EMT/Medical Student...Transfer of care

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

han14tra

Full Member
15+ Year Member
Joined
May 22, 2007
Messages
636
Reaction score
24
If you are an EMT and a medical student, can you still transfer care to another EMT?

I'm asking because I often direct respond in a personal vehicle to the scene, then if our ambulance has a full-crew there's no room for me to go. Can I transfer care to an EMT if I'm in the clinical years of medical school? What about in residency? When I am a resident will I be able to do on scene medical command?


Thanks

Members don't see this ad.
 
As I understand it if you aren't working in an official capacity you can "transfer" patient care to someone who is qualified in that juristiction even if they are of lower training. For example if a doctor sees an accident and stops to render aid, they are not required to accompany the patient to the hospital. The doctor can turn over patient care to the EMTs or paramedics. There are many places where paramedics can evaluate patients and decide that the patients are BLS and care can be given to EMTs, even though they are "lower" in training.

As a medical student you don't have a license to practice, nor are you trained for prehospital emergencies. So a third year medical student can't say "I out rank you" to an EMT and take care. Also I'm pretty sure that an EMT who is also a medical student is viewed simply as an EMT by the state, not as some sort of EMT plus (the same way that the EMS agency doesn't care that you are EMT + Lifeguard/Wilderness EMT/ phelbotomist etc. EMT=EMT)

As far as on scene command that's tough. Most of the agencies I've worked with have the policy that if a doctor on scene wants to "take charge" they have to ride in with the patient to the hospital. Also I think most providers wouldn't take orders from an on scene physician that contradicted their standing protocols. So as a resident I'm sure your help would be appreciated, but I don't see a situation where as a bystander you would be scene medical command. (Some residencies have residents be medical director for agencies and are medical command, on or off line, but that's a different situation.)
 
If you are an EMT and a medical student, can you still transfer care to another EMT?

I'm asking because I often direct respond in a personal vehicle to the scene, then if our ambulance has a full-crew there's no room for me to go. Can I transfer care to an EMT if I'm in the clinical years of medical school? What about in residency? When I am a resident will I be able to do on scene medical command?

Thanks

As an EMT, you may hand off care to anyone of equal or greater certification than yours (ie. another EMT, AEMT-I or P, RN, PA, MD). The last three typically only in the hospital. Your status as a medical student has no bearing on your pre-hospital certification.

Once you graduate medical school, if you are working as an EMT or Paramedic, I'm pretty sure those same rules apply then too. As for on-scene command, you may provide medical command if you sign a waiver and accept responsibility for the care of the patient and agree to accompany to the hospital (but that will be for ONE ALS patient). If you are an EM resident, you maybe able to provide medical control as long as you are credentialed to do so by the local REMAC.

Correct me if I am wrong about the MD/DO & EMT situation though. I recall though from anecdotal stories about a Physician who was also a Paramedic and while riding as a paramedic exceeding standing orders without consulting online medical control. He was disciplined because in the ambulance, if he is the sole provider, he is the paramedic. However, if there is another paramedic present, he because he is Physician credentialed by REMAC, he could provide OLMC.
 
Members don't see this ad :)
If you are an EMT and a medical student, can you still transfer care to another EMT?

I'm asking because I often direct respond in a personal vehicle to the scene, then if our ambulance has a full-crew there's no room for me to go. Can I transfer care to an EMT if I'm in the clinical years of medical school? What about in residency? When I am a resident will I be able to do on scene medical command?


Thanks

I can only speak for the area I'm in.

Unless you have a valid ACLS card and your medical license on your person on scene and are willing to assume complete liability for the patient, by signing paper work saying as much, as well as getting in the back of the rig and riding along to the hospital then no, you cannot assume control of the scene, nor can you provide medical direction to the Paramedics.

The Paramedic on scene may choose relinquish scene control to you if you can fulfill all of the above criteria, but you cannot take it from him without his consent. You can walk up and say "I'm a doctor" but don't expect to be offered command of the scene; they might have a use for you depending on the call, but don't expect to do much more then provide another set of hands. It all depends on whats going on.

A really good way to end up getting arrested or at very least detained by PD or SO is by interfering with a call against the wishes and without the invitation of the units responding, doctor or not.

Furthermore, in terms of patient custody within EMS, you can relinquish a patient to the EMT-B/I or Paramedic because you're only current certification is as an EMT-B.

-e-

In the event that it wasn't clear. You must be an MD/DO before you can even consider trying to take over a call.
 
Last edited:
Being a medical student doesn't mean jack.

Medical students are not licensed to practice medicine, nor certified for anything that would give us a higher level of responsibility than another EMT. You're an EMT, and that's it as far as the law is concerned, unless the laws of your state are radically different from mine.

Heck, I had a drunk medical student removed from my ambulance in handcuffs because he wouldn't listen to my order to "get the **** out of my ambulance."
 
