# Still Alarm Outside Your Jutisdiction



## thegreypilgrim (Jul 10, 2010)

OK, so this is a hypothetical scenario but is entirely plausible and I'm sure it happens all the time. It poses sort of a legal ambiguity although the ethical side of the issue at least appears clear.

Say you just got finished with a long distance transfer that has taken you a considerable distance away from the jurisdiction you're licensed/accredited/whatever to practice in. Being that it'll be along drive back to your area, you and your partner stop at a fast food joint to get something (terrible) to eat.

As you stand in line for your order a great commotion starts as one of the other customers has decided to go into a tonic-clinic seizure. Everyone's freaking out, its crowded, people are all looking at you, others have got their iPhones out recording the events for posterity, things are awkward. This isn't your area, you have no idea what hospitals are nearby or what their capabilities are, nor do you have any knowledge of the local EMS provider and their nearest resources. All you know, is you're a paramedic and you see someone seizing*. How do you proceed?

* This is just meant as an example. Feel free to imagine any other medical emergency unfolding (eg, chest pain, SOB, syncope, old person falls, etc.)


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## Lifeguards For Life (Jul 10, 2010)

thegreypilgrim said:


> OK, so this is a hypothetical scenario but is entirely plausible and I'm sure it happens all the time. It poses sort of a legal ambiguity although the ethical side of the issue at least appears clear.
> 
> Say you just got finished with a long distance transfer that has taken you a considerable distance away from the jurisdiction you're licensed/accredited/whatever to practice in. Being that it'll be along drive back to your area, you and your partner stop at a fast food joint to get something (terrible) to eat.
> 
> ...



Call 911, treat the patient on scene. Treat the patient as if you were an ALS engine first on scene, until an in-district ALS rescue arrives on scene.


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## thegreypilgrim (Jul 10, 2010)

Lifeguards For Life said:


> Call 911, treat the patient on scene. Treat the patient as if you were an ALS engine first on scene, until an in-district ALS rescue arrives on scene.


But you have no legal right to practice ALS in this region.


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## TransportJockey (Jul 10, 2010)

By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such


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## JPINFV (Jul 10, 2010)

I second the "begin treatment, call 911, offer assistance when local crews arrive" argument. 



thegreypilgrim said:


> But you have no legal right to practice ALS in this region.



That's nice. They can charge me all they want and I'll bet dollars to donuts that the case will be dropped as soon as the media starts running stories about how the big mean government is putting people's lives at risk. Any bureaucrat worth his post will be able to distinguish between a company trying to run calls without proper licensing and a crew who just happened upon a person in distress outside of their area.


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## thegreypilgrim (Jul 10, 2010)

jtpaintball70 said:


> By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such


Here's an example of "system" type differences among different regions of this country. I'm from California, and as such while we have statewide licensure we have to have local accreditation specific to one (or possibly multiple) county. The result is for CA medics driving from one county to another is a lot like entering a different state.

So, for those of you who have statewide authorization just imagine you've been transplanted across state lines as a result of a long-distance IFT.


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## JPINFV (Jul 10, 2010)

jtpaintball70 said:


> By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such




Depends. In California, for example, service licensing and protocols are done on a regional system (local emergency medical service agency) divided up by either counties or groups of counties. Essentially, if your service isn't licensed to be there, you shouldn't be running calls unless you're on a mutual aid call.


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## TransportJockey (Jul 10, 2010)

Right, sorry. I didn't look at location


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## thegreypilgrim (Jul 10, 2010)

JPINFV said:


> I second the "begin treatment, call 911, offer assistance when local crews arrive" argument.
> 
> 
> 
> That's nice. They can charge me all they want and I'll bet dollars to donuts that the case will be dropped as soon as the media starts running stories about how the big mean government is putting people's lives at risk. Any bureaucrat worth his post will be able to distinguish between a company trying to run calls without proper licensing and a crew who just happened upon a person in distress outside of their area.


I agree that this would be the most appropriate course of action to take, but isn't disturbing that the legal issues related to EMS could even give rise to a question like this? I bet a fair amount of providers would be reluctant or uncomfortable about doing anything beyond BLS in a situation like this, and thats a shame.


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## Shishkabob (Jul 10, 2010)

As far as my understanding goes--- As long as you are credentialed/certified/licensed in the state you're based out of, you can still do ALS stuff in other states.


This is why AMR is able to send Paramedics out on FEMA contracts and other gigs and still have them do full ALS, like for hurricanes, or for the gulf coast clean up, in other states without requiring them to get another state cert.


