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Tagged: procedures, protocols, role, scope of practice
- This topic has 6 replies, 5 voices, and was last updated 2 years, 9 months ago by
Tracey Gaslin.
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July 28, 2021 at 11:31 pm #43018
Phyllis Ramos
ParticipantI am an RN and occasionally help out at a Christian camp in central Illinois. They usually try to have a nurse, EMT, or paramedic in the first-aid office. There is no overseeing physician. There are no real procedures or protocols in place. My concern and question is; am I providing care as a substitute parent or in a more professional capacity? I couldn’t find anything in resources or other websites.
July 28, 2021 at 11:56 pm #43019Tracey Gaslin
MemberPhyllis:
Welcome to the Association of Camp Nursing. We are glad to assist with your question. If you are practicing as a nurse and telling people you are the camp nurse, there are legal requirements. These requirements include licensure and having medical oversight that provide orders for you to follow. Some camps have standing orders while others use different mechanisms (like calling the provider) and getting an order. It is not very efficient to have to call everytime you need to give a medication but every state can have different requirements. As a nurse you must have an order for all prescription and over the counter medications from an authorized prescriber in your state (physician, nurse practitioner, physician assistant).
Please know the same is true for an EMT. The EMT can only practice as an EMT under the direction of the physician who oversees their EMS operations. The EMT cannot practice independently. The EMT could operate as an assistive personnel but would need to have orientation and training provided by an RN or higher level care provider.
We are glad to discuss this with you more and provide resources for you. Please feel free to email at [email protected] if you would like further direction or support.
Best to you.
TAke care
Tracey GaslinMay 16, 2022 at 1:32 am #45183JIll Frey
ParticipantHi Tracey,
I have a similar question about how having an EMT is different from a first aider or an RN… It sounds like from what you say here it is more similar to the RN.I am wondering about treatment procedures.
For a First aider, they just do first aid. Treatment procedures are just the “first aid book”. For prescription medication that comes to camp with a child with a current prescription from a prescriber, they keep it locked up and “observe that the child takes the right dose at the right time and documents it”. We are not prescribing anything new. Is this ok to be the same for an EMT or RN?
Also for other-the-counter medications. Like Tylenol for a headache. We have the parents indicate on their health form if they give permission for the camper to have “Tylenol for a headache”. We list specific things for each common OTC medicine and then we give it if the camper has that issue with the parent’s permission and only according to the label. We do not give it without the parents permission on that form.
I know an RN needs a “treatment procedure” or standing order from a Dr to do the second. Is it the same for an EMT? I think maybe by what you said above.
The EMT would not really be functioning as EMS. We would be calling the local EMS, which is close if anything is needed.
If I have an EMT or a First aider, I will have an RN that will be the RN consultant and will wortk with them pre-camp for training and with check-in and will touch base with the EMT daily via zoom or in person.
I’m not sure if this makes sense. I think my question is Am I understanding what you’ve said above… Is it correct that if I have an EMT or a RN that we need ot have standing orders from a DR. If I have an EMT they need to have a RN to help with orientation and support.
Thanks,
Jill
JIll Frey
[email protected]May 20, 2022 at 1:59 am #45211Tracey Gaslin
MemberJill:
Thanks for your response. This situation is related to “scope of practice”. You must understand what the scope of practice is for an RN, for an EMT, and for a first aider in your state. Remember that a registered nurse is the appropriate level of licensure to oversee medication management. EMT scope of practice is practicing under the direction of an emergency medicine physician. Otherwise, they are not practicing at all as an EMT – they are an UAP, just like a trained counselor would be a UAP. This is important as you would not want an EMT responding to emergencies at camp as they would be operating outside of their scope in the camp setting. Confirm with your state regulations as well.