I do not believe a medical student is licensed to perform medical acts outside of a hospital or school-sanctioned clinical setting, so they would not be much help in the back of an ambulance. I also don't think I'd want them trying to practice intubating, starting IVs, or anything else in the back of a moving ambulance on any of my patients, unless they were there for the purpose of learning and not to take over a patient's care.
 
han14tra - I meant to ask this before, what do you mean when you say you often direct respond to calls in a personal vehicle?
 
Many volunteer departments carry pagers and respond from home or work in their personal cars, they will have a jump bag of first aid gear in their car or at home with them. As they are going to the scene someone else is headed to station to get the ambulance/fire truck. So you may have 4 personal cars and an ambulance on scene.
 
Correct me if I am wrong about the MD/DO & EMT situation though. I recall though from anecdotal stories about a Physician who was also a Paramedic and while riding as a paramedic exceeding standing orders without consulting online medical control. He was disciplined because in the ambulance, if he is the sole provider, he is the paramedic. However, if there is another paramedic present, he because he is Physician credentialed by REMAC, he could provide OLMC.


Although there may be a few nuances, a fully licensed physician can, by law, work in any capacity he/she chooses. Physicians have a fully independent license to practice medicine they do not need "orders" from anyone. I could legally do a thoracotomy on the sidewalk if I wanted (although that would probably be a bad, bad decision).
 
Although there may be a few nuances, a fully licensed physician can, by law, work in any capacity he/she chooses. Physicians have a fully independent license to practice medicine they do not need "orders" from anyone. I could legally do a thoracotomy on the sidewalk if I wanted (although that would probably be a bad, bad decision).

Not if he's working as a Paramedic in an EMS agency. Unless he is the Medical Director, there is no improvising, he is still bound by the Paramedic scope of practice. Same applies to an RN, PA or NP that is working as a Paramedic; their scope of practice may be beyond the bounds of a Paramedic's in terms of what they can do, but if they're working as a Paramedic they must stay within that scope of practice.
 
Not if he's working as a Paramedic in an EMS agency. Unless he is the Medical Director, there is no improvising, he is still bound by the Paramedic scope of practice. Same applies to an RN, PA or NP that is working as a Paramedic; their scope of practice may be beyond the bounds of a Paramedic's in terms of what they can do, but if they're working as a Paramedic they must stay within that scope of practice.

A MD who also works as a paramedic one, can do anything they want.. They would have to sign there own orders.. If they are going to step outside of protocol they must assume the liability. We have residents who ride with us all the time and if I want to do something outside protocol I just ask them.. One of the ED docs here still rides a couple times a month and its fun to have him on your truck because, he can sign orders for you to do whatever needs to be done.. MD's/DO's have no restrictions on practice rights. Paramedics are certified and must follow order given by the medical director..
 
Last edited:
Not if he's working as a Paramedic in an EMS agency. Unless he is the Medical Director, there is no improvising, he is still bound by the Paramedic scope of practice. Same applies to an RN, PA or NP that is working as a Paramedic; their scope of practice may be beyond the bounds of a Paramedic's in terms of what they can do, but if they're working as a Paramedic they must stay within that scope of practice.

Hmmm. OK, I suppose if a physician happens to also be a licensed paramedic (which by the way, for background I am both) somehow put themselves in the the position of a being a "paramedic" only I could possible see that. However, I don't really see that happening. Although I still love EMS, there is no way I would work as a "paramedic" now. I may still ride on a truck someday but not in my former capacity.

It's different from a nurse, NP or PA because they are not fully independent practitioners.

If I choose to ride on a truck, I can legally do any medical intervention I want. Legally, I could do brain surgery (with the big caveat that because you can doesn't mean you should). I don't have to answer to any medical director. This is a silly argument.
 
Last edited:
A MD who also works as a paramedic one, can do anything they want.. They would have to sign there own orders.. If they are going to step outside of protocol they must assume the liability. We have residents who ride with us all the time and if I want to do something outside protocol I just ask them.. One of the ED docs here still rides a couple times a month and its fun to have him on your truck because, he can sign orders for you to do whatever needs to be done.. MD's/DO's have no restrictions on practice rights. Paramedics are certified and must follow order given by the medical director..

Yup.
 
Members don't see this ad :)
If I choose to ride on a truck, I can legally do any medical intervention I want. Legally, I could do brain surgery (with the big caveat that because you can doesn't mean you should). I don't have to answer to any medical director. This is a silly argument.

I'm not sure if this is true. I had a long talk with the head of the national association of medial directors, and he said the law and rules regarding physicians riding on ambulances is very unclear. One of the big issues is liability for the ambulance service. Just because as a doctor you might feel comfortable doing a C section, the ambulance service doesn't have insurance that covers that kind of procedure. Same goes for other invasive procedures. Furthermore there is the question of if you were to miss something that a paramedic wouldn't be expected to pick up on, could the company be sued because the patient's family could say "that guy wasn't working as a medic, he was a doc."