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## JPINFV (Jul 10, 2010)

This is one of those scenarios where EMS is funny We're stuck between the the technician and professional designation. We want the respect of being a profession, the pay of being a profession, and latitude of being a professional health care provider right up until the water (either clinically or legally) gets the slightest bit murky or more education is required. Then people cry out about how they're 'not paid, educated, or empowered to make anything resembling an independent decision that might carry any liability.' Professional ethics, morals, and critical thinking says to treat and no one should require a written policy saying otherwise.


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## JPINFV (Jul 10, 2010)

Linuss said:


> As far as my understanding goes--- As long as you are credentialed/certified/licensed in the state you're based out of, you can still do ALS stuff in other states.
> 
> 
> This is why AMR is able to send Paramedics out on FEMA contracts and other gigs and still have them do full ALS, like for hurricanes, or for the gulf coast clean up, in other states without requiring them to get another state cert.



In general disaster relief work is going to be treated differently from day to day operations. I wouldn't take a paramedic licensed only in California, for example, and start having them run day to day dispatched calls in Nevada. Similar, regardless of how the law is technically written (which I'm willing to bet that there are exemptions for disasters), I highly doubt that the intent was or application of said laws to prevent providers from responding to still alarms. Even if a government official wanted to enforce the law, the "Home town hero in trouble for saving a life" story is going to be the local print and news media's proverbial wet dream.


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## firetender (Jul 10, 2010)

Maybe I missed it somewhere in the post but because standing orders are region by region, even hospital by hospital in some cases, ALS is not really an option without communication with a receiving hospital.

Until such a time as you can communicate and receive permission to treat (which would very much depend on your accurate assessment of it being a true emergency necessitating your immediate intervention -- in which case I'd do what needed to be done and ask for permission later) you're limited to basic stabilization. You can always ask 9-1-1 for an accurate ETA of local support.


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## TransportJockey (Jul 10, 2010)

In some states, standing orders and scope of practice is essentially universal state wide...


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## jjesusfreak01 (Jul 10, 2010)

Let me ask this. Why would your ability to practice medicine under your MDs license end at the county line, since their license doesn't end there? If you are on duty, out of zone, and witness an incident needing your assistance, surely your medical director wouldn't have a problem with you helping out here, but doesn't it just become the MDs call in the end? 

You are state certified, your MD is state licensed. County borders are used as jurisdictional borders simply so that you can have unified systems within that area. 

Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat. If you are done with your shift, you might as well be off duty. Probably a good idea to just call the medical director and ask permission if you need to do ALS interventions (code call).


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## TransportJockey (Jul 10, 2010)

jjesusfreak01 said:


> Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat.



As someone who has done long IFTs (anywhere from 4-12 hour trip one way) not eating till you get back in district doesn't always work very well.


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## Veneficus (Jul 10, 2010)

Around this area you must be credentialed in the state you are tranporting from and the state you are transporting to. 

In this state there is a standard scope of practice and all credentialed EMTs are authorized to perform the treatments of such in an emergency situation.

If you perform any paramedic level treatments you must give your cert number to the arriving EMS system and you are held to the level of care you provided. You are required to carry proof of your cert level here by law. 

If you don't have it on you anyway, your SSN will work as we have a statewide searchable database by either cert number or SSN that will list any cert you ever held here including expired ones.

If you are from out of state you must furnish a copy of your credentials prior to any care. (aka have a copy of your state card on you with a number)


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## WolfmanHarris (Jul 10, 2010)

firetender said:


> Until such a time as you can communicate and receive permission to treat



Not everywhere operates in this old way. Here only a couple very specific procedures require contact with a Physician. Most of those (save our current thrombolytics trial) can still go forward if contact fails.

For us the provincial system is seamless coverage. As I move from one dispatch area to another I have to book on with that dispatch centre, my truck than shows on their AVL system and I'm in service in their area as I move through. Usually this just happens as we transport to hospitals outside our usual area, but if we do a transfer far outside our area, but still within the province we can be utilized, to full scope of practice for any calls that occur. My home is over an hour from Toronto, but I once saw a TEMS truck responding to a call in downtown Peterborough, because they got stuck as the closest available unit when they cleared off a transfer.

This doesn't apply if I do a transfer outside the Province. At that point we would treat to full scope, call 911 and await local transport. Though this is more practical than regulation as we likely don't know the area. I know Ottawa Paramedic Service which does border Quebec, can and will do calls over the border if they're desperate. Which can be funny at the hospital since that part of Quebec has no ALS and the receiving staff get confused.

