Civilians to EMS, transition of care responsibilities...

[mysticlakecasinoemt]

Here's a good one for ya..

I already know that an EMT-B can only hand over care of

a patient to another who is currently certified at that same

EMS level or higher who also has their credentials on hand.

What happens if a civilian claims to be a "nurse" or "doctor"

and does not have proof, and won't leave when you tell them to.

No cops on hand.

What is the law.. Especially in Minnesota?

Could not find anything here at EMT City about Good Samaritan

Law for civilians or anything in search using the terms "transfer of care."

"transition of care." with respect to an EMT-B's legal responsibility in

actual writing or EMS law.

Does anybody know?

[vs-eh?]

I don't know about American law but...

No "real" RN or MD is going to be sticking around or refusing to leave after you have told them to do so when they are a bystandard type role. This is especially if they don't have their credentials on them or you threaten to call the police.

Think to yourself...Why would they risk their license/position because they happened on a "sick" person? They can offer help but if you refuse or ask them to leave that is it.

If they insist on staying/helping then they are probably not who they say they are.

[Ridryder 911]

- 5 points for double post :wink: , it does not matter ALS or BLS the law is the same. If they are a licensed medical physician in that current state, in fact one has to turnover care legally. Most physicians are smart enough to 1) never stop 2) never interfere unless something is going bad... Yes, I check credentials and yes let them talk to medical control.. very few ever make it that far.. they are happy to assist, but do want to get tied up with a case. Again, I inform them they have to ride in and assume ALL responsibility for care...

As a RN etc.. yes, technically I am higher trained than a Basic, Intermediate, etc.. as Paramedic I am as well = trained, but off duty I have no more control or authority to perform a procedure than the waver that flagged you down. Off duty, we are bucked down to 1'st responder level..

R/r 911.

[tnmyers]

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My understanding and I live and work in MN is that on scene you are in charge till you hand over care to someone with the same level training as you or higher. If a MD takes scene then he has to stay with that patient till they arrive at the receiving MD. As for RN they are trained to work in a stable secure environment not out on scene so you still have control of the scene. Most MDs and RNs will ask you what they can do to help. But there are times you will run into some who take scene then remind them that they will have to stay with that patient till they arrive at the hospital. A First Responder has more control in the field then a R.N. does.

I hope this helps.

[PRPGfirerescuetech]

your only as good as the equipment you have with you.

thus...

every bystander is a first responder.

at least in my mind at least....and my mind is such a nice place...

[NREMT-IL]

Perhaps the most important thing to remember is that failure to be certain that you have turned over care to a person of equal or higher medical certification as you constitutes legal abandonment...if you are not going to be absolutely certain to who you are transferring care and not going to take the extra minutes to check credentials so that you are not transferring you patient to a unit clerk or custodian, you may as well leave them sitting on the concrete floor of the hospitals ambulance bay. Because either way you have abandoned your patient and will definately get slapped with a law suit and probably lose your license.

Something interesting that we were taught (USA/IL) is that the patient you are currently caring for takes standing over anything that may come in and "stack up" while you are caring for them. We had an ALS unit in my town literally take the patient into the hospital, draw sheet him into a bed and run out the door to be present at a structure fire. Naughty naughty.

"This is my job. This is not my emergency."

[mysticlakecasinoemt]

[/font:febc42aed8]

My understanding and I live and work in MN is that on scene you are in charge till you hand over care to someone with the same level training as you or higher. A First Responder has more control in the field then a R.N. does.

That's what I thought. The ventilator was this nurse, who was suspect,

because why would a nurse anesthetist need to be coached on when to

breathe for someone during CPR? The compressor when we got there

was a soccer coach. We got a good carotid with his compressions.

What was in question was the fact this "nurse" had no credentials and

didn't step aside once the first responding team, in contact with ALS a

minute away, wanted to put in an oral and take over with an AED. The

soccer coach made tracks instantly and didn't hang around. ALS let the

"nurse" stay just on hearsay, without evidence of certification of anything.

