EMT-B in Doctors offices

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Hi! I'm a RN in a rural community in Colorado. One of the dotors offices here takes advantage of "Rule 800" of the Board of Medical Examiners specifications on deligation of medical acts in a private physicians office. Has anyone heard of this? Basicly it says that a physician can have an EMT-B with only 6 weeks of "medical training" (or anyone else who dose'nt have there own licenses) do anything the physician tells him to. I pulled the rule out myself and read it. It says that the physician can delegate any task they deem reasonable. It says that the physican should ensure the EMTs competance but there is no way provided to monitor these providers.

The reason I am bringing this up is that I have seen EMT - B in this office give 10 times the dose of MS that was ordered because she didn't know the difference between mg and ml. I have seen another basic give an overdose of the same drug becasue the doctor handed her a full one cc syringe of MS 15mg/1 cc with the order to give 2 mg and so the EMT pushed the syringe down to the number 2. That same EMT tried to hang a "valium drip" but I caught that one before she did it.

This doctor has his EMT-Bs read his x-rays over the phone to him and then tells them what to do to the patient. Now I am pretty sure they don't teach EMT-Bs how to read x-rays in a 6 week EMT class. They also do sutures when he is not there and who knows what else. The kicker is that this doctor has been turned in to the board and they didn't do anything but give him a copy of Rule 800.

I have never thought of myself as an activist but I am very concerned about this practice and this rule. I contacted the Board of Medical Examiners and they said that there has to be enough evidence to stand up in court or they can't do anything which I guess makes sense. Unfortunatly, it is easy to control your documentation when you have non-professionals working in your office. This particular doctor for example documented that the correct doses of medications were given and that he in fact gave them. I was there. I know it isn't true but I can't prove it.

I'm writting this is to see if anyone else has an issue with this "rule 800". I am sure this doctors office is not the only one that abuses this power. It seems to me that this rule should be far more limiting and specific as to the acts EMTs or other non-professional can do. Pluse shouldn't there be a method to monitor the situation to protect the public from unethical physicians like the one I told you about? He specificly doesn't allow his Employees to identify themselves as EMT's unless the patient specificly asks.

I'm attaching this URL - I hope it works so if your interested your can read it yourself. If it does'nt work let me know and I'll tell you how to find it.

I would appreciate any comments on this.

http://www.google.com/custom?q=cache:hh_paNnwf5AJ:www.dora.state.co.us/medical/Rule800.htm+%C2%A7+12-36-106(3)(l),+C.R.S.&hl=en&ie=UTF-8

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The link didn't work for me.

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scary stuff...omg....:eek:

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I would not want to be the RN working in a clinic with this stuff going on. Do you want to change things there and do you have any chance of succeeding? You could try a heart to heart with the clinic owner and/or doc if you felt so inclined...but sounds like they're comfortable with the situation...

To be honest I would leave and notify all applicable health depts and boards for an inquiry while running out the door. Good luck...doesn't sound like a good situation for a nurse to be involved in. :o

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Prior to becoming an LPN, I had my EMT-B license. After several months on the back of an ambulance, I hired into a hospital in the ER. My stay at this hospital was short for they expected me to work well beyond my scope of practise. There were several EMT Basics already employeed in the ER and they were comfortable with doing this and encouraged me to just follow suit, if I remeber correctly it was said "either swim or sink". Sorry, I just was not comfortable, so I bowed our gracefully. If I can't legally sign I did something, then I don't do it.

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tRY THIS LINK AND WHEN YOU GET THERE CLICK ON CACHE TO VIEW THE WHOLE THING.

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I DONT' WORK IN THE SAME OFFICE THAT USES THE EMTS LIKE THIS. I AM ALSO AN EMT ON THE LOCAL AMBULANCE SO THE THINGS I DESCRIBED ARE THINGS I HAVE SEEN WHEN PICKING UP PATIENTS TO TAKE TO THE HOSPITAL. THIS DOCTOR DOES NOT HIRE REAL RNS. MY THOUGHT IS THAT HE DOES THAT ON PURPOSE BECAUSE A REAL NURSE WOULD SEE ALL THE THINGS HE DOES IN HIS CLINIC AND HE WOULD GET IN A LOT OF TROUBLE. THE DOCTOR IN QUESTION IS AN ORTHOPEDIC SURGEON YET ADVERTISES PRIMARY AND EMERGENCY CARE. WE ARE AT A SKI RESORT SO HE SEES A LOT OF SERIOUS EMERGENCIES. SOMETIMES HE IS NOT EVEN IN THE OFFICE WHEN HE DELEGATES ACTS TO HIS EMT.

MIND YOU I CAN SEE A GOOD USE IN THE DOCTORS OFFICE FOR EMTS. I WORK WITH THEM IN MY CLINIC BUT THEY MOSTLY PERFORM WITH IN THE SCOPE OF THERE PRACTICE EXCEPT FOR A FEW NON-INVASIVE THINGS SUCH AS PEAK FLOW READINGS AND NEB TREATMENTS. FOR ALL OF THESE THINGS THEY HAVE BEEN WELL EDUCATED IN HOW TO PERFORM THE PROCEDURE. I HAVE THEM WRITE A SHORT PAPER ON ALBUTEROL AND WHEN WHY AND HOW TO USE THE NEB. PLUSE THEY ARE OBSERVED PERFORMING THE TASK TEN TIMES CORRECTLY AND ONLY WHEN THE NURSES FEEL COMFORTABLE THAT THEY KNOW WHAT THEY ARE DOING ARE THEY ALLOWED TO DO IT ON THERE OWN. ALLOWING THEM TO HELP OUT IN THIS WAY FREES THE NURSE UP FOR PATIENT EDUCATION AND PROCEDURES THAT ONLY THE NURSE SHOULD DO.