Over the US border though all I am allowed to do is first aid and await local resources. (We do the rare trip to NY or MI)


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## MrBrown (Jul 10, 2010)

I don't have a "jurisdiction" outside which I cannot treat, we are not in the sue happy USA.


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## JPINFV (Jul 10, 2010)

jjesusfreak01 said:


> Let me ask this. Why would your ability to practice medicine under your MDs license end at the county line, since their license doesn't end there?



Because, speaking of California at least, medical licensing and EMS licensing are not comparable. There are no local licensing issues with physicians like there are with EMS providers in states with a strong regional system. 


> You are state certified, your MD is state licensed. County borders are used as jurisdictional borders simply so that you can have unified systems within that area.



That would be true, except ambulance services aren't supposed to accept calls originating in counties that they aren't licensed in. 



> Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat.


You don't do very many long distance transfers, do you?


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## Akulahawk (Jul 10, 2010)

Unless I've been granted some form of reciprocity, if I'm outside an area where I'm authorized to do ALS, I'll function at a BLS level, call 911, and turn over to the local EMS people once they arrive on scene.


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## JPINFV (Jul 10, 2010)

Akulahawk said:


> Unless I've been granted some form of reciprocity, if I'm outside an area where I'm authorized to do ALS, I'll function at a BLS level, call 911, and turn over to the local EMS people once they arrive on scene.



So, you witness a cardiac arrest (who didn't see this scenario happening?). Your monitor does not function as an AED. You would delay converting a lethal rhythm because you're outside of your jurisdiction?


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## Akulahawk (Jul 10, 2010)

JPINFV said:


> So, you witness a cardiac arrest (who didn't see this scenario happening?). Your monitor does not function as an AED. You would delay converting a lethal rhythm because you're outside of your jurisdiction?


Would I delay that? No. Would I have to delay other ALS interventions? Yes. I'll take the blame for CPR + Sparky... beyond that, I'm not about to get my License yanked because I got convicted for practicing medicine without a license... all because I'm not Licensed to perform ALS in that area/state. 

Do I like that idea? Not one bit.


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## JPINFV (Jul 11, 2010)

There's never anything to like about scenarios like these. However I view it as being an EMT or paramedic on an airplane (however, granted, airlines have online med control, but they aren't your online med control). I could present many more scenarios that I'm sure you'd end up agreeing to provide ALS interventions (say, anaphlaxis with an extended paramedic response time? How about Albuterol for reactive airway emergencies?  How long are you going to withhold D50 from a patient in hypoglycemia? Magill forceps and FBAOs?). I guarantee you, though, that the general public isn't going to care that you're 'on the wrong side of the county line,' nor the jury at your civil trial if there's a bad outcome that could have been adverted and any EMS agency or office who is going to raise a stink about an out of area, region, or state ambulance providing care to the best of their abilities on a still alarm doesn't care about the citizens who they are supposed to be protecting. To give a perfect example, even though they were EMTs, the patient and the public didn't care that the primary job of those two FDNY dispatchers was dispatching and not field work.


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## CAOX3 (Jul 11, 2010)

I do what I was trained to do.  Its going to be worse for everything involved including the patient (remember them) when they realize a fully staffed ambulance was in the parking lot eating their chicken nuggets but didnt act because of a line drawn in the sand by some bureaucrat.

Then again I dont I dont do my job in fear of litigation.


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## DrParasite (Jul 11, 2010)

hopefully you have a GPS, and put in nearest hospital lol

do what you got to do.  does someone need help?  looks like it.  can you help?  looks like it.  

book answer?  call the AHJ, stabilize as best you can until they get there.  

my answer?  do what you got to do, call your medical director as protocol dictates (during a call or afterwards to advise him/her), tell your boss what you did when you get back to your area (probably write an incident report to explain why you did what you did), transport to the hospital, and don't get lost.


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## jjesusfreak01 (Jul 11, 2010)

JPINFV said:


> That would be true, except ambulance services aren't supposed to accept calls originating in counties that they aren't licensed in.


I'm referring to a situation in which you happen to find yourself at a scene, not one where you accept a call outside your area. (Except in an MCI, the counties surrounding mine would never dispatch an out of county truck to a call, and if they did, they would need to do it through our dispatch)



> You don't do very many long distance transfers, do you?


Nope, we have lots of good hospitals in the immediate area. People roll in, walk out.


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## medicwilliams19822010 (Jul 11, 2010)

Well its not my district or area but i'm on duty so i would have to treat the Siezing Patient as my own until the local district E.M.S.A. Arrives on scene. And I would have to start siezure protocol and get the patient on board our rig or unit and continue treatment until the Local EMSA arrives. And apon their arrival I would bring the local E.M.S.A. / incident commander / captain up to speed on patients conditions and other vital Information. As well as what protocol we used and then sign patient over to the local area E.M.S.A.