Headaches for our reports and surveillance tape. The woman was

shocked twice and we got a return of viable vital signs. Started

spontaneous breathing en route to the hospital. I needed to know with

this thread, the legal responsibility I have when civilians are already

on a new patient of mine. Major CYA instincts, ya know..

So, kick off civilians rendering aid if they're helping? Or not? Only after

credential proofs? Or not? This is new territory for me. Still waiting to

hear back outcome for this woman. Sixties apparent age.

Hey tnmyers? I'm forty, too.. Where do you work in Minnesota? I'm in a

casino near the Twin Cities. We just did a mock triage last week.

Admin.. sorry about the double posting. I wasn't sure whether or not medics

would read the BLS and vice versa to get my answering advice.

Thanks to all who answer and explain the how-it-is to me.

Patti

[chbare]

Mysticlakecasinoemt, hmmm, bad ju ju to let somebody work a patient on word alone. I am with Ridryder 911 on this one. Check credentials, have that person talk with your medical control, and then document your butt of about how that person took personal responsibility of the patient. (if medical control even agrees to let the person ride) I also agree with Vs-eh?. I cannot understand why somebody would refuse to let the crew take over patient care? What am I going to do with my nursing license? Use it to stuff into a bleeding wound in the hopes that it will stop the blood loss because I do not have all of the gear required to treat somebody in the field? Unfortunately, I have been at the scene of a few accidents and incidents and I am more than happy to let the crew take over unless they specifically ask for my help. In addition, the only time I have ever told anybody I was a nurse was when a person was hit by a van in front of me while out walking. I told a bystander that I was a nurse and borrowed her cell phone to call 911 and call the ER directly and give them an on scene report while I rendered first aid so they could prep the trauma room. As soon as the Paramedic crew arrived, I gave report and got out of their way.

Take care,

chbare.

[Ace844]

"mysticlakecasinoemt,"

Here as an 'ACEP offical policy statement,' which will provide you with some guidelines and information which is pretty much universal to the situation you posted about. I hope this helps,

ACE844

(Direction of Prehospital Care at the Scene of Medical Emergencies

Approved by the ACEP Board of Directors October 1993

Reaffirmed October 2001 by ACEP Board of Directors

Reaffirmed October 1997 by ACEP Board of Directors

(Policy #400153 @ Reaffirmed October 2001))

ACEP believes that the direction of prehospital care at the scene of a medical emergency should be the responsibility of the individual in attendance who is most appropriately trained and knowledgeable in providing prehospital emergency stabilization and transport. The prehospital provider is responsible for management of the patient and acts as an agent of medical direction unless the patient's physician is present (as would occur in a physician's office).

If the private physician is present and assumes responsibility for the patient's care:

The prehospital provider should defer to the orders of the private physician. On-line medical direction, if that capability exists, should be contacted for record keeping purposes. The prehospital provider retains the right to re-establish medical direction with the on-line physician if the prehospital provider believes that the emergency care rendered by the private physician is inconsistent with quality patient care. Prehospital providers shall not comply with orders which exceed their scope of practice. The prehospital provider's responsibility reverts to off-line medical direction (i.e., existing EMS protocols) or on-line medical direction at any time when the private physician is no longer in attendance.

If an intervener physician3 is present and on-line medical direction is not available:

A prehospital provider at an emergency scene should relinquish responsibility for patient management when the intervener physician has:

been properly identified

agreed to assume responsibility and

agreed to document the intervention in a manner acceptable to the local emergency medical services system (EMSS).

When these conditions exist, the prehospital provider should defer to the wishes of the physician on the scene. If the treatment at the emergency scene differs from existing EMS protocols and is contradictory to quality patient care, the prehospital provider retains the right to revert to existing EMS protocols for the continued management of the patient: Prehospital providers shall not comply with orders which exceed their scope of practice. The intervener physician should agree in advance to accompany the patient to the hospital if required or needed. In the event of a mass casualty incident or disaster, however, patient care needs may require the intervener physician to remain at the scene.

