The setback of paramedicine back into the 1970s

[Pufahl, Jo M.]

As an RN, Flight RN, EMT, prehospital caregiver, transport nurse since 1985,
I couldn't agree more with all your statements.  I did not see the original
posting as a nurse/medic bashing, but as a political response to an isolated
hospital with a specific problem.  To develop a bill, push it through the
legislature where it will impact all hospitals, transports, staff, staffing,
etc. to fix one hospital's problem is ludicrous. 

Just my $ 0.02 worth. Jo Pufahl, RN, BAN, CEN, CFRN, EMT, First Responder,
Fire Fighter

-----Original Message-----
From: jneff71 at aol.com [mailto:jneff71 at aol.com]
Sent: Friday, April 08, 2005 1:56 PM
To: flightmed at flightweb.com
Subject: Re: The setback of paramedicine back into the 1970s


I dont believe this is a "trash the nurse" issue.  What I read this to mean
is that the State of NH is taking steps that could potentially bring harm,
through a lack of environment specific education and training, to the
patient requiring an out of hospital transport.
 
We should not use this thread to begin to rehash the RN vs EMTP level of
care, licensure versus certification et al discussions of past.
 
Despite what some Paramedics think, there are, currently, patients who will
require the knowledge and expertise of a Critically Care trained RN to
assist in the care and transportation of a patient.  The out of hospital
care environment, like it or not, is vastly different from the ED or ICU
setting.  
 
Appropriate cross training can occur and can alleviate this "throw the RN in
the truck and go" issue.  That action is as acceptable as saying that we
should just send a crew of Paramedics to a code in an inpatient setting.
 
One quick personal reference to support Mr Clark's statement.  While working
as a Flight paramedic I pulled shifts on a non-emergency ground transport
unit.  I had the occasion to transport a stable cardiac patient on a nitro
drip.  Upon arrival at the sending unit (non-critical care) I was advised an
RN would accompany me to manage the nitro drip. During the trip the patient
developed chest pain. Because the RN had not been trained appropriately she
did not react appropriately.  In addition she had no experience in
transport.  As she used her cell phone to page the physician to ask if we
should stop transport and what medication actions were needed, I medicated
the patient and resolved the CP.  The moral??  She was not appropriately
trained for the situation.  I know her personally, she is very intelligent
and I would allow her to work on any member of my family... IN THE HOSPITAL.
 
If the State of NH is going to allow this, the training must be regulated
and proposed prior to approval of the bill.  A subset of staff should be
identified that would be able to travel with a patient and that staff would
need to maintain credentials and training sufficient to do no harm to the
patient.  It cant be thrown together off the cuff.  Perhaps the State of NH
should invest in their Emergency Service Professionals, expand scope of care
to include CCT and resolve part of the issue in that manner.  Secondly, the
institution that is having the transport difficulties should refine their
business practice, see the impact to the bottom line a transport service can
have, and develop a system to transport their patients in a timely manner.
There are avenues to address the root cause of this issue versus going
through the State Legistlature.
 
Regards
 
Josh
Paramedic
 
-----Original Message-----
From: Summers, David <David.Summers at tenethealth.com>
To: Flightmed <flightmed at flightweb.com>
Sent: Fri, 8 Apr 2005 14:28:19 -0400
Subject: RE: The setback of paramedicine back into the 1970s


I noticed one of your initials include being an attorney.

Doesn't maintaining a certain level of care once the patient is hospitalized

occur in NH?
Some States require a critical care RN to maintain the same level of service

once the patient is within the confines of the hospital due to technology
higher 
than the Paramedic has been trained for.
.
If the EMS (prehospital) service has within their protocols that the
Paramedic 
is trained to care for Nipride, IV nitro,diprovan drips,  multi-pressors 
situations, administration of blood, Alines, swann ganz, cardiac cath lines,

chest tubes to dry-seal / suction units, ECMO, etc etc etc. then have at it.

In Florida, we prefer to release these patients to a flight team that has a 
nurse-medic/medic configuration. Then the maintaining of similar level of
care 
is not an issue.  Even some of the EMS service based heli programs are now 
nurse-medic/medic teams.  Ground units- send the nurse with the ambulance
crew.

Just one person's opinion.

David A. Summers RN, CFRN, EMT-P
Pediatric Trauma Nurse Coordinator
EMS PI Coordinator
St Mary's Medical Center
West Palm Beach FL 33407
561.882.6429
561.881.0945 fax
david.summers at tenethealth.com

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-----Original Message-----
From: flightmed-bounces at flightweb.com
[mailto:flightmed-bounces at flightweb.com]On Behalf Of John R. Clark, JD,
NREMT-P, FP-C
Sent: Sunday, April 10, 2005 1:37 PM
To: flightmed at flightweb.com
Subject: The setback of paramedicine back into the 1970s


EMS Community-at-large:
 
On behalf of the New Hampshire Paramedics Association, I ask that you 
take a minute and look at this issue.  New Hampshire EMS providers need 
your support!  If you have any political savvy and would like to prevent 
the abomination of the EMS rules and the setback of paramedicine back 
into the 1970s, I urge you to get involved in any way you can (letters, 
phone calls, Association support etc.).  
 
A bill has been introduced in the New Hampshire Senate that would allow 
a nurse with only minimal training in interfaclility transport (relying 
on a module that has not been developed, described nor determined) get 
in an ambulance to transport a patient if the ETA or an appropriately 
trained critical care transport team is greater than 30 minutes.  The 
text of the bill in part follows:   
 
NH Senate Bill 88 - amendment -

/"Insert after NH RSA 153-A:16 II:
 
In the event that a physician determines that an inter-facility transfer 
of a Critical Access hospital patient is urgent and the availability of 
two licensed EMS providers exceeds the 30 minutes, a registered nurse, 
certified in emergency nursing and advanced cardiac life support may act 
as the responsible provider for the patient during the transfer after 
completion of an inter-facility training module."/
 
The initial draft of NH SB 88, which came out the the blue was 
horrible and basically would have allowed any nurse to jump on any 
ambulance and be a crew member. It was introduced by a Senator that 
responded to the plea of one of his constituent's who is a nurse who 
said it was taking too long to move patients out of the ER.  The general 
rule change being introduced would allow any RN to be licensed EMS 
provider.  The amendment above would at least allow a 30 minute window 
before a nurse could Shanghai the transport.
 
For additional info and complete text of the bill, click on the New 
Hampshire Paramedic Association website at  
http://nhpa.home.comcast.net/ and look for the March 28 posting titled 
"Senate Bill 88 - Good or Bad?"
 
Please pass this along to anyone that you believe can help. 

To contact the president of the New Hampshire Paramedic Association, 
email spidermedic at yahoo.com 
<http://us.f535.mail.yahoo.com/ym/Compose?To=spidermedic@yahoo.com>.
The Chief of the NH Bureau of EMS can be reached at 
sprentiss at safety.state.nh.us 
<http://us.f535.mail.yahoo.com/ym/Compose?To=sprentiss@safety.state.nh.us>
for 
questions or comments.
The NH Legislature's home page is http://www.gencourt.state.nh.us/ns to 
send email and snail mail to one of over 400 legislators.
 
This issue could push paramedicine in NH back into the days of Johnny & 
Roy  if the bill is not blocked.  Get involved!!!
 
Thanks,

John R. Clark, JD, NREMT-P, FP-C
A New Hampshire paramedic
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