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Here
in Arizona, our EMS system developed in such a manner that field treatment
and transport are different components in many instances, so historically it has
been quite common for fire department paramedics to provide ALS aboard a BLS
transport vehicle and flight crews typically have been allowed some discretion
in choosing whether to request a BLS or ALS transport
vehicle.
The
legal status of a non-resident flight crew while aboard an Arizona-licensed
ambulance is far from clear and I can't even make an educated guess as to how
the liability would fall in the event of an untoward incident in the ambulance
that lead to a bad outcome for the patient. Such case law as exists
addresses only the circumstance of a non-resident nurse working within a federal
facility and provides that the Arizona Board of Nursing only has jurisdiction if
that nurse holds an Arizona license. An interesting legal argument has
been proposed that the well-established Federal pre-emption of State regulation
of air medical services could be used to provide some protection for
non-resident healthcare practitioners during the ground transport leg, but I
find that argument weak in view of decisions that IHS facilities are Federal
facilities, airways and airports are Federal facilities and in some case, the
receiving hospitals are Federal facilities, but the ground transport between
them is not unless provided by an agency of the Federal government or the
transport involves Native American patients within the legal boundaries of a
reservation. Because severe cephalgia is the only predictable
outcome of an attempt to rationally analyze the possibilities, we generally
operate on the far more palatable "Ignorance is bliss"
principle.
My
best judgement would be that it would be advisable to request an ALS ambulance
any time the patient is receiving ALS-level care en route (or may reasonably be
expected to require such care at any point prior to arrival at the receiving
facility). In addition to avoiding potentially messy liability issues, the
fact that the ambulance is fully equipped provides an additional layer of
benefit to the patient should your equipment fail (not an uncommon scenario, in
my experience). I recognize that fixed-wing operators often work on a
competitive bid basis and the cost of the ground component is often built into
the quote so there can be a market disadvantage in over-using ALS ground
transport when BLS transport would do. But if we're really talking about
seamless interfacility transport, it would seem prudent to use ALS transport
whenever the patient requires ALS care.
regards!
paul
Paul
M. Wright, jr.
Mesa,
AZ
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