Paul,
As always well said...
Jim K
>>That would be myself,
>>as an RN making a diagnoses based on
"my field experience". I would love to
>>be that patients lawyer.
I
have to kind of chuckle whenever I read that kind of statement because it
usually means all the really good arguments have been used up. The legal
reality is that lawsuits are based on bad outcomes and the liability generally
falls to those shown to have acted unreasonably with regards to the standard
of care. In my experience, credibility weighs much more heavily than
credentials in those cases but regardless, patient care should be rendered for
best possible outcome and not because of a hypothetical future
lawsuit.
In
the real world, flight nurses can and do make changes in the care plan that
are often somewhat at odds with the direction established by the referring
physician. When those changes are made within an accepted system
of medical control, the liability is not significantly different than when a
physician is present as a member of the flight team. Your statement
implies otherwise, but I doubt you can back it up with either case law or
anecdote that demonstrates the difference.
>>As far as the Australian study, you are
right, there has been no study in
>>North America or Canada
(and I am not sure why?...anybody know?)
I
can venture a guess that it's because there is severe competition for
resources to study things that matter and this particular issue doesn't.
If a program can support the cost of physician staffing and if there is
determined to be a marketable competitive edge to it, the clinical efficacy
doesn't matter - you either accept it or you don't and a study is not going to
sway anyone's opinion. Looking at it from the perspective of a program
that offers physician staffing and uses it as a differentiator in the market,
do you really want to commit resources to a study that will, in all
likelihood, fail to convince anyone of the value of what you're doing unless
they are already a true believer?
On
the other hand, for the vast majority of air medical programs for which the
cost or logistics would be prohibitive, it really doesn't make sense to commit
to study something you can't afford anyway.
regards!
paul
Paul
M. Wright, Jr.
Mesa, AZ
