Re: Paramedic procedures and charting

[Laurie Romig <laurieromig@yahoo.com>]

David:

Bayflite has flown with the RN/medic configuration
since our inception over 13 years ago. We fly
primarily (over 80%)trauma scene flights, which
probably influences how we work.
>      
>        Do you allow the paramedics to do chest tubes
> or central lines or 
> venous cut downs?

All of our crew members are trained identically in
intubation, needle thoracostomy, chest tube placement,
central line placement, pericardiocentesis, RSI,
surgical crics, etc. The only procedure which is still
basically RN only is blood transfusion. Just by the
way our teams settle into a routine, most intubations
end up being done by medics (who all have other field
jobs and intubate more frequently), but we do have
minimum competencies for everyone on all procedures.
  
>         Are flight paramedics generally regarded as
> subordinate members of 
> the flight team?  Is equal responsibility shared
> between nurses and medics 
> for successes and problems in patient care?

Our crews really do work as equal partners, with the
realization that one member or the other may have more
experience or expertise in any given situation. Any
potential problems or questions, as well as kudos, are
always addressed with both crew members.

            
>  Do you allow paramedics to chart on patients?
>  If so, under what circumstances?  Do you believe
that your program and your nurses have a 
> greater degree of liability when paramedics are
> allowed to chart?

We do allow paramedics to chart on patients for whom
interventions were within their scope of practice, but
the RN is required to review and sign the chart.
Because of this, I don't believe that we experience a
greater liability. Our current documentation software
(Golden Hour)is greatly pull-down menu based rather
than narrative, so that makes for more consistent
charting.
>       
>        Do you know of any national standard or
> guidelines that exist for 
> regarding the scope of procedures flight paramedics
> can do and / or paramedic 
> charting?  If so, can you refer me to it?

Scope of practice varies so much on a state by state
basis that I doubt that you'll find any national
guidelines.

Hope this helps!

Laurie Romig, MD
Bayflite, St. Pete, FL

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