Paramedic function in ER in Florida

They can't do as much as they can in the field in a hospital setting. They can start IVs EKG foleys. I know they can do much more in the field. But ask the ER director for info on what u can do. Or HR for policy and procedures for the medic

The issue we ran into is the fact that we currently do not have a job description for them. At the present time they are able to do PCT functions as well as triage and start lines. The biggest thing that the medics would like to do include intubation, med administration, and take orders. I didn't know, however, if there was a state policy that prohibited them from doing things like this. I know the nurse practice act has a lot of wording about nursing process, judgements, etc. It's just hard to make sense of who it would apply to!

And again I don't want anyone to think I am trying to reopen the argument of us versus them.... I hate to hear one group talk about another, especially when we are all impoetant

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Thanks for your reply!

Florida EMS statutes are pretty specific in their definition of "PRE-HOSPITAL" which defines the Paramedic scope of practice only for that area with recently defined amendments for interfacility. Since there is no definition, the Paramedic would be nursing services since they do not have the ability to charge for advanced services performed within the hospital. Since they would be under the supervision of the RN, the BON might then state what can be delegated to a tech in the ER or anywhere in the hospital. I also believe it was Florida which had a couple of significant incidents where Paramedics were placed in triage.

http://www.doh.state.fl.us/demo/ems/RulesStatutes/RulesPDFS/CHAPTER401July12009.pdf

This is in line with the old statute which states an RN must be an EMT or Paramedic or accompanied by one to ride on an ambulance (air or ground) except for Specialty transport even though they will function under the BON and their RN license.

Thanks for posting the link!

We have a few medics in our ED right now and their primary function is to assist with triaging and starting IV lines. A few of them are now asking to be able to provide more advanced services, such as intubation, meds, etc. The concern was the since this would be taking place in an actual hospital, that it was a "nursing" function where you must hold a nursing license to do it. I was not sure if it was up to each individual facility to determine what the paramedic scope would be when in the ED, or if there was already a compiled statement from either DOH or BON that layed out the specifics.

Again, thank you all for your help! I appreciate it!!

Thanks for posting the link!

We have a few medics in our ED right now and their primary function is to assist with triaging and starting IV lines. A few of them are now asking to be able to provide more advanced services, such as intubation, meds, etc. The concern was the since this would be taking place in an actual hospital, that it was a "nursing" function where you must hold a nursing license to do it. I was not sure if it was up to each individual facility to determine what the paramedic scope would be when in the ED, or if there was already a compiled statement from either DOH or BON that layed out the specifics.

Again, thank you all for your help! I appreciate it!!

Get away from the notion that nursing is holding Paramedics back. That is just another ******* match used by those who do not understand JCAHO, CMS and licensing. The State EMS administration wrote EMS statutes and made them very specific. If anything EMS held nurses back from Flight and EMS as well as establishing the PHRN in that state in an attempt to override the existing statute.

Education is also another thing holding EMS back. Reading through those statutes only 110 hours is required for EMT and a mere 700 for Paramedic. Even the PCTs in that state have 700 hours and some CNAs have 2 semesters of college. So essentially in Florida as in many other states, the skills training is there but not the education for EMS providers. But, this was not any different than all the other professionals such as Respiratory, Radiology, EEG and CVTs, all of which had been tech school certs at one time but are now degreed professionals recognized by CMS. CMS, the hospitals and all the other professions realized the importance of an education and not just tech skills to perform advanced skills and education to patients. EMS still has not grasped that probably due to the short time with a patient and the destination is to a hospital. It would be a slap in the face for all the professionals who advanced their education to perform advanced skills if a tech was to replace them and forgo all reimbursement. Look at the states and EMS agencies which have used EMT-I and EMT-Bs to do advanced skills. TX and Ohio allowed EMT-Bs to do ETI. No Paramedics needed. The lesser trained and educated were good enough. Some Paramedics have an opinion about that also

But, there have been changes for EMS in Florida which made national headlines a few years ago for some specialty interfacility transports in an attempt to get away from the warm body with a patch mentality and to give quality care to neonates and pediatrics during transport.

Nurses can NOT charge for many skills which they do. MDs, NPs, PAs and RTs can charge for ABGs draws, A-line placement and intubation. RTs can also charge for nebulizers and asthma education while an RN can not. But, with the cutbacks in reimbursement, it is sometimes not worth it to put someone who has the degree education and certifications in those specialties in the ER. It is easier to put a cheaper tech who can do the same things under the supervision of nurses and the hospital does not feel as bad about eating some of the costs by not being able to bill. They can then free up those who can bill for the what is still reimbursed. You also have to remember that Paramedics in Florida, as in many other states, are protected by various immunity laws. You are NOT in a hospital. Even the big money lawsuits in Florida concerning EMS hit the companies but not the individual for monetary settlements. The municipal and county agencies are also protected by immunity caps. If you want to see some frightening things look up some of the harsh penalties for other professions who have messed up in some way and which would probably be taken very lightly had they been in the EMS world as Paramedics.