If an intervener physician is present and on-line medical direction does exist:

The on-line physician is ultimately responsible. If there is any disagreement between the intervener physician and the on-line physician, the prehospital provider should take orders from the on-line physician and place the intervener physician in contact with the on-line physician. The on-line physician has the option of managing the case entirely, working with the intervener physician, or allowing the intervener physician to assume responsibility. In the event that the intervener physician assumes responsibility, all orders to the prehospital provider should be repeated over the radio for purposes of recording. The intervener physician should document the intervention in a manner acceptable to the local EMSS. The prehospital provider and on-line medical direction may re-establish on-line medical direction if either believes that the emergency care rendered by the intervener physician is contradictory to EMS protocols and quality patient care. The decision of the intervener physician to accompany the patient to the hospital should be made in consultation with the on-line physician. If the intervener physician does not accompany the patient to the hospital, responsibility for the patient reverts to on-line medical direction.

On-line medical direction exists when EMS personnel are in direct communication with a designated physician, as described in the College's position statement on medical control2, who assumes responsibility and gives direction for patient management.

Private physician is a physician who provides evidence of medical licensure in that state, has established a prior physician/patient relationship, wishes to take charge of a medical emergency, and is willing to accompany the patient to the hospital when so requested.

Intervener physician is a physician who provides evidence of medical licensure, has not established a prior physician/patient relationship, wishes to take charge of a medical emergency, and is willing to accompany the patient to the hospital when so requested.

Unsolicited Medical Personnel Volunteering at Disaster Scenes

Approved by the ACEP Board of Directors June 2002

(Policy #400320, Approved June 2002)

The American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) believe an organized approach is needed for the utilization of unsolicited medical personnel who volunteer to respond to disaster scenes or mass casualty incidents. To ensure the efficient, effective, and safe mobilization of such volunteer medical resources, medical command must come under the authority of the medical director for the emergency medical services (EMS) system and the jurisdiction's established incident command system (ICS). This practice will ensure the integration of all medical functions in the area and accountability under the jurisdiction's established (ICS) without hampering authorized and established functioning rescue efforts.

Volunteer medical personnel (eg, physicians, nurses, emergency medical technicians, etc.) should not respond to a disaster scene unless officially requested by the jurisdiction's established ICS. All personnel must understand the authority and resources of local EMS and health care systems, the importance of staffing their facilities as their primary responsibility, and the dangerous conditions associated with on-site operations.

Good Samaritan Status

AEP believes that any person, regardless of prior medical background, that provides emergency medical assistance in good faith to another person be protected from liability resulting from that assistance.

Pre-Hospital Care by Licensed Practitioners Other Than Physicians

AEP believes that licensed practitioners, ie, Physicians Assistants and Registered Nurses, rendering pre-hospital care as an individual citizen (good samaritan), at the scene of an emergency should function to the level of competence of their license using available emergency equipment. Upon arrival of EMS units operating under supervision of an EMS Physician Medical Director a doctor/patient relationship occurs between the Medical Director and the patient. At this time the care of the patient should be transferred from the individual practitioner to the EMS providers. A formal "sign out" of pertinent information concerning the patient's care should be done to allow for continuity of care.

AEP believes that Physician Assistants and Registered Nurses formally responding to pre-hospital emergencies as part of an EMS system, volunteer or paid, must be appropriately trained in pre-hospital care. AEP believes that by using the individuals base licensure, ie, PA-C or RN, and adding an appropriate, abbreviated pre-hospital curriculum, these practitioners can be certified to function safely and beneficially in the pre-hospital setting. This additional curriculum should receive the sponsorship of the P.A. or R.N. licensing agencies with significant input and approval from the State EMS Authority and the State EMS Physician Medical Director. These pre-hospital practitioners should maintain their base licensure via standard means. The pre-hospital certification component should be maintained separately with fixed expiration, requirements for EMS specific CME and recertification mechanism. The certification should not permit function above the State maximum ALS level authorized by the State EMS Physician Medical Director. The certification should require adherence to pre-hospital medical protocols. The individual licensing agency should issue a separate certification card identifying the individual as a pre-hospital provider, ie, Certified Pre-hospital RN, EMS-RN, Pre-hospital PA or EMS-PA or equivalent.

