a nurse were to decide to delegate to a medic, it

would be

> > > illegal.

> > >

> > > So, medics in a hospital work under a physician's license or not at

> > all.

> > >

> > > Gene G.

> > >

December 28, 2006

Again, Gene is correct. If the paramedic hires into the ER as a Housekeeping

employee, then he is not rendering care and is not practicing as a paramedic.

Do not look for zebra's in a mule barn. If you hire on to do any patient care,

you MUST be under a Medical Director's Protocols. If you are a paramedic and

hire into the hospital as a computer analyst, it has nothing to do with being a

paramedic. End of subject. Stop the rhetoric.

Andy Foote

Re: Re: Need some help.

I disagree. I cannot find any law that authorizes a " charge nurse " to

direct the care by a paramedic or mandates the nurse being responsible for care

rendered by persons that the Nursing Practice Act prohibits them from delegating

duties to.

As I said earlier, the Charge Nurse can assign duties in terms of what

patients the paramedic will be working with, but he or she cannot order them to

do

anything beyond what the Nursing Practice Act allows.

A physician, however, can.

Now, on the subject of responsibility for acts of paramedics, will a nurse be

held responsible for the acts of a paramedic who is acting under a

physician's standing orders? It would seem not, but if the same act could be

performed

by the nurse, whose judgment prevails? And who has the power to control the

situation? That is a thorny question, and it is one that I haven't found

any case law on. The statutes do not address this situation. I would suggest

that the hospital ought to have clearly stated policies addressing this

issue.

It is possible for the hospital to write policies saying who has the ultimate

authority in a given situation, so long as the policy recognizes the legal

rights and responsibilities of each member of the team.

My experience is that few hospitals have gone to the trouble of enacting

policies that are clear and definitive regarding these problems. That's the

job

of the risk manager, but too often the risk manager is not familiar with the

nuances of these problems.

And so we sow a fertile plain for litigation.

Gene G.

>

> Precisely. That's why I'm of the opinion that it would depend on the

> specific situation. I know of a few hospitals that hire paramedics as

> " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> the care and subsequently being responsible for said care performed by

> these personnel, regardless of their certification with DSHS OEMS/TS.

>

> -Alfonso R. Ochoa

>

> >

> > In a message dated 12/27/2006 3:13:07 P.M. Central Standard Time,

> > asclapius@.. asclapiu

> >

> > If paramedics aren't functioning to the standard scope of

> > practice and are instead functioning similarly to nurses aides, then

> > wouldn't the RN be " in charge " somewhat of the paramedic's actions?

> >

> > And might that not be dependent upon the job description or job

> title they

> > are working under?

> >

> > For example could a hospital allow and EMT-I to be a staff

> phlebotomist?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/ FF/

> > Freelance Consultant/Trainer/ Freelance Cons Freelance Consul

> Consultant

> >

> > LNMolino@...

> >

> > (Cell Phone)

> > (Home Phone)

> > (IFW/TFW/FSS Office)

> > (IFW/TFW/FSS Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > " Great minds discuss ideas; Average minds discuss events; Small minds

> > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

> >

> > The comments contained in this E-mail are the opinions of the

> author and the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated

> with unless I

> > specifically state that I am doing so. Further this E-mail is

> intended only for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public

> domain by the

> > original author.

> >

December 28, 2006

People,

This could rage forever...Gene is right. Just take one little look at the Texas

Medical Practice Act. I clearly defines who can delegate authority to whom.

Under Chapter 157 of the Occupations Code, " Authority of Physician to Delegate

Certain Medical Acts " . Section 157.003 specifically deals with Emergency

Medical Personnel. No place in the Texas Occupation Code, including Chapter

301. " Nurses " is anyone allowed to delegate the medical practice of any

prehospital personnel, with regard to their certification or licensure by DSHS,

except by a bonafide physician. Anything else is the unlicensed practice of

medical, regardless of what the omnipotent BNE would like you or your favorite

RN to believe.

The link to 157 is

http://tlo2.tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000157.00.do\

c

The link to 301 is

http://tlo2.tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000301.00.do\

c

After all...if Al Gore could create the internet (snicker), and the State of

Texas could manage to get the statutes on-line, the least you could do is look

at it. Takes less time than the argument.

Vernon Gresham

City of Ganado EMS

Re: Re: Need some help.

No. I don't think that's possible under Texas law. A paramedic cannot

work under an RN's license. The Nursing Practice Act simply does not permit

it.