These issues make many companies reluctant to have docs who aren't their medical director ride in a paramedic/EMT capacity. If I was a medical director I don't think I'd feel great about having someone on my service saying "I'm not going to follow company protocols, because I'm an MD I'm going to do what I want. Even if they are "working under their own license" it increases the companies exposure.
 
I'm not sure if this is true. I had a long talk with the head of the national association of medial directors, and he said the law and rules regarding physicians riding on ambulances is very unclear. One of the big issues is liability for the ambulance service. Just because as a doctor you might feel comfortable doing a C section, the ambulance service doesn't have insurance that covers that kind of procedure. Same goes for other invasive procedures. Furthermore there is the question of if you were to miss something that a paramedic wouldn't be expected to pick up on, could the company be sued because the patient's family could say "that guy wasn't working as a medic, he was a doc."

These issues make many companies reluctant to have docs who aren't their medical director ride in a paramedic/EMT capacity. If I was a medical director I don't think I'd feel great about having someone on my service saying "I'm not going to follow company protocols, because I'm an MD I'm going to do what I want. Even if they are "working under their own license" it increases the companies exposure.

I agree with you. As I said, just because you can legally do something doesn't mean you should. I wasn't saying that if I were on an ambulance I would do anything particularly cavalier. My point was, contrary to what medmack said, a physician isn't legally bound to the same rules as an EMS provider. They are apples and oranges.

That said, yes there are lots of liability issues. The water is very murky there and I have discussed this as well, but that has nothing to do with legal authority. That would be another good topic for discussion though.
 
I agree with you. As I said, just because you can legally do something doesn't mean you should. I wasn't saying that if I were on an ambulance I would do anything particularly cavalier. My point was, contrary to what medmack said, a physician isn't legally bound to the same rules as an EMS provider. They are apples and oranges.

That said, yes there are lots of liability issues. The water is very murky there and I have discussed this as well, but that has nothing to do with legal authority. That would be another good topic for discussion though.

First off, I don't know why an MD/DO would want to ride in a rig as a Paramedic specifically because as an MD/DO their scope of practice is so far beyond that of a Medic. Second, I think I may have worded my original point wrong. Yes, an MD/DO could override Medical Direction, but then they would be assuming complete liability for the patient and any adverse reactions to their interventions. I can't imagine a Medical Director allowing that to continue, it'd be like having an intervener physician on scene for every call that the rescue went on.

Again, I can only speak for the agencies I ride with, and those are ALS Fire Rescue and we don't have MD/DO's riding on our trucks. I asked this question point blank to one of our EMS Captains and he was pretty concise, doctors riding as a Paramedic must function as a Paramedic, not a MD/DO. Again, an MD/DO can try to assume control of the scene and the call, but thats at the discretion of the Medic on the truck unless you're the Medical Director for the EMS agency.

Essentially, unless you assume complete liability for everything that happens on the truck or you are operating as an MD/DO within, or on contract with, the Agency that owns the rig you aren't going to be giving any orders or performing any procedures. This might be different in other places, but this is how it works in the Agencies I have experience with.
 
First off, I don't know why an MD/DO would want to ride in a rig as a Paramedic specifically because as an MD/DO their scope of practice is so far beyond that of a Medic. Second, I think I may have worded my original point wrong. Yes, an MD/DO could override Medical Direction, but then they would be assuming complete liability for the patient and any adverse reactions to their interventions. I can't imagine a Medical Director allowing that to continue, it'd be like having an intervener physician on scene for every call that the rescue went on.

Again, I can only speak for the agencies I ride with, and those are ALS Fire Rescue and we don't have MD/DO's riding on our trucks. I asked this question point blank to one of our EMS Captains and he was pretty concise, doctors riding as a Paramedic must function as a Paramedic, not a MD/DO. Again, an MD/DO can try to assume control of the scene and the call, but thats at the discretion of the Medic on the truck unless you're the Medical Director for the EMS agency.

Essentially, unless you assume complete liability for everything that happens on the truck or you are operating as an MD/DO within, or on contract with, the Agency that owns the rig you aren't going to be giving any orders or performing any procedures. This might be different in other places, but this is how it works in the Agencies I have experience with.

Your EMS captains has no idea on the matter because he is not a DR. We have Docs riding with us because part of the residency training is a month of EMS which includes riding on rigs. Most residents will not do much outside of protocol but the one ER Doc that does go out on the road once and a while does do things outside protocol.. I as a medic go outside protocol once and a while too.. As long as you can justify what you were doing was for the good of the patient...
 
It's important, in this discussion, to be specific about the type of regulation or limitations you're talking about. Some that come to mind here are:
- Criminal law (for example, practicing medicine without a license). As noted above, not an issue here because physicians have unrestricted licenses. For the same reason, EMS scope of practice issues don't really apply.
- Civil law (torts/malpractice). There are issues here about what the standard of care might be for a physician in the prehospital environment.
- (related to #2) insurance carrier regulations or contracts (unless the physician wants to just go without coverage)
- EMS agency regulations. This is probably the most significant one. A question that needs to be addressed, if you're talking about physicians working on ambulances, is how the the doctor get to be there in the first place? Usually you have to be affiliated with an agency in some capacity to be working on their apparatus, so this is all kind of a moot point for most agencies.