Medical Control on Scene

Pre-hospital care by physicians other than authorized EMS Physicians.

AEP believes that any person, including a physician, that offers pre-hospital assistance in an emergency be encouraged to do so. A physician should use whatever means and equipment available to stabilize the patient pending EMS system intervention. Once EMS units are on scene, under authority of an EMS Physician Medical Director, the physician should "sign out" the patient to the EMS providers. If the physician believes their care is still required, and evidence of medical licensure and identification is produced, the EMS providers should take direction from this physician to the level of their certified ability. Once the patient is stable and an appropriate level of pre-hospital provider is available, the physician may be released from the scene. If the physician performed any procedure or administered any medication above the level permitted in the EMS system, this physician should accompany the patient to a physician staffed medical facility.

Medical Direction of Emergency Medical Services

Pre-hospital medical care is the practice of medicine outside a certified medical facility.

Medical Direction of EMS Systems is a medical specialty best practiced by qualified EMS Physicians, (see AEP Policy Statement "EMS Physician Qualifications").

All pre-hospital/EMS activities must be directed by accountable EMS Physicians on both the state and local level. This includes, administration, system design, unit staffing, training, legislation, communications, QA/CQI and direct patient care.

Individual local jurisdictions, ie, town, city or county level, must have dedicated, accessible In- Field Medical Directors as key members of the local EMS agency in addition to Off-Line Medical Directors. This will; insure continuity and appropriateness of medical care locally; add expert local medical support and response capability; allow for local QA/CQI medical audit; improve relations between the EMS agency, the public and other medical professionals; enrich in-field teaching and foster better working relationships between EMS Physicians and pre-hospital providers.

Physicians should be certified or credentialed as EMS Physicians by the appropriate state medical licensing board. Appropriate pre-hospital identification should be issued, ie, EMS-Physician, EMS- MD, EMS-DO or equivalent.

AIR & SURFACE TRANSPORT NURSES ASSOCIATION (ASTNA) ROLE OF THE REGISTERED NURSE IN THE PREHOSPITAL ENVIRONMENT]

STATEMENT OF PROBLEM

Registered nurses have participated in the prehospital care environment for many years and their role as providers of care during patient transport by air or ground has been well documented. Additionally, registered nurses have a long and effective history of providing education to prehospital care providers throughout the United States. In the absence of specific nursing education or comprehensive practice standards for nurses to work in the prehospital environment, the nursing community often turned to the knowledge base and standards that exist for EMT and Paramedic practice. In many states, the Registered Nurse who chooses to practice in the prehospital environment is required to become a certified EMT or Paramedic. These circumstances have resulted in the following problems:

Many State Emergency Medical Services (EMS) agencies regulate the practice of registered nurses in the prehospital environment.

Registered nurses who practice in the prehospital environment are required by law in some states to function under a prehospital provider credential rather than under a nursing license, which causes both a legal and ethical conflict.

States differ regarding whether prehospital practice by RNs is regulated by the Board of Nursing, the state EMS office, or both, even though nurses are held accountable to their higher care license.

In some states, emergency and transport nurses are not permitted to teach in training programs for prehospital care providers without certification as an Emergency Medical Technician (EMT) or EMT-Paramedic.

