Camp Nursing RN with EMT

[Bear92, BSN, PhD, RN]

Hi Fellow Nurses. I am filling in as a volunteer Camp Nurse at a Jr High Camp next week in the State of Wisconsin. I am an RN (BSN with PhD in Counseling). The other "nurse" is actually an EMT (The camp is calling the EMT a "nurse"). Having an EMT as co-worker is wonderful for emergent situations. I have a couple of questions concerning delegation of responsibilities. Is an EMT allowed to distribute medications? To what extent am I responsible for his/her actions? I will of course foster a good working relationship. I am just appropriately concerned over license and liability issues.

Thank you in advance for your thoughts.

[RNtoFNP20yrs]

I guess it would vary by state! I would see what your state's Nurse Practice act says.

[Purple_roses]

It's too bad they aren't calling the EMT an EMT. Telling people you have two nurses is fine and dandy, but telling people you have both a nurse AND an EMT--I mean that combo is a perfect fit for so many situations that could happen. It's like you've got the perfect squad there.

[Wuzzie]

Is the other person an EMT-B or a Paramedic? An EMT-B is generally limited to only a few medications (albuterol, epi-pen, Nitro and ASA) and only in emergency settings. This may vary state to state. If they are a medic it gets a little murkier as their scope of practice is usually dictated by their medical director. Again this may vary depending on the state. Where I live they cannot administer routine meds in the setting you describe. A nurse is required. However, having an EMT is a wonderful asset as they are trained to a greater extent than nurses to care for the types of injuries you may see in a camping environment. Sounds like a really smart set-up utilizing the training of different yet complimentary health care providers.

[HarleyGrandma, RN, EMT-B]

I have one year left of nursing school, and have spent my summer break in an EMT class (16 weeks). Like the BON for nursing, the state EMS counsel (and then local jurisdication) governs what an EMT scope of practice can include. To protect your license I would want written, detailed protocols, etc. The previous posters listed the main medications that an EMT-B can administer, but those are given under the protocols of the EMS (and we try to call the ED for verification before giving for CYA). EMT-I can give a few more, and then EMT-P can give a ton more (if they have a med box at the camp?).

Calling the EMT anything other than an EMT is lazy by the camp and does a disservice to you both. What a great opportunity that could be to explain to the campers what a nurse does, what an EMT does, what you have in common, what is different.

I know I have a much deeper appreciation for the unique training of EMS providers now! :-)

[emergenceRN17, ASN, BSN, RN]

Is this person an EMT-B or an EMT-P? Vast differences in what they do

[Alex Egan, LPN, EMT-B]

So this is a copy and paste job from a similar question. It is also geared twards the state of Pennsylvania.

My understanding of paramedic use in camp is that there are two approaches. The first and most common is to just consider them UAPs (unlicensed assistive personnel). As UAPs any nursing task can be

delegated to them as directed by the nurse practice act. As a general rule, there is some level of supervision required in delegation, and a pretty universal tenet of nurse practice acts is that nursing judgment, and assessment cannot be delegated. In this model, the meds wouldn't be an issue because you would delegate the routine meds to the medic, who has adequate training to safely deliver them. The issue is with PRN meds and sick call. Any PRN med that doesn't have specific parameters requires an assessment to determine need and then another for effectiveness. I think this is where the issue really lies in using medics as primary providers. An RN cannot delegate the assessment portion, so they cannot (to my understanding) independently handle a sick call. Even a sore throat requires assessment and nursing judgment to decide to treat with PRN OTCs or see the MD.

Now some camps have language on their parental permission forms that allows staff to give over the counter medications that the parents authorize, this can be a work around for administering PRN medications, as the parents authorize basically anyone with a pulse, and the directors permission, to give medications. The nuts and bolts of this and the liability ramifications are beyond my knowledge and would require a lawyer and insurance agent to even consider.

The other model is what's called a closed medical system. This is the system that allows medics and athletic trainers to function with extreme autonomy on sports teams and such. Basically, a physician

establishes practice and protocols and delegates authority directly to the provider. This is how a medical assistant with no license can give you injections and other interventions, they are considered an

extension of the physician. The issue here is the doctor who is in charge is assuming all risk and liability for the person they delegate to.

Paramedics generally function on a similar, but better established medical model where they have strict protocols from the state, and to provide ALS skills they need the blessing of a medical command physician (MCP). The MCP is responsible for supervising, QA, and assure the competency of the medics they supervise. In some services, the MCP will set up additional protocols for their medics to follow in addition to a state protocol thus setting up a closed medical system where the medics under that particular doctor can do skill over and above the state regulations. This is, to my understanding, what's happening with community paramedicine, where medics are visiting chronic system users and assessing them routinely to try and prevent 911 use for what is a non-emergency medical issue, or could be handled in a non-emergency fashion. Admittedly I am not as up on community paramedicine programs, as they are fairly new, and are not in my part of the state yet. However, they may be a good bridge for camp use eventually as they set the precedent for paramedic use in a none emergency setting, but to my understanding, there are no state protocols for community paramedicine at this time in PA.

As far as who can supervise health services on camp, that is an interesting question. It depends on who you ask. The state of PA is very silent on camps and healthcare, all the regulations that I can find are really related to facilities and sanitation. See PA code chapter 19 on organized camps and campgrounds. This is how boy scouts and other organizations get away with using EMTs and "health officers" they basically find someone who is willing to do the job, in the case of EMTs they are ignorant of their own practice restrictions, and then set them loose. The state does have extensive regulations on residential care and facilities in state code 3800, but most camps are

exempt from these regulations because they are in operation for less than 90 days.

The Amercian Camp Association, however, is pretty clear they want under the following health standards.

HW.1 Health Care Provider: Resident camp must have a licensed physician or registered nurse on site daily. Day camp may have prearranged phone access.

*HW.2 First Aid and Emergency Care Personnel: A staff member with training in the appropriate level of first aid and CPR must be on duty at all times in camp and on camp trips.

HW.4 Staff Training: Staff must be trained in role/responsibilities in health care.

HW.11 HealthCare Policies: Written policies must include scope and limits of services provided and authority/responsibilities of camp staff, and supplies, emergency health care assistance, etc.

HW.12 Treatment Procedures: Health care staff must follow written treatment procedures for reasonably anticipated injury/illness

Of course, these standards only matter if the camp is accredited.

I hope this helps.

Alex