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## Veneficus (Jul 11, 2010)

I have to ask...

Is this a problem in any other place except California?


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## JPINFV (Jul 11, 2010)

Veneficus said:


> Is this a problem in any other place except California?



Any place near state lines. When I worked in Massachusetts we had a dialysis patient who lived in Mass and had his dialysis in Rhode Island. We posted down there for the duration of his treatment (very small company and this patient had a habit of ending his treatment early) and it was a very real probability that someone could have come up to us while we were posting (which, looking at the map, was normally just on the RI side of the state line) or eating breakfast (Danny's Breakfast Place in Woonsocket has wonderful food at an awesome price). Similarly, any company that does long distance transports past state lines. I know that the company I worked for in California would end up with a transport going to Nevada a few times a year (these crews were assigned in advance). I imagine that there was a very real risk for them as well, especially if they ended up grabbing a motel room for the night.


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## Veneficus (Jul 11, 2010)

JPINFV said:


> Any place near state lines. When I worked in Massachusetts we had a dialysis patient who lived in Mass and had his dialysis in Rhode Island. We posted down there for the duration of his treatment (very small company and this patient had a habit of ending his treatment early) and it was a very real probability that someone could have come up to us while we were posting (which, looking at the map, was normally just on the RI side of the state line) or eating breakfast (Danny's Breakfast Place in Woonsocket has wonderful food at an awesome price). Similarly, any company that does long distance transports past state lines. I know that the company I worked for in California would end up with a transport going to Nevada a few times a year (these crews were assigned in advance). I imagine that there was a very real risk for them as well, especially if they ended up grabbing a motel room for the night.



The providers didn't have to have a cert for the second state or was there automatic reciprocity?


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## JPINFV (Jul 11, 2010)

For the CA->NV trips: never as we had absolutely no intention of ever picking up patients in NV. 

For MA->RI, my understanding is that return transports are treated differently than initial transports.


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## Simusid (Jul 15, 2010)

We routinely transport patients across the border from MA into RI.   One scenario is that we could witness an MVA on the highway during our return trip and would be the first responders on scene.  I've been told that we would work at BLS level until the locals arrive.    If ALS is required, one option is to have the RI dispatcher request mutual aid since we have an agreement in place.   Then we can actually take the call.

I don't know if we could legally hand over ALS care from a MA medic to an RI cardiac though.


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## jjesusfreak01 (Jul 15, 2010)

Simusid said:


> We routinely transport patients across the border from MA into RI.   One scenario is that we could witness an MVA on the highway during our return trip and would be the first responders on scene.  I've been told that we would work at BLS level until the locals arrive.    If ALS is required, one option is to have the RI dispatcher request mutual aid since we have an agreement in place.   Then we can actually take the call.
> 
> I don't know if we could legally hand over ALS care from a MA medic to an RI cardiac though.



Hmm, in my complete inexperience, I would say that if it's an ALS level call, you would probably need the medics staying with the patient unless...the cardiac scope of practice included everything necessary to care for the patient. I have been looking over the protocols for RI, and while it looks like the EMT-Cs can do almost all of the treatments used for cardiac patients, they are still somewhat limited. 

Were I faced with that odd situation, I would have the EMTs on scene call their medical director. If they MD was ok with the transfer to the cardiacs, then all is well.


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## exodus (Jul 15, 2010)

Call BH and simply get online orders for any procedures...


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## JPINFV (Jul 15, 2010)

You know... calling base hospital doesn't really change the fact that you're "responding" to a still alarm (responding doesn't really feel like the right verb) in an area you aren't licensed to operate in, which is what the entire conundrum is. The medical director isn't going to have any additional information about what the official policy and/or law is (besides, you can't be ordered to violate state law anyways). As I mentioned earlier, this is one of the issues that separate EMS from a professional and a technical trade. Are you going to rely on your judgment to decide what your actions are going to be based on your training, understanding of both the letter and application of the law, and the situation at hand, or are you going to follow a check list (which includes playing the 'phone a friend' card in the "I'm afraid to make a decision, so I want to put the liability on someone else" card). 

I've already shown earlier how "Well, no ALS because..." card gets thrown out of the window when legitimate, time critical, life threatening pathologies are present. Should it be expected that paramedics operating outside of their area operate at their fullest? Probably not. There's a difference between someone needing an intervention -now- and someone who would get the IV/Monitor/Transport just in case treatment.  If we're already waiting on the primary paramedic responders to respond, it makes sense putting off some interventions. However I can't think of a single reason why someone would put off an immediately life saving intervention.