JOINT ASSOCIATION POSITIONS

ASTNA believes that qualified nurses practicing in the prehospital environment should not be required to certify as emergency or flight medical technicians, at any level, before assuming a nursing role in the prehospital environment provided that they have obtained the appropriate knowledge and demonstrated skill proficiency unique to the delivery of prehospital care and are not designated as first responders or provide search and rescue. ASTNA endorses the need for special education requirements for nurses practicing in the prehospital environment. Focused education and subsequent maintenance of specifically identified and recognized prehospital knowledge and skills must be a prerequisite for registered nurses who practice in this environment. ASTNA recognizes that EMS personnel possess a specialized body of knowledge and skills. The organizations recognize the need for collaboration and communication with EMS agencies regarding all aspects of the prehospital role.

ASTNA supports the State Boards of Nursing as the regulatory agencies for the profession of nursing. The practice of nursing in the prehospital environment is identified as a specialty area within nursing, thus the State Boards of Nursing are the definitive authority for regulating this specialty practice.

ASTNA seeks recognition by state EMS agencies for registered nurses in the unique position as a provider of emergency are in the prehospital setting.

ASTNA endorses a collaborative role for specifically prepared registered nurses in the delivery of prehospital care.

ASTNA supports the utilization of the National Standard Guidelines for Prehospital Nursing Curriculum as developed by ENA in collaboration with other EMS liaison organizations for the use in the preparation of registered nurses for providing prehospital care. This document would be the foundation from which to start a program of instruction. The curriculum is meat to be a guideline for designing a course to meet the organizational needs (state or local) in conjunction with the medical control and legislative requirements. The manual is not a stand-alone document, but a tool to be used in conjunction with other competency testing programs such as: ACLS, PALS, BTLS, PHTLS, TNCC, ENPC, or TNATC, to assess skills application. This curriculum defines a standardized knowledge base for the practice of nursing in the prehospital environment including validation of cognitive and psychomotor skills. When primary prehospital practice areas will be air medical transport, ASTNA supports the utilization of Critical Care Transport: Principles and Practice, Air Medical Crew National Standard Curriculum, in conjunction with Practice Standards for Flight Nursing as the basis for training and education.

ASTNA believes that it is the role of the registered nurse to deliver prehospital care by initiating the nursing process, which include the following:

Conducting a physical assessment appropriate to the situation including pertinent history of present illness and injury.

Formulating of nursing diagnoses, expected outcomes and a plan of care, which reflects the synthesis, and application of knowledge, assessment data, and available resources. Implementing of prehospital and inter-hospital interventions based upon the nursing diagnoses and patient problems, and patient priorities commensurate with national standards for prehospital practice, emergency/flight nursing, and local standards of medical direction.

Evaluating the efficacy and outcome of nursing and medical interventions throughout the treatment and transfer process with continued reassessment of the patient plan of care based on patient responses and medical direction.

Collaborating and coordinating with other personnel in the prehospital, inter-hospital and intra-hospital settings to facilitate optimum patient care.

Communicating of relevant data to the designated facility.

Delivering accurate and thorough report, both written and verbal, of patient information to the receiving health care team upon delivery of the patient.

ASTNA further believes that registered nurses in the prehospital environment, in addition to the patient care role, have responsibility and accountability for implementing the following roles in relation to prehospital care:

The research role involves describing and investigating phenomena, problems or ideas pertinent to prehospital nursing practice, developing data bases, contributing to the scientific knowledge base for prehospital care, and integrating research findings to affect patient outcomes and assist in the prevention of illness and injury.

The educational role includes participating in the education of patients, the community, and other health care providers. All nurses have a responsibility to acquire and maintain a knowledge and skills commensurate with their scope of practice. Emergency and transport nurses should continue to have a major role in the education and training of prehospital

care providers.

The management role may include aspects of scene control, mass casualty triage and allocation of resources. This role is interdependent and requires collaboration and authorization from the local EMS agency and medical direction authority.

The consultation role involves enhancing the communication between personnel of various agencies and facilities. Nurses must collaborate with others to improve and enhance the care delivered to the patients in the emergency medical system.

The advocacy role involves protecting of patient rights, facilitating patient entry into the EMS system and promoting recovery and wellness to the community at large. The administrative role may include program and personnel administration for continuous quality improvement.

