Came across a pedestrian vs vehicle scene while driving and stopped & have questions

[kashton]

I was driving home from work still wearing my uniform (I just got my first job as an EMT-Basic, waiting on my Texas cert. for Paramedic) and was stopped at a light when I noticed three people standing over a guy who was in the fetal position grabbing his knee with a painful look on his face. I pulled over and parked on the side of the road and got out... I came up to the people and asked what happened and started assessing the guy. I wasn't on the job so I was a little iffy as to what scope of practice I was allowed to do. I got as much information as I could from the patient (where he was hurting, looking for any obvious traumas, C-ABCs) and asked how fast the guy was going (the guy that was driving the car was present). The county Paramedics showed up about 2 minutes later and I told them everything I knew and took over.

What am I legally allowed/required to do since I am not on-duty?

 

[Flight-LP]

Nothing more than any other lay citizen, unless you are on authorized first responder in your own district with equipment. Honestly, I think you made a risky move by stopping in uniform. You had no equipment and the perception from the other bystanders looking around could have been that you were not doing your job. Not trying to sound harsh, but you have to protect your personal investment. I would have just made sure someone called 911 and moved on or called them myself...............................

btw, shoot me a pm and let me know where you decided to work. Congrads on your Paramedic...........

 

[medic001918]

I agree. I wouldn't have stopped. I don't typically stop when I'm not at work and it doesn't matter if I'm wearing my uniform (while driving) or not. I don't want to incur any additional liability. I would have called 911 and let them send the proper response.

Shane
NREMT-P

 

[mdtaylor]

In Texas you can legally ignore it and drive on, unless a LEO requests your assistance. However, once you make patient contact you have established a duty to act whether in uniform or not. Your scope of practice does not change, even though it may be limited based on available equipment and your local protocols.

Your local protocols dictate what your actions should have been. In my county in Texas, our protocols are to stop and render aid anywhere within the county. Yours may be different. You should seek out and learn them asap.

 

[Flight-LP]

You can still decline to assist despite what any law enforcement officer says. If you are off duty, you are under no obligation to assist. Easiest way to get out of that one, tell 'em you have been drinking! Works every time.

 

[Aileana]

Easiest way to get out of that one, tell 'em you have been drinking! Works every time.

that works unless you're driving by the scene

 

[Capt.Hook]

Good post. I have been planning to post a similar Q after a call we had yesterday.

We have a volly fire/ first responder department. No transport, as we have ALS 20 mins away 10-39. In our territory, I would expect you to give your assessment and then back away, as it seems you did. Even as a Medic, there still isn't much more you can do in this particular situation. On a critical case, heck, I'll take whatever help I can get, as long as things don't go outside our scope of practice.

We had a 2 car MVA yesterday. My pt. was PNB, needing extrication. A bystander came to me asking if he could help. He ID'd as an anesthetist (sp?) and asked if we had an ET-tube. Our conversation, while I was trying to gain access to my PT, went something like: no, we are only BLS. Oh, well if you had one, I could put it in for you. Well, if we had one, I could put it in myself!, but first, I have to get this guy out of the car! Oh. yeah, right. But, we do have combitube if an oral doesn't do good enough. THUMBS UP!

Then, this guy keeps bugging me about more blankets for the other pt. I do proceed to tell him where every blanket (10 degrees and snow) is on every truck there is, but he won't leave me alone. Turns out he witnessed the collision.

I don't mind folks helping if they can, but sometimes people need to back off when told no. Oh yeah, then, while lifting the one pt onto the cot, a woman comes up and asks if we needed help. Another anesthetist (sp?). A newer member said "uh, I'll check" I say Nope, we're OK, thanks. This woman then says "well what about that guy?" Nope, all taken care of, thanks. (That guy, my original pt., had a tarp over his face and was already pronounced). This is when there was already four fire trucks, two ambulances, and about fifteen people in fire gear already there. Had that been me, I would have stayed in my truck and waited for traffic to let me through.

In our territory, you did the right thing. Asses for life threats, pass on. Even as BLS non transport, there's still not much you can do that we can't for this guy. Everything you tell me gets relayed to the Medics arriving. If they have an issue with you, that's between you guys!

 

[kashton]

I just wasn't sure what I was legally supposed to do. I am a brand new medic, and I am still waiting for my Texas certification to come in the mail. I felt like I needed to help him, and I wanted to help him, I just didn't have the equipment with me. So I just told the medics what I knew when they arrived on scene and backed off to let them do their thing.

 

[mdtaylor]

I am a brand new medic, and I am still waiting for my Texas certification to come in the mail.