I do believe this comes up with volunteer squads sometimes. I know of doctors who do ride, and I've heard of them doing things that are outside of a paramedic's scope, but don't know the details of how this worked.

It is pointless to say that a doctor can or cannot do this or that without addressing why.

All this is off the topic brought up by the OP's ridiculous question, of course.
 
I don't know if all states are the same...but where I live and work:

A paramedic cannot function as a paramedic unless they are working under the license of a doctor(usually the medical director). You can be a fully licensed, nationally registered paramedic but if you don't have a JOB(or sometimes volunteer association) with a Medical Director(doctor) to work under....your license doesn't mean jack ****. It's not like you can take your license and start decompressing chests on the highway. YOU must be operating under a medical director.
If a paramedic IS working under a medical director, the paramedic can do ANYTHING approved by the medical director. If a paramedic is working a trauma code on the side of a highway and another doctor walks up and tries to take over the scene, he must contact the medical director and accept full responsibility of the patient. For some companies(like where I work) that means the doctor must sign a form releasing the paramedics(thus, releasing the medical director) from all responsibility. This means the paramedics are free to move on to the next call and the doctor must find other means to care for the patient.
Paramedics have a license but it is technically an extension of the doctor's license. A paramedic is to function as the ears, eyes and hands of the doctor(medical director) when he is not around. A paramedic gets to do whatever is approved by the medical director and is usually following standing orders from that doctor. If a paramedic screws up but followed protocols...then the monkey falls on the medical director's back. If someone dies because a paramedic deviates from the doc's protocols...the paramedic is responsible.
It has its good parts and bad. We don't get to make much money and constantly need to answer to the doctor about what we have been doing while under his' license but if you just do a good job and don't make stupid mistakes, it can be a damn good time. We get to do many things that nurses(with the exception of ER or ICU nurses) don't get to do. Plus, most of it is pre-authorized so we don't need to chase a doctor around for orders to intubate a patient or push some valium.
 
I don't know if all states are the same...but where I live and work:

A paramedic cannot function as a paramedic unless they are working under the license of a doctor(usually the medical director). You can be a fully licensed, nationally registered paramedic but if you don't have a JOB(or sometimes volunteer association) with a Medical Director(doctor) to work under....your license doesn't mean jack ****. It's not like you can take your license and start decompressing chests on the highway. YOU must be operating under a medical director.
If a paramedic IS working under a medical director, the paramedic can do ANYTHING approved by the medical director. If a paramedic is working a trauma code on the side of a highway and another doctor walks up and tries to take over the scene, he must contact the medical director and accept full responsibility of the patient. For some companies(like where I work) that means the doctor must sign a form releasing the paramedics(thus, releasing the medical director) from all responsibility. This means the paramedics are free to move on to the next call and the doctor must find other means to care for the patient.
Paramedics have a license but it is technically an extension of the doctor's license. A paramedic is to function as the ears, eyes and hands of the doctor(medical director) when he is not around. A paramedic gets to do whatever is approved by the medical director and is usually following standing orders from that doctor. If a paramedic screws up but followed protocols...then the monkey falls on the medical director's back. If someone dies because a paramedic deviates from the doc's protocols...the paramedic is responsible.
It has its good parts and bad. We don't get to make much money and constantly need to answer to the doctor about what we have been doing while under his' license but if you just do a good job and don't make stupid mistakes, it can be a damn good time. We get to do many things that nurses(with the exception of ER or ICU nurses) don't get to do. Plus, most of it is pre-authorized so we don't need to chase a doctor around for orders to intubate a patient or push some valium.

National Registry is a certification not a license. About 45 or so states certify not license paramedics... If your medical director allows another on scene DR to take over care that does not release you from the scene...By your DR giving control to that DR everything falls on his shoulders. You must still follow his orders as long as you don't think they are dangerous..
 
National Registry is a certification not a license. About 45 or so states certify not license paramedics... If your medical director allows another on scene DR to take over care that does not release you from the scene...By your DR giving control to that DR everything falls on his shoulders. You must still follow his orders as long as you don't think they are dangerous..

Actually, I have 2 licenses. One is for Kansas and the other is a Missouri license. After you take the national registry, you submit you information with your national registry to the state and they give you a state Paramedic license.....unless you live somewhere WAY different. I have also had a license in the state of California. My uncle is a doc in Cali and I stayed with him for 2 summers.
As far the doctor passing control from himself to another doc.....we have one form. We carry it in all ambulances. It states that the medical director AND the responding company is to be released from all medical liability for that patient. It was explained to us that this document is actually meant to discourage stray medical professionals from attempting to assume medical control. It is not meant to be an easy process. By the time the medical director could be contacted to hand off the patient...any patient in a TRUE emergency would most likely be dead. From what I have heard, they usually read the form and have a change of heart.
 
