RE: Incoming Fixed WIng flight personnel on ground units

["Paul M. Wright, Jr." <pmwright@home.com>]

George -

 

As is usually the case, I find a lot to like in your take on the situation and I particularly agree that in some respects, law and regulation have a lot of catching up to do.

 

In regards to the licensure issue, there has been some discussion of a formal mechanism that would create a temporary recognition of reciprocity for licensed healthcare professionals who are attending a flight that terminates in a state in which they are not licensed.  But one of the sticky points is whether this could also be applied to flights that originate in a state in which they are not licensed and most folks with whom I've spoken are pretty adamant that it should not.  But it's an interesting and potentially useful mechanism.

 

I appreciated your point that BLS transport is often all you have.  Even in areas where there is a choice,  if ALS resources are scarce,  using a BLS vehicle can often be defended on a basis of doing the most good for the most people within the available resources.  If your patient is already receiving ALS care, one could easily argue against tying up another ALS resource for that same patient.  I didn't make that argument in my earlier post (and in fact argued for the opposite) but I didn't consider it from a resource allocation perspective at the time.  In retrospect, I should have.

 

But as Dr. Romig pointed out in her post from Florida, there ARE states where providing ALS on a BLS-licensed ambulance is a problem and that is the kind of information that was requested in the original post.  We operate kind of lassez-faire here in Arizona but that is not true everywhere and maybe someday it won't be here.  I could perhaps draw the parallel that before you go driving in another state, you are expected to know the rules of the road because you are responsible for observing them regardless of your state of licensure.  I think flight programs operating across state lines have a similar duty to know and observe the pertinent regulations but I also think the transport providers have a duty to educate the flight programs at the time of the call for service as to what is permissible and what is not.

 

I wish I could share your confidence that the "powers that be" will continue to address these issues with benevolent neglect, but I'm already seeing litigation that I believe will eventually compel a regulatory or legislative response.  So even though the question has been asked many times before with the same answer (Don't worry - be happy!), that answer may have to change for us in the near future.  In other states, it already has.

 

regards!

 

paul

 

 

Paul M. Wright, Jr.

Mesa, AZ

 

 

 

 

 

 

 -----Original Message-----
From: flightmed-admin@flightweb.com [mailto:flightmed-admin@flightweb.com]On Behalf Of GBSimons@aol.com
Sent: Friday, June 22, 2001 8:47 PM
To: flightmed@flightweb.com
Subject: Re: Incoming Fixed WIng flight personnel on ground units

Hello All!
      This is a question that has come up frequently. We used to do fixed
wing transports to and from other states, and still do some rotor wing
transports to another state. We posed the question to our management and
medical director long ago. Personally, I don't think it is an issue to fret
over. Sure, if you read regulations verbatim, it seems like we are all
violating the law when we transport a patient to another state in which we
are not licensed. But, stop and think about what we would have to do if we
wanted to follow the letter of the law.
      We would have to turn patients over to another provider every time we
crossed a state line. We would not be able to pick up or drop off a patient
in any state in which we were not licensed. We are talking not only about
nursing licenses and paramedic certifications, there is also the air
ambulance which is probably only licensed in the state it is based.
      Of course, it is ludicrous to think that any program is going to
license their personnel and hardware in every state. I think the "powers that
be" recognize this and are willing to let flight programs do what they do.
Because we are appropriately licensed and trained in our home state, and
because we are operating under medical direction, I don't think anyone is
going to make an issue of our going into other states to pick up or drop off
patients.
      I can see where a program that may be based in one state but operate
heavily in two or more contiguous states may be required by those states to
meet their requirements for EMS transport. As far as occasional transports by
a flight program to other states, I don't see any need to worry about it.
      Back to the "letter of the law." The literal law is one thing, the
intent of the law is another. The intent in this case is to provide standards
and mechanisms within a state to regulate EMS so the public is protected from
every Tom, Dick, and Harry who wants to run an ambulance service or fire
department. The public can count on getting a standardized, quality service
throughout the state. As mentioned above, our meeting the requirements in our
own state, in addition to having medical control and direction, is, in my
opinion, an adequate assurance to the state we are traveling into that we are
not bozos (well, I don't know about myself but my colleagues are quite
competent).
      As far as the specific question about using a BLS or ALS ambulance to
transport a patient from a fixed wing flight, again, I don't think it is a
huge issue. I have been to many places where all that was available was a BLS
unit. State regulations notwithstanding about not allowing ALS things to
happen in a BLS ambulance, what are you going to do if that is all that is
available in the community you are servicing? We have always taken our ALS
equipment with us to maintain the standard of care from bedside to bedside.
If we have to drag a lot of stuff onto a BLS ambulance, so be it. We are
still under medical direction and are caring for the patient until turned
over to a higher or equivalent level of care.
      I don't know if this has ever been challenged, but I don't believe it
will become a transport issue. Air medical transport came along after all the
nurse practice acts and EMS regulations were written. Laws will have to play
catch-up with the current technology, a problem we are seeing in many fields
today.

George Simons, RN, MS, FNP-C
Flight Nurse
LifeNet Arizona
Tucson, Arizona