IT SEEMS TO ME THAT IF ENOUGH NURSES WERE CONCERNED ABOUT THIS WE COULD DO SOMETHING ABOUT IT. i JUST DON'T KNOW HOW TO GO ABOUT INITIATING SOMETHING LIKE THIS.

OTHER LOCAL DOCTORS HAVE TRIED TO TURN THIS GUY IN AND NOTHING HAPPENS BECAUSE NO ONE CAN PROVE ANYTHING. ALSO I AM SURE THERE ARE OTHER OFFICES THAT ABUSE RULE 800. SO IT SEEMS LOGICAL THAT WE NEED TO CHANGE THE RULE IN GENERAL AND NOT GO AFTER INDIVIDUAL DOCTORS. THERE IS NO PROVISION FOR MONITORING DOCTORS OFFICES THAT USE EMTS OR ANY OTHER UNLICENSED PERSON. THEY ARE SUPPOSE TO KEEP DOCUMENTATION OF THE EDUCATION AND COMPETANCY OF THESE PEOPLE BUT NO ONE CHECKS TO SEE IF THEY HAVE DONE IT. I THINK THE RULE SHOULD GIVE A SPECIFIC LIST OF ACTS ALLOWED FOR NON-PROFESSIONAL IN A DOCTORS OFFICE JUST AS RULE 500 LIST ACTS ALLOWED FOR THE PREHOSPITAL SETTING (PREHOSPITAL SETTING IS THE AMBULANCE).

BUT I GUESS EVERYONE NEEDS TO READ THE RULE THEMSELVES. TRY THIS LINK AND THEN CLICK ON CACHE. ON JUST GO TO THE COLORADO BOARD OF MEDICAL EXAMINERS. SEARCH IN THERE SITE FOR RULE 800. I FOUND I HAD TO GO TO CACHE TO READ THE WHOLE THING.

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I am a full time EMT-Intermediate allowed to administer:

O2, glucose, glucagon, lasix, dextrose, epi, lidocaine, nitro, asa, albuterol, benadryl, narcan, among others.

The course is a one and half year program.

I do NOT appreciate being called a "non-professional"

:(

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http://www.dora.state.co.us/medical/Rule800.htm.

OOPS I GUESS I DIDN'T ADD THE LINK. I HAD AN AMBULANCE CALL IN THE MIDDLE OF THE NIGHT AND WAS UP MOST OF THE NIGHT. SORRY!!

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I APPOLOGIZE FOR THE "NON-PROFESSIONAL" THING. I USED THAT TERM BECAUSE THE BME USES IT. I THINK THEY REFER TO NON-LICENSED PEOPLE LIKE THAT. EMT'S ARE NOT "LICENSED THEY ARE CERTIFIED. THERE IS A DIFFERENCE. I HAVE NEVER HEARD OF AN EMT-I COURSE THAT LAST A YEAR AND A HALF. HOW MANY ACTUAL HOURS IS THAT. HERE THEY GO FOR 6 WEEKS BUT GO 3-4 DAYS/WEEK FOR 4 HOUR CLASSES. THE "I" CLASS LAST ABOUT 6 MONTHS. I HAVE A LOT OF RESPECT FOR EMT'S AT ANY LEVEL - I WORK WITH THEM ON A DAILY BASIS AND MY HUSBAND IS AN "I" GOING FOR PARAMEDIC SCHOOL. NONE THE LESS YOU ARE NOT A LICENSED NURSE OR PHYSICAN OR PA OR SO FORTH. YOU ARE EDUCATED TO DO SPECIFIC THINGS IN A SPECIFIC ENVIRONMENT. YOU NOR I SHOULD FUNCTION OUTSIDE THE SCOPE OF OUR PRACTICE - AT LEAST NOT AS MUCH AS THE EMT'S IN THE CLINIC I HAVE DICUSSED.

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Originally posted by nurse62

Prior to becoming an LPN, I had my EMT-B license. After several months on the back of an ambulance, I hired into a hospital in the ER. My stay at this hospital was short for they expected me to work well beyond my scope of practise. There were several EMT Basics already employeed in the ER and they were comfortable with doing this and encouraged me to just follow suit, if I remeber correctly it was said "either swim or sink". Sorry, I just was not comfortable, so I bowed our gracefully. If I can't legally sign I did something, then I don't do it.

I GIVE YOU A LOT OF CREDIT. THE EMT'S IN THIS OFFICE ARE VERY FRESH. I'M NOT SURE THEY KNOW ENOUGH TO KNOW THEY DON'T KNOW ENOUGH TO DO THE THINGS THEY ARE DOING.

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I must apologize for being offended so easily. I am having a hard time adjusting to nursing school after being an EMT for so long. We go to so many nursing homes and clinics where the RNs can't administer any meds because they don't have an order and so we do it in the ambulance and the pt is discharged from ER before my report is done.

I agree with not practicing outside your scope of practice and the EMTs you are talking about could be in a lot of trouble. It seems that the laws in Colorado and Illinois are very different. Do you have an EMS Coordinator? They should be advised.

My card reads "EMT-Intermediate License", and I have seen the state pull it from someone for much less than those you have mentioned.

:)

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