Actually, I have 2 licenses. One is for Kansas and the other is a Missouri license. After you take the national registry, you submit you information with your national registry to the state and they give you a state Paramedic license.....unless you live somewhere WAY different. I have also had a license in the state of California. My uncle is a doc in Cali and I stayed with him for 2 summers.
As far the doctor passing control from himself to another doc.....we have one form. We carry it in all ambulances. It states that the medical director AND the responding company is to be released from all medical liability for that patient. It was explained to us that this document is actually meant to discourage stray medical professionals from attempting to assume medical control. It is not meant to be an easy process. By the time the medical director could be contacted to hand off the patient...any patient in a TRUE emergency would most likely be dead. From what I have heard, they usually read the form and have a change of heart.

Florida doesn't license Paramedics, it just certifies them. Florida also maintains its own certification separate from the NREMT, so you can take the NREMT test, but its not going to get you a Florida Certification, you still have to pass the state test.
 
Actually, I have 2 licenses. One is for Kansas and the other is a Missouri license. After you take the national registry, you submit you information with your national registry to the state and they give you a state Paramedic license.....unless you live somewhere WAY different. I have also had a license in the state of California. My uncle is a doc in Cali and I stayed with him for 2 summers.
As far the doctor passing control from himself to another doc.....we have one form. We carry it in all ambulances. It states that the medical director AND the responding company is to be released from all medical liability for that patient. It was explained to us that this document is actually meant to discourage stray medical professionals from attempting to assume medical control. It is not meant to be an easy process. By the time the medical director could be contacted to hand off the patient...any patient in a TRUE emergency would most likely be dead. From what I have heard, they usually read the form and have a change of heart.

From a quick check Kansas does not license paramedics it certifies. But you are right it would take for ever for a on scene DOC to take over care.. http://www.ksbems.org/certification.html
 
Last edited:
From a quick check Kansas does not license paramedics it certifies. But you are right it would take for ever for a on scene DOC to take over care..

They do have a license in Kansas. It's called an MICT license instead of paramedic while in Kansas.
 
They do have a license in Kansas. It's called an MICT license instead of paramedic while in Kansas.

Its still a certification according to the state board of EMS...
 
Its still a certification according to the state board of EMS...

Actually, you are correct. After I read your post, I checked my cards. My Missouri and California say license but my Kansas does only say Medical Intensive Care Transport Certification. My bad. Either way, they all mean the same thing since a paramedic license is only valid when used as an extension of a medical director. Either way, I can't just run over to the next town, while off duty, grab and old lady and start pacing her,lol. I can only do that when working under a doctor.
 
It's important, in this discussion, to be specific about the type of regulation or limitations you're talking about. Some that come to mind here are:
- Criminal law (for example, practicing medicine without a license). As noted above, not an issue here because physicians have unrestricted licenses. For the same reason, EMS scope of practice issues don't really apply.
- Civil law (torts/malpractice). There are issues here about what the standard of care might be for a physician in the prehospital environment.
- (related to #2) insurance carrier regulations or contracts (unless the physician wants to just go without coverage)
- EMS agency regulations. This is probably the most significant one. A question that needs to be addressed, if you're talking about physicians working on ambulances, is how the the doctor get to be there in the first place? Usually you have to be affiliated with an agency in some capacity to be working on their apparatus, so this is all kind of a moot point for most agencies.

I do believe this comes up with volunteer squads sometimes. I know of doctors who do ride, and I've heard of them doing things that are outside of a paramedic's scope, but don't know the details of how this worked.

It is pointless to say that a doctor can or cannot do this or that without addressing why.

All this is off the topic brought up by the OP's ridiculous question, of course.

Absolutely. This is the credited response.

And as far as a nurse thinking she can just walk up to the scene of a car wreck and take over.....this is just funny. I actually had one arrested because she was trying to tell me NOT to intubate an unresponsive pt with a GCS of about 6 and wanted me to just rush them to the hospital. She actually grabbed my kit from my hand(that's when I told the cops to get her away from my scene). What an idiot. Sure, lets just let the patient go a 10-15 minute transport without adequate oxygen just because the nurse thought intubation should only happen in the hospital. They just give us these ACLS cards because they are so purty,lol.
 
a GCS of about 6 and wanted me to just rush them to the hospital. She actually grabbed my kit from my hand(that's when I told the cops to get her away from my scene). What an idiot. Sure, lets just let the patient go a 10-15 minute transport without adequate oxygen just because the nurse thought intubation should only happen in the hospital. They just give us these ACLS cards because they are so purty,lol.
Only because we were discussing this in the other forum, I will ask you why you thought your patient needed to be intubated on scene? The old maxim of GCS < 8 = intubate does not necessarily apply anymore, at least not in a trauma patient in the pre-hospital arena. If the patient was not breathing spontaneously and you were unable to ventilate by mask, that would definitely be an indication to intubate on scene.

