Re: Paramedics In-House

[Ken Lawson-Williams <Macgyver@FlightMedicMail.com>]

>From Alberta: Paramedics in-house in Medicine Hat, Grand Prairie and Peace River as well. Only Medicine Hat are hospital employees, but all work in ER (Peace River and Grand Prairie are EMS employees seconded to hospital). BE-200 programs only with 4.5 hour average mission length, and 12+ hours multiple consecutive missions are common.

Problems initially with resistance from nursing managers and floor nurses as medic's allowed more lattitude than themselves in treatments. Initially job descriptions were the same as the RN's, but medic's refused to aaccept positions as was a lessening of scope of practice. RN's then uptight when new descriptions allowed medic's more autonomy (when MD absent) and wider skill set. 

Resolved when new descriptions developed that did not specify RN or REMT-P but instead ALS team member. Everyone now on same footing, RN's who wanted to expand scope could get in-hospital training and ER unit certification for intubation/cric's/deco/iv-push med's and defib per standing orders in absence of MD (previously only MD's could push meds, except code drugs for ICU RN's - and no RN could intubate or give any med without an order). Medics now could get waiver from provincial scope of practice (legal reg.) to initiate blood (previously only could monitor existing infusions).

As to other units, can float and do specialling in ICU, still unclear if the medics must follow RN job description when not in ER or on a flight. Technically they only have that description when in the ER as that is the only unit that uses an ALS provider type job description. Grey area not being pushed or resolved as so busy in ER/flights that rarely in use elsewhere unless staffing crisis exists. Other units being looked at are L+D, OR, PARR, ICU, Medical Daycare (invasive outpatient clinic) but no rush as few medics want to work there - will likely change if average age rises....

Pay discrepency still an issue, RN's make more and work less hours because of different contracts when system started. Gap gradually narrowing with each successive contract but still a sore spot. RN contract had a medevac bonus that was lost - annoyed them. Gap about $5 an hour and increases with seniority (down from about $10).  

Biggest problem revolves around utilisation in ER. Too easy for unit managers to let staffing slide when sick call-ins etc since extra staff in-house. Then a flight comes in and the ER is understaffed until the float RN's are retrieved from thee unit they are on back to ER - npow leaving the other unit's short. 

Also since a 12 hour shift, overtime very common and extensive (fixed wing, quite often 10 hours in ER before a flight comes in, then 12-14 hours before aircraft back at base - just in time to get ready for the next 12 hour ER/Flight shift). Reduced now with 16 hour maximum duty day - previously was "operational requirement" contract option for management to have you work a double shift (24 hours). Also now a mandatory 8 hours off after any 12-16 hour shift. Pushing for 10 hours (to ensure 8 hours "pillow time"). 

No real legal concerns - flight teams work under medical control, primarily off-line with extensive standing orders and an overall "delegation of function" document that does not differentiate between RN or Medic. Only problem initially was the blood issue with medics that was a result of provincial law. New legislation pending eliminates that barrier, and College of Paramedics issued a waiver specific to flight teams (with government consent) in the meantime. 

Fly Safe. 
Ken L-W CCEMT-P/WMT

"If in the last few years you haven't discarded a major opinion or 
acquired a new one, check your pulse. You may be dead."
- Gelett Burgess


>We are a Part 135 hospital owned and operated flight program.  We have two
>B200 King Airs and one Bell 230.  Our flight program is currently in the
>process of bringing flight paramedics in-house. 
>I'm asking for assistance from the group for information relating to both
>job description and salary.  We plan on utilizing the medics (as we are
>currently doing) in the ER (when not performing flight related duties) but
>would be interested to know if there are other areas of the hospital they
>may work.  They'll be primarily working 12 hour shifts with some 24 hour
>call time.
>
>In particular, I'm interested if anyone has encountered any JCAHO or medical
>control restrictions that may apply to paramedics.

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