RN/firefighter policies and procedures

i'll try to keep this short. i am an rn who works in the emergency department. i am also a volunteer firefighter. while we don't run medical calls our district is along a very busy interstate and we run many many mva's. what can/can't i do without a medical director over the fire department? can i do anything? basically all the local ambulance company ever asks me to do is start iv's, assist with spinal immobilization, bag patients, splint fractures, and the like... the two that worry me are iv initiation and splinting. i am very capable of both tasks and the ambulance company always asks for my help (it's a small area and the medics know me well from the er). i don't mind helping them out but don't want to go out of my scope. with that said, what if a local doctor wrote standing orders and we had policies and procedures for me to do basic things like saline locks and place oral or nasal airways? thanks for the help.
Check with the governing agency over EMS in your state in Texas it is the Dept. of Health. there is a medical director over the EMS area of the health department and each service/ area has their own medical controll,(MD/DO). As far as what you can do in the hospital that will depend on the hospital and your level of training as far as what you can do outside of the hospital I would check with your states board of nursing, you may want to look into becoming an EMT or paramedic in addition to your RN license.if you are wanting to function outside of the hospital setting. I was a flight nurse for many years and maintained paramedic status as well as being an RN. Hope this helps.

Quote from errn324i'll try to keep this short. i am an rn who works in the emergency department. i am also a volunteer firefighter. while we don't run medical calls our district is along a very busy interstate and we run many many mva's. what can/can't i do without a medical director over the fire department? can i do anything? basically all the local ambulance company ever asks me to do is start iv's, assist with spinal immobilization, bag patients, splint fractures, and the like... the two that worry me are iv initiation and splinting. i am very capable of both tasks and the ambulance company always asks for my help (it's a small area and the medics know me well from the er). i don't mind helping them out but don't want to go out of my scope. with that said, what if a local doctor wrote standing orders and we had policies and procedures for me to do basic things like saline locks and place oral or nasal airways? thanks for the help.

Unless/until you have a medical director authorizing all of that (perhaps the EMS service's that you operate with) I'd stick to BLS, first responder-type operations. You're covered with spinal immobilization. As a medic, I've directed bystanders to assist me with that before, and we're taught to do so if necessary. I know we all think it's reasonable and prudent to help when/where necessary, but that's not the case. As an officer, I've been on scene and helped medics with BLS, spiked IV bags, etc, but I don't/won't perform ALS skills. I've actually directed what appeared to be an incompetent medic before on what he needed to do, and he did it, lol. Was that prudent? Probably not. I remember back when I was in medic school, and often third riding with the local EMS, there was a S-10 pickup v. huge tree collision. Tree won. Middle passenger in the bench seat of the truck experienced bilateral femur fractures, fractured pevils, and I think some vertebral lumbar fractures. I think he actually died in the hospital, but at any rate, during a prolonged extrication I was there because I heard the collision at my house, plus I knew the VFD I was on would get paged so I was actually the first responder other than the person whose yard the tree was in. This won't be grammatically correct, but...I recall me, another basic EMT who happend to show up in addition to the ambulance service, a reserve deputy who was a medical technologist, and both members of the EMS crew trying to find veins on the guy. Adult IOs weren't in practice at the time. He'd lost enough internal blood that his veins were too small to find. Interestingly, it was the reserve deputy / MT that found a tiny little vein, and we all got access through there. Was he out of his scope? Yep. Did he do any harm? Nope. Could the guy's family have sued him, the sheriff, the medic, the ambulance service, the county, etc? Probably, lol.

My understanding is that everything you mentioned is out of your scope in the field. Unless your board of nursing says otherwise. Where I'm at, the BON has a position statement regarding RNs working transport. Basically you fall under the rules set by the office of EMS, which require you to have a medical director. And chances are, if you had a medical director, it would be the one over the EMS agencies or first responders. And that medical director would probably either require you to obtain your EMT cert or limit you to practice at the level of EMT or medical responder. Not to metion that nursing school doesn't teach how to properly splint or spinal a patient. I know it's easy, but you never received proper instruction on it. And the way my nurse practice act is written, requires the nurse to have proper education or it's put of their nursing scope of practice.

Quote from NickRN/EMTNot to metion that nursing school doesn't teach how to properly splint or spinal a patient. I know it's easy, but you never received proper instruction on it. And the way my nurse practice act is written, requires the nurse to have proper education or it's put of their nursing scope of practice.