RATIONALE

The practice of nursing the prehospital environment depends on independent judgment, analytical thinking, decision-making, and prioritization. The nurse must also possess advanced assessment and intervention skills in order to recognize subtle or latent patient symptomology and have the ability to initiate care independently and with local medical direction in collaboration with their colleagues under conditions that may make optimal patient care difficult.

Nurses practicing in the prehospital environment are held accountable to a standard of care that is commensurate with their knowledge, education, experience, and licensure.

Emergency and transport nurses have the educational background and experience which prepares them to asses, diagnose, plan, implement and evaluate the care of acutely ill or inured patients and to oversee and monitor the practice of non-RN care givers. This general knowledge is enhanced with experience and education, appropriate to the specialty of prehospital care, in order to participate in the education of prehospital care providers.

REFERENCES

Department of Transportation (1988). Air medical crew national standard curriculum. ASHBEAMS, Pasadena, CA.

Emergency Nurses Association (ENA). National standard guidelines for prehospital nursing curriculum, Chicago, IL: Emergency Nurses Association.

Jaimovich, D.G. & Vidyasagar, D. (1995). Handbook of pediatric & neonatal transport medicine. Hanley & Belfus, Inc.; Phildadelphia PA/Mosby-Yearbook, Inc.; St. Louis, MO.

Johnson, R. & Herron, H. (1993). Regulation of prehospital nursing practice: A national survey. Journal of Emergency Nursing, 19(5), pp. 437-440.

Semonin-Holleran, R. (1996). Flight Nursing: Principles & Practices, St. Louis, MO; Mosby; Third edition in progress.

National Flight Nurses Association (1995). Practice standard for flight nursing, St. Louis, MO; Mosby-Yearbook, Inc.

National Flight Nurses Association (1995). Standards of flight nursing practice, Second Edition, St. Louis, MO; Mosby-Yearbook, Inc.

Semonin-Holleran, Renee (1996). Flight Nursing: Principles & Practices; Second Edition; St. Louis MO; Mosby.

Semonin-Holleran, Renee (1994). Prehospital Nursing, St. Louis, MO; Mosby-Yearbook.

Approved by the ASTNA Board of Directors, December 2001

http://www.mmaonline.net/policycomp/sectio...m?recNum=220.00 ; Minnestota Medical Association; 220.02 Control of Pre-Hospital Care at the Scene of Emergencies]The MMA adopts the following policy on control of pre-hospital care at the scene of emergencies:

In situations where a physician is present at an emergency, several guidelines should apply in determining who should be in charge of managing the patient's care:

1. If the patient's personal physician is present and wishes to assume responsibility for the patient's care, the paramedic should defer to the orders of the personal physician, and so inform the radio control physician.

The personal physician should verify orders by signing the EMS form as soon as time permits. The radio control physician should be contacted enroute if indicated according to local operating procedures. The radio control physician may be contacted from the scene if indicated and the personal physician wishes. The paramedic's responsibility reverts back to the radio control physician (or standing orders per local protocol) at any time when the personal physician is no longer in attendance. However, regardless of whether the personal physician is present enroute, the radio control physician should honor the wishes of the personal physician during the enroute care of the patient, in a manner consistent with standards of patient care.

2. An intervening physician not wishing to assume complete responsibility may elect to assist the paramedics and act as a medical consultant to them and to the radio control physician.

3. When no radio control exists and an intervening physician wishes to assume responsibility for the patient, the paramedics should relinquish responsibility for patient management. The intervening physician must accompany the patient to the hospital. Physicians intervening at an emergency scene should avoid involvement in resuscitation measures that exceed their prior training and experience.

The intervening physician should present identification that includes name, address, degrees, and state license number. He or she should sign appropriate forms assuming responsibility and verifying orders. The paramedics should present the physician with a statement regarding area policies and authority of paramedics and the medical control physician. This should include the role of the physician on the scene as developed by local participating physicians and medical societies.