Oh, but nevertheless that nurse was a real #$@!$ to try and tell you what to do on scene in that manner.
 
Only because we were discussing this in the other forum, I will ask you why you thought your patient needed to be intubated on scene? The old maxim of GCS < 8 = intubate does not necessarily apply anymore, at least not in a trauma patient in the pre-hospital arena. If the patient was not breathing spontaneously and you were unable to ventilate by mask, that would definitely be an indication to intubate on scene.

Oh, but nevertheless that nurse was a real #$@!$ to try and tell you what to do on scene in that manner.

I only intubate on scene when absolutely necessary. Most of the time, they are NOT breathing spontaneously when I intubate. There have been a few special circumstances...like an 11 year old boy that hung himself...but that was a whole different story. Actually, his trismus was so bad that we just quick-trached him. But Like I said, that was a different situation. I understand the new changes about GCS and intubation. Paramedics are required to stay up-to-date on that stuff and especially me since I teach ACLS. We also intubate people with spontaneous respirations if they have excess blood pooling into the airway(like from a gunshot wound). As long as they are kinda breathing and keep their O2 sats up, we stick to the BVM.
 
I only intubate on scene when absolutely necessary. Most of the time, they are NOT breathing spontaneously when I intubate. There have been a few special circumstances...like an 11 year old boy that hung himself...but that was a whole different story. Actually, his trismus was so bad that we just quick-trached him. But Like I said, that was a different situation. I understand the new changes about GCS and intubation. Paramedics are required to stay up-to-date on that stuff and especially me since I teach ACLS. We also intubate people with spontaneous respirations if they have excess blood pooling into the airway(like from a gunshot wound). As long as they are kinda breathing and keep their O2 sats up, we stick to the BVM.
Goood schei&#223;e, good schei&#223;e. :thumbup: Forgot to mention though that most people seem to recommend now that you don't have to intubate an apneic patient, as long as you are able to ventilate adequately with a bag-valve-mask without too high of peak inspiratory pressures.
 
Last edited:
Good answer. But don't bank on the ACLS teaching thing. You don't even have to be a medic or EMT to teach ACLS....
 
Good answer. But don't bank on the ACLS teaching thing. You don't even have to be a medic or EMT to teach ACLS....

True...but it's a good indicator one might know a little bit about ACLS if they teach it. Just sayin'.
 
True...but it's a good indicator one might know a little bit about ACLS if they teach it. Just sayin'.

Yea but another thing about working around here is if we take a patient to the ER with no gag reflex and crappy breathing.... the docs get PISSED. If it only takes a few seconds and benefits the patient, I would rather do it and keep the docs happy(and not calling my supervisor) than NOT doing it because it isn't required.
 
Yea but another thing about working around here is if we take a patient to the ER with no gag reflex and crappy breathing.... the docs get PISSED. If it only takes a few seconds and benefits the patient, I would rather do it and keep the docs happy(and not calling my supervisor) than NOT doing it because it isn't required.
If that's the case it sounds like the doctors in your area need to be educated on the importance of reducing on-scene times. Maybe refer them to the OPALS study which was finally published about a month ago.
 
If that's the case it sounds like the doctors in your area need to be educated on the importance of reducing on-scene times. Maybe refer them to the OPALS study which was finally published about a month ago.
Our doctors are actually VERY strict about on-scene times. On trauma calls, we don't intubate on scene. We get the patient packaged, put them in the ambulance and do everything else en route. We areexpected to get the patient intubated and everything else(IVs, meds, fluids...and so on) going when we are en route to the hospital. It is quite the juggling act if you consider we are only about 10-15 minutes from the hospital. It is especially hard if it is a code because we bring a couple of firefighters to do chest compressions and BVM while we are pushing meds and talking to the hospital. It is not fun because it gets very crowded in the back of the ambulance....but we get it all done. If we don't, we get chewed out by the docs. Our scene times are usually only a couple of minutes because we do everything en route.
 
Our doctors are actually VERY strict about on-scene times. On trauma calls, we don't intubate on scene. We get the patient packaged, put them in the ambulance and do everything else en route. We areexpected to get the patient intubated and everything else(IVs, meds, fluids...and so on) going when we are en route to the hospital. It is quite the juggling act if you consider we are only about 10-15 minutes from the hospital. It is especially hard if it is a code because we bring a couple of firefighters to do chest compressions and BVM while we are pushing meds and talking to the hospital. It is not fun because it gets very crowded in the back of the ambulance....but we get it all done. If we don't, we get chewed out by the docs. Our scene times are usually only a couple of minutes because we do everything en route.
Ahhh...I see. That's not bad then, intubating en route, although quite challenging with such a short time to the hospital! I know what you mean though, I've brought a multi-stabbing patient into the hospital without even an IV started, because we were literally 2 minutes away and I didn't even have time to cut off his clothes. :laugh:

As for codes though...we definitely stay on scene for a non-traumatic arrest! Do you guys still transport to hospital for that? That is something where you can do everything for the patient on scene, and in fact transporting the patient basically removes any chance they had of survival due to the poor quality of CPR while in the back of an ambo (at least, that's what they tell me ;) )
 
That is something where you can do everything for the patient on scene, and in fact transporting the patient basically removes any chance they had of survival due to the poor quality of CPR while in the back of an ambo (at least, that's what they tell me ;) )
I'd agree with that for asystole, but I would feel pretty uncomfortable calling a patient who was still in Vfib/V tach or a PEA. Especially since PEA can be fixed if you can ID the problem and a lot of those Hs and Ts you can't really deal with in the field (hypothermia, H+, thrombosis, etc)

But if your asystole doesn't come back after intubation, good CPR, and two rounds of drugs I'd say call it. Oh, and there was something I heard awhile back on the predicitve use of capnography after intubation on arrests. Something like if the inital C02 reading was less than 7 or 6 the chances of sucessful revival was 0%. (Can't look for sources now, maybe will dig it up next week)
 
I'd agree with that for asystole, but I would feel pretty uncomfortable calling a patient who was still in Vfib/V tach or a PEA. Especially since PEA can be fixed if you can ID the problem and a lot of those Hs and Ts you can't really deal with in the field (hypothermia, H+, thrombosis, etc)

But if your asystole doesn't come back after intubation, good CPR, and two rounds of drugs I'd say call it. Oh, and there was something I heard awhile back on the predicitve use of capnography after intubation on arrests. Something like if the inital C02 reading was less than 7 or 6 the chances of sucessful revival was 0%. (Can't look for sources now, maybe will dig it up next week)

Interesting...well, our guidelines here are to stay on scene and give it our best shot for 6 cycles/12 minutes. At that point, we call the local MD to ask whether to stay on scene or transport with CPR en route. If you have PEA with an obvious reverseable cause of arrest, then that would of course change things.
 
Ahhh...I see. That's not bad then, intubating en route, although quite challenging with such a short time to the hospital! I know what you mean though, I've brought a multi-stabbing patient into the hospital without even an IV started, because we were literally 2 minutes away and I didn't even have time to cut off his clothes. :laugh:

As for codes though...we definitely stay on scene for a non-traumatic arrest! Do you guys still transport to hospital for that? That is something where you can do everything for the patient on scene, and in fact transporting the patient basically removes any chance they had of survival due to the poor quality of CPR while in the back of an ambo (at least, that's what they tell me ;) )

You are quite right. As far as a non-traumatic code, we don't always transport.
We intubate, medicate and defib.(as needed) and contact medical control. We do all of this on scene. If we are getting any signs of improvement(changes on the monitor)...we transport and continue treatment while en route. If we have maxed out on all doses of the appropriate meds and been working the code for 20 minutes...we contact medical control and they usually tell us to call it on scene. If we transport a patient to the hospital after they have been given the 3 rounds of atropine, epi, intubated, CPR...and so on, with no improvement....they look at us like they want to slap us. They don't like it when when use their rooms and time for dead people.
You get the idea;)
 
You are quite right. As far as a non-traumatic code, we don't always transport.
We intubate, medicate and defib.(as needed) and contact medical control. We do all of this on scene. If we are getting any signs of improvement(changes on the monitor)...we transport and continue treatment while en route. If we have maxed out on all doses of the appropriate meds and been working the code for 20 minutes...we contact medical control and they usually tell us to call it on scene. If we transport a patient to the hospital after they have been given the 3 rounds of atropine, epi, intubated, CPR...and so on, with no improvement....they look at us like they want to slap us. They don't like it when when use their rooms and time for dead people.
You get the idea;)

Yeah, that sounds about right. ;) Here our policy is to actually run a code for a full 30 minutes. After 30 minutes of resuscitation with no ROSC, we will contact the EP for orders to terminate regardless of what the rhythm is or any other circumstances*. No ROSC after that long = you are flogging a dead corpse.

*Errr, notwithstanding hypothermia, pediatric arrests, and a few other scenarios.
 
Yeah, that sounds about right. ;) Here our policy is to actually run a code for a full 30 minutes. After 30 minutes of resuscitation with no ROSC, we will contact the EP for orders to terminate regardless of what the rhythm is or any other circumstances*. No ROSC after that long = you are flogging a dead corpse.

*Errr, notwithstanding hypothermia, pediatric arrests, and a few other scenarios.

Exactly. If there is an unknown down time, like with an unwitnessed arrest(with asystole on the monitor), the doc usually has us call it even sooner.
It sounds like you treat the peds, hypothermias....and so on the same as we do.
 
If you are an EMT and a medical student, can you still transfer care to another EMT?