That changes everything. You are NOT a medic yet. Until you get your cert you are not a certified medic. If you have a lower cert, then you are whatever the lower cert defines. Your scope would be limited to the lower, IN HAND cert. Then by the equipment available.


Sorry Flight....I had the understanding that even an uncertified person had the obligation in Texas to stop and render aid upon request of LOE. I guess I was mistaken.

 

[Asclepius]

Most states you can choose to drive on except under certain circumstances. For instance, if your vehicle has a paramedic or emt endorsed license plate (you know, the kind you get when you donate to the states EMS fund and then you get a specialized plate) then you could face charges. Here in Missouri, that can really only happen if someone sees and records your license plate number.

In most cases, when you are off duty, you have no duty to act. Regardless of what clothes you're wearing. Although, I agree, from a PR stand point stopping in your uniform might not have been a wise choice. You would be protected by the Good Samaritan Act and therefore it would be highly unlikely that you could be sued. Don't get me wrong, anyone can bring suit against you, but unless you did something really stupid, it would be unsuccessful.

To prove negligence, you have to violate all four - not just one or two or three - of the following factors. BTW, this is EMTB stuff. 1. There has to have been a duty to act (there was none in your case) 2. You breached your duty to act. (You didn't have a legal obligation to respond so no breach can have occured.) 3. Your actions would have had to have caused harm to the patient. 4. The injury sustained to the patient can be tracked back to your action or inaction.

I stop alot, especially when I see no other emergency care around. I carry an emergency kit with BLS equipment in it. Basic bandages, oral and nasal pharyngeal airways, an ambu bag (no oxygen), etc. I feel that, even though I may not have a legal obligation to render care, I have a moral obligation. I have limitations though. I typically will not stop with my family in my car, especially at night or poorly lit areas, for example.

Regardless of whether you're an Intermediate, Paramedic or RN...scope of practice means nothing in an off duty assist. In order to function as a paramedic and render ALS care you need to have the permission of your medical director. I don't know very many medical directors that are going to be giving permission to off duty people to render ALS care. Therefore, you can really only do simple care anyway.

 

[JJR512]

...I have limitations though. I typically will not stop with my family in my car, especially at night or poorly lit areas, for example.

When I'm by myself, I usually haven't stopped, but when I'm with my family, my wife always insists that I do stop! I think she just has a morbid curiosity that she can satisfy through me.

 

[firetender]

There's something very disgusting about being in a situation where your life-skills could be useful, maybe even could save a life -- and you have to stop for even a second to worry about being sued.

Responding to that worry IMHO, and the wondering "Could I have made a difference?" is far worse than just getting in there and seeing if you can help.

 

[firecoins]

I have stopped at several MVAs that I have come across while driving. This is what I have learned.

1. Don't stop if your safety is at risk. Needless to say this is probably most of the time.

2. BLS skills only at most. I am of the opinion the less you do, the better. You can triage/assess patinets and relay the details to 911. I identify the injured and do the minimally necessary care. Hold C-Spine, stabalize fracutres, control bleeding, CPR or in most cases just calming them down.

3. If the injured don't want your care, move on. You are not obligated to care for them and they are not obligated to be treated by you.

4. When responding units arrive, they are in charge. They run the call. You support them if needed or leave if not needed.

I have done this without giving my name to responding police. I am not saying this is right or wrong. The police had little interest in me if I didn't witness the events in question.

 

[Ridryder911]

Just remember if you are not under direct orders (standing/written/verbal) you do not have authorization to practice further than a first responder. No matter, if you have star-of-life placards, certification or licensed, or a Phd. Therefore, regardless unless you have an current independent license to practice medicine within that state, all levels (basic to CCP, RN) have to work as a first aider.

As well, those supposedly enforced "duty to act" regulations are just B.S. They are impossible to enforce and regulate. All one has to say is that they were not in the vehicle or loaned their vehicle, etc...

R/r 911

 

[Jon]

I stopped for an MVC w/ vehicle off the road on Sunday, on my way into work. The MVC must have just happened, becuase it was only going out over the pager as I pulled up on scene. I was in my security uniform, with a non-marked duty jacket over top (it was raining- HARD). The accident was around the corner from my house, on a limited access highway. I am a member of the local FD (that also has a BLS ambulance) but I don't actively run with them because of Volly FD politics

I did a basic assesment and determined that the patient had no complaints except isolated arm pain. I was leaning towards NOT holding C-Spine, as there was no LOC and no back/neck pain, however I did take manual C-Spine stabilization. The patient had taken out a large "exit" marker sign in the shoulder and was actually seated on one of the "I" support beams of the sign... and the sign and car was in a patch of tall weeds behind a guardrail... there was also a large amount of standing water in some areas... the sign was the driest place

While we were waiting, another person pulled over. He preformed much of the same checks as I had, and when I asked who/what he was, he stated he was a paramedic in Philadelphia (and I vaguely recognized him, as I've worked with lots of Philly Medics) He verified there was nothing that he could do that I wasn't doing, and I think he left before the ambulance showed up. In retrospect, I don't think EITHER him or I introduced ourselves to the patient by certification.... just who we were.