GG

>

> So in Texas, at least in theory, a hospital could hire a paramedic and

> have him/her work under a RN's license as a UAP so long as they have a

> job description of performing specific tasks and not to the fullest

> potential of paramedic training. This is how I understand it.

>

> -Alfonso R. Ochoa

>

> >

> > In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> > asclapius@.. asclapiu

> >

> > Precisely. That's why I'm of the opinion that it would depend on the

> > specific situation. I know of a few hospitals that hire paramedics as

> > " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> > the care and subsequently being responsible for said care performed by

> > these personnel, regardless of their certification with DSHS OEMS/TS.

> >

> > -Alfonso R. Ochoa

> >

> > Exactly, I know that in NJ, PA and DE it is common practice to have

> a job

> > description where one of the Chinese menu approaches to being

> qualified for the

> > job is to have a B or P card (none of these states have I's). The

> > phlebotomists is likely the best example. A few of the Medics I

> know that worked for ALS

> > services that had some cutbacks were offered phlebotomist jobs as a

> way to

> > keep them in the system till those short term issues were worked

> out (albeit

> > at a lower pay grade then Medic).

> >

> > Given the numbers of Legal beagles that hospitals have I'm sure that

> if the

> > facility wanted to do this they cod do so.

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/ FF/

> > Freelance Consultant/Trainer/ Freelance Cons Freelance Consul

> Consultant

> >

> > LNMolino@...

> >

> > (Cell Phone)

> > (Home Phone)

> > (IFW/TFW/FSS Office)

> > (IFW/TFW/FSS Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > " Great minds discuss ideas; Average minds discuss events; Small minds

> > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

> >

> > The comments contained in this E-mail are the opinions of the

> author and the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated

> with unless I

> > specifically state that I am doing so. Further this E-mail is

> intended only for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public

> domain by the

> > original author.

> >

December 28, 2006

I dealt with this issue several years ago when running some EDs. Hospitals

hire EMTs and paramedics as " unlicensed personnel " meaning they can do

certain well-defined tasks that do not qualify as nursing per se. I wanted

to establish protocols for the paramedics to do " nursing level " tasks under

my license. The Baylor attorneys cried foul unless I was there all the time.

Gene is right in that nurses cannot delegate to paramedics or EMTs. There is

something in the nursing statutes that basically makes it necessary for only

an RN to triage. It was not long before the TNA was involved and it became

clear that all we could have the paramedics do was glorified ED tech or

orderly duties. But, as the hospital paid better than EMS there were takers.

The fact that EMS personnel in Texas are not " licensed " hurts funding

(Medicare) as you cannot bill for work done by unlicensed personnel and they

don't count in your personnel to patient ratios.

Kentucky has established state statutes that allows paramedics to staff EDs

(http://www.lrc.ky.gov/kar/202/007/701.htm):

Section 5. Paramedic Hospital Scope of Practice. (1) Paramedics functioning

in the hospital environment shall perform within the scope of practice, as

defined in this administrative regulation.

(2) Employment of paramedics in hospital emergency department

settings, exclusive of their being employed by air or ground transport

components, or both, owned or operated by the hospital, shall be subject to

demonstrating knowledge based and clinical competencies at a level

satisfactory to the employing hospital and subject to applicable laws and

administrative regulations.

(3) The employers shall not dictate practice for a paramedic that

exceeds the defined scope of practice. The paramedic shall inform the

employing institution or supervising staff of any inability or limitation to

perform an ordered skill or procedure based upon:

(a) A lack of knowledge of or training or education in the procedure

or skill; or

( The order or directive exceeding the paramedic's scope of

practice.

(4) Employers may provide education or educational opportunities to

expand the documented clinical practice of the paramedic but shall not do so

with the intent of requiring the paramedic to perform skills or procedures

that exceed their statutorily defined scope of practice while in the

hospital's employ.

(5) Paramedics shall have a duty to:

(a) Maintain strict patient confidentiality;

( Provide and assure continuity of care to their patients;

(d) Follow the hospital's chain of command;

(e) Be knowledgeable and function within the scope of practice of a

paramedic;

(f) Be clearly identified as a licensed paramedic while functioning in

the hospital's employ;

(g) Appropriately document on patient care records all interventions,

treatments and assessments performed by the paramedic;

(h) Perform patient assessment, which may include triage; and

(i) Institute appropriate therapy in the care of patients subject to

the limitation of existing protocols.

