The HPCSA brought out a ruling in March 2008 stating that anyone not “suitably qualified” and “duly registered” with the HPCSA (in terms of the Health Professions Act, Act 56 of 1974), may not respond to incidents involving patients and potential patients. Furthermore, “it is permissible that unregistered persons such as fire fighters, allied health professionals or non-medical lay persons accompany registered emergency care providers, paramedics or practitioners solely for purposes of observation on such vehicles subject to the following conditions: a) These observers are not entitled to assess or manage patients in any way whatsoever...”. (italics by the author)
Technically, this implies that Registered Nurses (RNs) (registered by the South African Nursing Council) are included in this stipulation.
ENSSA responded to this ruling in August 2010, stating its dissatisfaction with this ruling. There are situations when nurses should be able to practice in the EMS environment, including for example flight nurses and emergency nursing students gaining experiential learning experience on EMS vehicles. When the Act is analysed closely, no mention is made about the environment in which persons registered with the HPCSA may practice. Considering the RN’s scope of practice (Regulation 2598 of 1984), they may practice in the pre-hospital environment, should they be trained and competent to do so. The Nursing Act, Act 33 of 2005 also does not stipulate the exact environment in which nurses may practice.
HPCSA briefly responded to ENSSA’s communication, stating once again that “in terms of section 17 of the Health Professions Act, 1974 (Act 56 of 1974), persons who work within the scope of emergency care on ambulances have to be registered with the HPCSA.”
Interestingly, a recent Western Cape Services Act 2010, Act 33 of 2010 (published in a Provincial Government’s Gazette - number 6806 – in November 2010), describes “Ambulance Personnel” as including nurses registered under the Nursing Act, Act 33 of 2005 (section 31).... This contradicts the HPCSA’s ruling.
We at ENSSA would like to encourage the HPCSA to reconsider the 2008 ruling. Further communication with the HPCSA is still pending. Comments are welcome.
I have been involved with EMS operations on and off for the last 15 years, and the objection of having nurses on emergency vehicles has been around since before I got involved, but as you say the HPCSA has only made this official in 2008.
ReplyDeleteWhen I look at why many Emergency Care Providers do not like working with Nurses on emergency vehicles(EV’s), I think initially our basic nursing training does not equip us to work in that environment. It is small and cramped, often dirty, exposed to the elements, such as sun, rain and hail, not to mention a nursing assessment that we are thought in nursing school, is out rightly to cumbersome, and does not focus on the life threatening areas that could kill patients during a medical emergency. So there will always be the conflict between the training basic training as a nurse, and the basic training as an Emergency Care Provider.
Then one has to ask, how often is the basically trained nurse interested and / or exposed to work on EV’s. I would guess not many, but it’s not very scientific. And I am not sure if this is the idea forum to try to gauge this, as we all show an interest in Emergency Medicine just by reading this.
The next question that begs answering is what value can Nurses bring to the EV environment, especially with the ALS paramedic program now expanding to include the B-Tech level where they are trained in the use of muscular relaxants, interpretation of 12 lead ECG’s, to name but a few. I can for example remember a few instances where I had to accompany Coronary Care patients form one hospital to another, while on Intra-aortic Balloon Pump. Apart from the safety issues involved with the actual transport of the equipment, while connected to the patient, being ICU trained as well, was of great benefit to me, and the service, because we were the only service that had staff available who could perform the transport.
Perhaps we can discuss more situations where well trained nurses would be beneficial in a pre hospital service?