Upon the arrivial of BLS and EMS officers 2 minutes later, I gave a report. As part of my report, I mentioned that the windshield was partially starred, but there was no airbag activation and the patient was wearing a seatbelt... the buystanders than said that the car had flipped (Good thing I took C-spine). I kept holding C-spine, because the FD treated me as part of their crew (because I am, sort of). I assisted BLS and FD with the immobilization and movement of the patient and then I left and went to work.

I had a decent set of BLS gear in the trunk of my car, but it didn't even come out... I knew that BLS and ALS were 5-10 minutes out, and there was nothing that I NEEDED to do that couldn't wait... so I didn't leave the patient to go dig out my C-collar (which is buried in my bag).


If I had stopped out of district, I think the response would have been similar, and if I wasn't known to the crews onscene, I probably would have been "pushed away" earlier (which would have been fine for me). As I said, since I knew the responders, I felt I was treated the same as if I'd climbed off of the fire truck.

 

[princess]

In Texas you can legally ignore it and drive on, unless a LEO requests your assistance. However, once you make patient contact you have established a duty to act whether in uniform or not. Your scope of practice does not change, even though it may be limited based on available equipment and your local protocols.

Your local protocols dictate what your actions should have been. In my county in Texas, our protocols are to stop and render aid anywhere within the county. Yours may be different. You should seek out and learn them asap.

Correct, check your protocols. My county service protocols read (not a direct quote): An off-duty employee may treat within their scope of practice - not only in our county, but in our RAC also. The RAC includes all surrounding counties.

 

[kashton]

Does anyone know where I can find the protocols for Austin, Travis County Texas?

 

[Ridryder911]

Correct, check your protocols. My county service protocols read (not a direct quote): An off-duty employee may treat within their scope of practice - not only in our county, but in our RAC also. The RAC includes all surrounding counties.

Then technically your never off duty, otherwise you would be acting upon your own and be practicing medicine. Curious, because Federal law prohibits one from carrying any medications, advanced airways, IV fluids, even C-collars,etc. without a license to prescribe (hence: unless under protocol). As well, who covers you for malpractice while under off duty. Good Samaritan Act only covers for those that act "in good faith", not associated or connected (as on duty) to a provider.

I would definitely read more and get a better understanding of the coverage before providing anything more than BLS (first-aid).

For as stopping at MVC's etc, personally I do not. I used to for several years and found that it did not change any outcome, only to cause more problems personally.

I found it was always a hassle with other by-standers (usually one LPN or nursing home RN in the crowd that knew more than anyone else) or arriving EMS always ignored report or assistance. As well, over the years I have found that most MVA's either die immediately or it is a surgical problem and really, realistically there is nothing for us to do other assess and package then transport.

I no longer carry any medical equipment with me, nor personal protection. Usually (unless it is rural) EMS (fire, police, EMS) is within a few minutes away
and me holding a c-spine or even placing a 4x4 on a lacc is not going to change the outcome. Research is demonstrating more and more of the C-spine injuries occur during impact and not related to movement afterwards.

It is a personal issue, If one wants to, that is great but after years of getting exposed, ruining clothes, and being late, I know longer see the difference from interacting and not.

R/r 911

 

[firecoins]

I no longer carry any medical equipment with me, nor personal protection. R/r 911

I always have at least a condom on me. <_<

When I stop, I am sure it doesn't change whether or not they need surgery, prevent spinal injuries or whatever. What it does is bring panicky people into a more relaxed state knowing that someone knows what they are doing. I have had RNs who came to help come up to me and thank me for running the scene so well. Most of the police were glad someone else did the first aid rather than themselves. Sad but true. The incoming EMS crews had a somewhat easier time becuase I basically triaged everyone involved. I don't know that patient outcomes were different but I seemed to make a difference in moving things along.

 

[BossyCow]

Just as a side note: You were wearing your uniform home? Don't you change and leave the icky uniform at work and go home in your civvies?