In KY, nurses can delegate to paramedics in the ED and allows them to triage

(http://www.kbn.ky.gov/NR/rdonlyres/939467E5-00AD-420B-938E-CE9EC13EA064/0/a

os33.pdf)

Such changes will have to occur in Texas before this can work. Until EMS

personnel in Texas are " licensed " this discussion is moot.

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of Vernon A. Gresham

Sent: Thursday, December 28, 2006 10:29 AM

To: texasems-l ; Asclapius@...

Subject: Re: Re: Need some help.

People,

This could rage forever...Gene is right. Just take one little look at the

Texas Medical Practice Act. I clearly defines who can delegate authority to

whom. Under Chapter 157 of the Occupations Code, " Authority of Physician to

Delegate Certain Medical Acts " . Section 157.003 specifically deals with

Emergency Medical Personnel. No place in the Texas Occupation Code,

including Chapter 301. " Nurses " is anyone allowed to delegate the medical

practice of any prehospital personnel, with regard to their certification or

licensure by DSHS, except by a bonafide physician. Anything else is the

unlicensed practice of medical, regardless of what the omnipotent BNE would

like you or your favorite RN to believe.

The link to 157 is http://tlo2.

<http://tlo2.tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000157.

00.doc>

tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000157.00.doc

The link to 301 is http://tlo2.

<http://tlo2.tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000301.

00.doc>

tlc.state.tx.us/statutes/docs/OC/content/word/oc.003.00.000301.00.doc

After all...if Al Gore could create the internet (snicker), and the State of

Texas could manage to get the statutes on-line, the least you could do is

look at it. Takes less time than the argument.

Vernon Gresham

City of Ganado EMS

Re: Re: Need some help.

No. I don't think that's possible under Texas law. A paramedic cannot

work under an RN's license. The Nursing Practice Act simply does not permit

it.

GG

In a message dated 12/27/06 5:50:07 PM, asclapius (AT) aol (DOT)

<mailto:asclapius%40aol.com> com writes:

>

> So in Texas, at least in theory, a hospital could hire a paramedic and

> have him/her work under a RN's license as a UAP so long as they have a

> job description of performing specific tasks and not to the fullest

> potential of paramedic training. This is how I understand it.

>

> -Alfonso R. Ochoa

>

> >

> > In a message dated 12/27/2006 4:59:36 P.M. Central Standard Time,

> > asclapius@.. asclapiu

> >

> > Precisely. That's why I'm of the opinion that it would depend on the

> > specific situation. I know of a few hospitals that hire paramedics as

> > " ER Techs " or " Patient Care Techs, " thus the charge nurse directing

> > the care and subsequently being responsible for said care performed by

> > these personnel, regardless of their certification with DSHS OEMS/TS.

> >

> > -Alfonso R. Ochoa

> >

> > Exactly, I know that in NJ, PA and DE it is common practice to have

> a job

> > description where one of the Chinese menu approaches to being

> qualified for the

> > job is to have a B or P card (none of these states have I's). The

> > phlebotomists is likely the best example. A few of the Medics I

> know that worked for ALS

> > services that had some cutbacks were offered phlebotomist jobs as a

> way to

> > keep them in the system till those short term issues were worked

> out (albeit

> > at a lower pay grade then Medic).

> >

> > Given the numbers of Legal beagles that hospitals have I'm sure that

> if the

> > facility wanted to do this they cod do so.

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/ FF/

> > Freelance Consultant/Trainer/ Freelance Cons Freelance Consul

> Consultant

> >

> > LNMolino@...

> >

> > (Cell Phone)

> > (Home Phone)

> > (IFW/TFW/FSS Office)

> > (IFW/TFW/FSS Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > " Great minds discuss ideas; Average minds discuss events; Small minds

> > discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

> >

> > The comments contained in this E-mail are the opinions of the

> author and the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated

> with unless I

> > specifically state that I am doing so. Further this E-mail is

> intended only for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public

> domain by the

> > original author.

> >

December 28, 2006

I was told by a friend who is a Firefighter that the local college

there,

College, wanted to start a Paramedic to RN program, but the Nursing " faculty "

stated they

didn't like that idea, so, down the drain it went !

As " Rodney " once said so eloquently: " CAN'T WE ALL JUST GET ALONG? "

" Bledsoe, DO " wrote:

I dealt with this issue several years ago when running some EDs.

Hospitals