As an RN, you can delegate the TASK of medication dispensing to an UAP. However, no decision-making or judgment activities should be delegated. For example, a staff member can be trained to give a pill (you should have a clear and documented orientation) but they cannot be delegated the decision about what to do if a camper loses a pill or has an adverse reaction, or refuses to take medication. That is the role of the RN. Only the RN can do decision-making. I share this as it will be important to consider who is making decisions when campers arrive in the health center and the RN is not onsite. Decision-making and judgment cannot be delegated by an RN according to the scope of practice.
Please know that parents can sign that they agree for their child to receive certain OTC medications, but you still need a standing order from a prescriber. The child’s physician can provide that order or you can have standing orders for the camp signed by a prescriber.
I hope this provides some clarification. Let us know if more questions arise.
Tracey GaslinMay 20, 2022 at 4:10 pm #45221Mary Marugg
MemberJill,
There are some good resources on the ACH website about the various roles in camp healthcare/scope of practice:A chart on Health Providers: https://allianceforcamphealth.org/wp-content/uploads/2018/11/Health-Providers-Chart.pdf
The ACH Practice Guideline on Delegation
https://www.allianceforcamphealth.org/wp-content/uploads/2019/08/Delegation-PG-2020-ACH.pdf(You can find links and additional information on the Medication Management page of the ACH website: https://allianceforcamphealth.org/education-and-resources/medication-management/
Best,
Mary
Mary Marugg, RN
May 25, 2022 at 12:13 am #45245Lindsay Gates
ParticipantHi Jill,
I am much less experienced in this than many of these other ladies and gents, but I just wanted to add a persepective. The camp I am with is a Boy Scouts of America camp, they use the National Camp Accreditation Program for their accreditation, I know another common one used at many camps is American Camp Association. Do you know who your camp is accredited by? That provides a starting place for operating guidelines.
For example: per the National Camp Accreditation Program
-When EMS is LESS than 10 minutes away, the “camp health officer” must be **certified** in American Red Cross Standard First Aid and CPR/AED for healthcare personnel or other equivalent (American Heart Association programs is an equivalent example.)
-When EMS is MORE than 10 minutes away, the “camp health officer” must be **licensed** as a physician, nurse practitioner, nurse (LPN or RN), physician assistant, paramedic or EMT.
-When EMS is MORE than 60 minutes away, in additioned to being a **licensed** professional, they “camp health officer” must also be certified in American Red Cross Wilderness and Remote First Aid.So that dictates who can staff our med lodge- scope of practice and proximity to emergency services.
Another thing that I find helpful is that our medical protocols (standing orders) are color coded based on a protocol legend. It’s a long explaination, but one of the color codes indicates the medical protocol can only be carried out by an EMT or higher, the best example of this would be administering over the counter medication per standard order. Basically below the level of EMT we’re just talking about putting on ice and band-aids.
Hope that helps!
May 25, 2022 at 1:38 am #45246Tracey Gaslin
MemberLindsay:
Thanks for sharing your perspective. I want to be sure I provide clarity here for everyone. Every camp is not accredited and the Boy Scouts do their own accreditation process. Accreditation is a voluntary process and does not hold “legal” weight that your state law and state camp health requirements do for camp operations. Accreditation is a statement to the public that a camp is demonstrating a basic level of care and safety as part of their operations.
Please note, that in most states an EMT can only practice as an EMT under the direction of an emergency medicine physician associated with the EMS program to which they are employed. Please check your state regulations regarding EMT scope of practice. Therefore, at camp, they most likely cannot function as an EMT as they are not under the direction of the emergency medicine physician. Please have any of your EMT’s confirm this as well.
This means that most EMT’s function as unlicensed assistive personnel (UAPs) at camp. They can perform delegated tasks as directed by an RN (or higher licensure) but they cannot perform activities that require decision-making or a judgment call for care. EMTs can be very helpful but they have a very narrow scope of practice and we must be careful to not assume that their EMT skills are applicable at camps unless your state has some unusual regulations. I can’t recall the regulations in every state, so be sure to understand your state laws for the safety of your camp operations.
Best to you all
Tracey Gaslin -
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