We had several RNs riding as EMTs (basic) on our ambulance. There were only allowed to perform tasks as an EMT. As others have mentioned, check with your state protocols for EMS.

RN's work on the doctors orders in the hospital. EMS has a physician medical director with standing orders and radio contact with a doctor. These orders are ONLY for appropriately licensed EMS personel. You're operating without physicians orders in the field and are on your own. I've done ER-RN and volunteer Basic EMT and this was always an issue. That said, I'd rather face a jury having done what's best for my patient, than for withholding skills allowed in the ER but not as a Basic EMT. I'd brake protocol to save a life anytime, but it's entirely my own liability.

Quote from GreyGullNick, I would hope that you don't believe just having the title of RN behind one's name makes one incapable of learning how to splint or spinal(?) a patient. A nurse (and CNAs, PCTs, PTs, OTs and RTs) working in an ED, ICU or many other areas of the hospital would be able to learn the proper technique and probably would be required to know such things. I couldn't imagine having ortho, surgical or trauma patients without getting some of these basics while working in those areas. Education doesn't stop with the diploma. These are not skills limited only to EMS and some in EMS would be amazed by what type of patients and their spinal accessories RNs do work with, most of which EMTs or Paramedics will never see.

Quote from NickRN/EMTI think you missed the point of my earlier statement. What I was trying to say, is that my practice act states that the RN must have proper education, and show proficiency. Nursing school doesn't teach those skills. As I said before, I know these are very easy skills to learn. What I meant by the proper education is that without some type of proof that they learned those skills and showed proficiency, one could say they are out of their scope. Something as small as someone showing them, and then watching and getting "checked off" would probably work. I never meant that an RN couldn't learn to do it. I'm sure that OTs and PTs could learn it as well. I don't think that UAPs like CNAs and PCTs would be able to though, considering it requires ongoing assessment, planning, and implementation. And it can require modification for each patient. This would go against every "rule" of delegation. At least that is my opinion.

Quote from GreyGullIf we were to use your logic, Paramedics would also be at a great disadvantage since ETCO2 and 12-Lead ECGs are not part of many Paramedic programs. Also, if someone was trained by the 2000 AHA ACLS standards, how would you expect them to function with the 2005 guidelines? How on earth can Paramedics ever be expected to do such things since they didn't learn them in school? I am finding a lot of good information in other threads and some good links. Here is one from the emergency section about ENA and ASTNA's position on prehospital RNs.http://www.astna.org/PDF/HOSPENV.pdfAlso, the EMT-B class is essentially a "check off" of skills with very little education since 110 hours of training is not very much time.

Quote from NickRN/EMTGreyGull, I'm sorry if you took my last reply or this one as an argument. I'm only trying to have a professional conversation.

12 Lead is still relatively new to EMS. I got into EMS in 2001, and 12 lead didn't come about here until 2005-06. I think 50% is an incredible number. Also, emergency medical technicians aren't meant to have a large scope of knowledge. They're technicians. Procedures and algorithmic approaches to patient care serve that level of education / training well. So many people want to "advance" EMS these days and make it some type of primary care organization which is ridiculous. Remember the "profession" was devised due to automobile collisions (emergencies), and rather than just scooping the bodies up off the pavement EMTs were given a basic set of skills to prolong their lives until they could get them to definitive care. Now we "stabilize." Later heart attacks (more emergencies) came in as being the leading cause of death so it was time for EMTs (now paramedics) to learn to do something about that as well. Ever seen the tv show Emergency? Squad 51! Paramedics were new at the time. The show took two rescue technicians / firefighters and put them through a hospital-based course of training that lasted all of like three weeks, lol. I think it's phenomenal that it takes about two years now to become a paramedic. I think all in all they're doing a good job. I wish all the people going to community college, etc to become paramedics would get at least an associate's degree out of the deal with courses in A&P and so forth. I favor educational classes too like English, social sciences, and others like those. More "understanding" would be great, but EMS doesn't pay enough to keep people that crave more understanding and education. The activists for the profession are a rare breed, and the people like you seen on here from EMS were those that craved more understanding (and possibly a change of atmosphere) so they studied more, got another degree out of it, and ended up with a job that paid more. DOT establishes curricular guidelines for EMS, and I wish they were much more uniform.