When these conditions exist, the paramedics should defer to the wishes of the physician on the scene. If the treatment by that physician differs from that outlined by local protocol, the physician should agree in advance to accompany the patient to the hospital. (In the event of a mass casualty incident, patient care needs may require the intervening physician to remain at the scene.)

4. In the case of multiple intervening physicians at the scene (as at an athletic event), the paramedics should request that the physicians designate one physician to direct the patient care. If the medical director of the paramedics or his or her designee is present at the scene, that physician should direct the patient care.

5. Except as noted in #1 (where the patient's personal physician is present), the radio control physician is ultimately responsible. If an intervening physician wishes to assume responsibility for the patient and radio control exists, the intervening physician must accompany the patient to the hospital. The paramedics shall contact the radio control center as they normally would, and allow communication between the two physicians. The exchange of credentials should proceed as noted in #3 above.

If there is any disagreement between the intervening physician and the local protocols or the radio control physician, the paramedics should follow the orders of the radio control physician and place the intervening physician in radio contact with the radio control physician.

The radio control physician has the option of managing the case entirely, working with the intervening physician, or allowing the intervening physician to assume responsibility. In the event that the intervening physician assumes responsibility, all orders to the paramedics should be recorded on the ambulance form and signed by the physician, or repeated over the radio for purposes of recording.

( http://www.revisor.leg.state.mn.us/stats/144E/001.html ; 144E.001 Definitions. Subdivision 1. Scope. For the purposes of sections 144E.001 to 144E.52 @ the terms defined in this section have the

meanings given them.

Subd. 3a. Ambulance service personnel.)

"Ambulance service personnel" means individuals who are authorized by a

licensed ambulance service to provide emergency care for the

ambulance service and are:

(1) EMTs, EMT-Is, or EMT-Ps;

(2) Minnesota registered nurses who are: (i) EMTs, are

currently practicing nursing, and have passed a paramedic

practical skills test, as approved by the board and administered

by a training program approved by the board; (ii) on the roster

of an ambulance service on or before January 1, 2000; or (iii)

after petitioning the board, deemed by the board to have

training and skills equivalent to an EMT, as determined on a

case-by-case basis; or

(3) Minnesota registered physician assistants who are: (i)

EMTs, are currently practicing as physician assistants, and have

passed a paramedic practical skills test, as approved by the

board and administered by a training program approved by the

board; (ii) on the roster of an ambulance service on or before

January 1, 2000; or (iii) after petitioning the board, deemed by

the board to have training and skills equivalent to an EMT, as

determined on a case-by-case basis.

[Ace844]

There are many nurses who are required to be AHA Health care professional level trained at minimum. Also, many of the nurses who work in Critical care and or telemetry, etc.. are required to have their ACLS certs for all that is worth. Next, this nurse ws interefering with your ability to provide adequate patient care to acceptable minimum standards, which YOU ARE REQUIRED TO ENSURE!! You have a variety of options at this point.

1.) IF LE is not on scene request them IMMEDIATELY, and inform them of the situation, if the nurse persists, have her 'arrested' for interfering with an EMT or Medic in the execution of his office. Here, that's a felony. Additionally, if they are not lisceneced to the level they ID themselves as being at and can't 'prove' such, then have them brought up and or add, 'IMPERSONATING AN EMT, PD OR FF' also a felony charge here.

2.) Request the individual show identification, and if they don't have it, ask for their 'personal info, and liscence numbers and Document all of the preceeding. Also, you can ask them to 'relinquish care to you, if they refuse or are unable to provide any of the aforementioned...FOLLOW #1

3.) NO MATTER WHAT DOCUMENT, DOCUMENT, DOCUMENT ALL EVENTS AND CYA!!

4.) After getting this individuals information report them to the nursing practice board for misconduct, etc... and let their peers look into this and make a decision.

Sounds like he was the only bystander 'with a clue!!' ATTA BOY for HIM!!!