I'm asking because I often direct respond in a personal vehicle to the scene, then if our ambulance has a full-crew there's no room for me to go. Can I transfer care to an EMT if I'm in the clinical years of medical school? What about in residency? When I am a resident will I be able to do on scene medical command?


Thanks

The second you touch the patient you can only transfer care to your level of care or higher.
 
The second you touch the patient you can only transfer care to your level of care or higher.

Being a medical student is not a "level of care" in any way. Medical students aren't licensed to do anything.

Also, what you wrote is not true in general. If it were, paramedics couldn't turn over BLS calls to BLS providers.
 
Being a medical student is not a "level of care" in any way. Medical students aren't licensed to do anything.

Also, what you wrote is not true in general. If it were, paramedics couldn't turn over BLS calls to BLS providers.
While you are correct, just wait and see what happens when an ALS paramedic hands a "BLS" patient to a BLS crew and that patient later dies in their care. So there is a certain degree of risk involved in that.
 
Being a medical student is not a "level of care" in any way. Medical students aren't licensed to do anything.

Also, what you wrote is not true in general. If it were, paramedics couldn't turn over BLS calls to BLS providers.

For one I assumed that because IT IS an EMS thread my input is directed from an EMS legal side of things. YES by law you are only legally allowed to transfer care from your level-upwards.

Second, I have no idea what country, state you live in but YOU ARE NOT TO EVER transfer a patient to an EMT (if you are a fully registered and licenced paramedic), NEVER. Not done here, never heard of it being allowed anywhere else.
Cheers
 
For one I assumed that because IT IS an EMS thread my input is directed from an EMS legal side of things. YES by law you are only legally allowed to transfer care from your level-upwards.

Second, I have no idea what country, state you live in but YOU ARE NOT TO EVER transfer a patient to an EMT (if you are a fully registered and licenced paramedic), NEVER. Not done here, never heard of it being allowed anywhere else.
Cheers

As it says in the little box below my name, I'm in Richmond, Virginia. Here and in California, paramedics routinely hand off patients to BLS providers if the call can be handled by them. I worked full time for a year as an EMT-B, transporting patients with a private company for the Santa Monica Fire Dept. Most of our calls involved the SMFD paramedics signing patients over to us.

And yes, leviathan is of course correct that there is liability risk if the medic makes the wrong call about whether the patient is BLS or not. That still doesn't make this practice illegal.

Perhaps the rules are different in Canada. In the US, paramedics can hand off patients to EMTs as long as they haven't initiated ALS care.

Also, think about: if you could NEVER give a patient to a lower trained person, how would interfacility transports work?
 
As it says in the little box below my name, I'm in Richmond, Virginia. Here and in California, paramedics routinely hand off patients to BLS providers if the call can be handled by them. I worked full time for a year as an EMT-B, transporting patients with a private company for the Santa Monica Fire Dept. Most of our calls involved the SMFD paramedics signing patients over to us.

And yes, leviathan is of course correct that there is liability risk if the medic makes the wrong call about whether the patient is BLS or not. That still doesn't make this practice illegal.

Perhaps the rules are different in Canada. In the US, paramedics can hand off patients to EMTs as long as they haven't initiated ALS care.

Also, think about: if you could NEVER give a patient to a lower trained person, how would interfacility transports work?

AI can't even bare to imagine an Paramedic ever handing over care to an EMT regardless of of what has already been started. Here you legally obligated to transfer care (as I have posted twice) only to your level or higher.

As for interfacility transfers? a BLS patients stick to BLS crews ;) a simple concept ;)
Done.
 
AI can't even bare to imagine an Paramedic ever handing over care to an EMT regardless of of what has already been started. Here you legally obligated to transfer care (as I have posted twice) only to your level or higher.

As for interfacility transfers? a BLS patients stick to BLS crews ;) a simple concept ;)
Done.

OK, it sounds like the rules are different in Canada. Fair enough.

What I meant about interfacility transports is that by your logic they would have to be done be physicians.

Anyway, this doesn't have much to do with the OP's implication that an EMT who is a medical student is somehow a higher level of care than any other EMT. I hope you'll agree that's absurd.
 
MacBook said:
As for interfacility transfers? a BLS patients stick to BLS crews ;) a simple concept ;)
Done.

So who determines that they are BLS patients? Someone has evaluated that patient, a doctor, and determined that the pt can be cared for by BLS. Same thing happens when a medic evaluates a patient and decides that an EMT can take them.

In the US at least there is a difference between abandoment and appropriately transfering a patient to someone with a lower level of training.
 
It depends. For interfacility the physician requesting the transfer is the one who decided what level of crews he wants. That's an issue you will only in rural areas.
Our province is cared by an EMS system that has 90% ALS crews. There are very few basic life support services. Using your levels of training in the states, if I were an EMT I would not be allowed to pass my patient down to a basic regardless of patient presentation. As a paramedic I cannot and will not hand over my patients to anything less than another paramedic or in hospital staff.
 
Top