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## exodus (Jul 15, 2010)

JPINFV said:


> You know... calling base hospital doesn't really change the fact that you're "responding" to a still alarm (responding doesn't really feel like the right verb) in an area you aren't licensed to operate in, which is what the entire conundrum is. The medical director isn't going to have any additional information about what the official policy and/or law is (besides, you can't be ordered to violate state law anyways). As I mentioned earlier, this is one of the issues that separate EMS from a professional and a technical trade. Are you going to rely on your judgment to decide what your actions are going to be based on your training, understanding of both the letter and application of the law, and the situation at hand, or are you going to follow a check list (which includes playing the 'phone a friend' card in the "I'm afraid to make a decision, so I want to put the liability on someone else" card).
> 
> I've already shown earlier how "Well, no ALS because..." card gets thrown out of the window when legitimate, time critical, life threatening pathologies are present. Should it be expected that paramedics operating outside of their area operate at their fullest? Probably not. There's a difference between someone needing an intervention -now- and someone who would get the IV/Monitor/Transport just in case treatment.  If we're already waiting on the primary paramedic responders to respond, it makes sense putting off some interventions. However I can't think of a single reason why someone would put off an immediately life saving intervention.



Sorry i should have clarified.. Call the *local* and get orders from that doc. That way you are operating under his license.


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## JPINFV (Jul 15, 2010)

That's assuming you have the ability to contact (or even know the procedure for obtaining medical control) a local base hospital.

Edit: Also, how long are you going to work on establishing base hospital contact while your patient is actively dying (I'm not trying to be overly dramatic, but if the patient isn't actively dying, there's little need to not wait on local resources).


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## CAOX3 (Jul 16, 2010)

I dont even get the question.  I read post after post on this site about decking out your car with all the coolest strobes, stickers and lights then packing it with as much gear as possible, risk your lives off duty at MVAs you on site.

But while on duty someone drops and everyone quoting area regulations and limitations.

If im on duty and confronted with a medical emergency, I will act as if I was dispatched to it and that includes transporting if I have to wait for the vollies to mount up.  If you or your chief have a problem you can contact my service, medical director or whoever else floats your boat.

Liability is the last thing on my mind, I am on duty, Im being paid and its about patinet care.  Ill notify you that where in your area and on scene at a medical emergency.  I can wait a reasonable amount of time but Im not delaying any time sensitive complaint because your on a power trip.


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## Simusid (Jul 16, 2010)

CAOX3 said:


> I dont even get the question.  I read post after post on this site about decking out your car with all the coolest strobes, stickers and lights then packing it with as much gear as possible, risk your lives off duty at MVAs you on site.
> 
> But while on duty someone drops and everyone quoting area regulations and limitations.
> 
> ...



I don't disagree with you when operating at the Basic level.   But I do think there is a serious and realistic liability to an ALS responder that takes this same attitude.   Using my example above of a MA medic who is out of their service area in RI, I'm pretty sure that the RI cardiac and MA medic protocols overlap a lot but I would be willing to bet that there are procedures that the Medic may do that the cardiac may not.   (note my careful use of "may" instead of "can") 

"Scope of Practice" was covered on day one or two of my Basic class and this is clearly an example of being outside of it.


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## CAOX3 (Jul 16, 2010)

Its seems that we have become a bit overwhelmed by the threat of litigation here.

I dont operate as an ALS provider so I cant answer that question.

Contact your medical control, I doubt he will instruct you to walk away.


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## tom (Jul 17, 2010)

i think you sould stil treat because althogh your registered in one state you still have your certificate to treat, but i do agree on calling 911 still


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## MIkePrekopa (Jul 23, 2010)

I haven't done any out of state trips (yet), but another company in town has a contract that brings them to NYC, from Scranton PA, fairly often.

The way I see it, it should go like this (assumed that you are an EMT-P, and out of state): 
mind you this is coming from a new EMT-B

911: (insert local 911 speal here)

You (being a EMT-P): This is YourState Medic 1234 from YourCounty. While stopped at ABC rest stop there was a (Cardiac/Epileptic/whatever) emergency and we have started pt care at a BLS level. we are ALS capable and would like to begin ALS care. can you contact local medical command for us?

Now I don't know all the legal aspects of a PA medic in NYC, but the way I see it, know what your medical command DR thinks about the situation, and contact the medical command dr of a nearby hospital to see what they think.


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## tom (Jul 23, 2010)

thats an good idea 




(and yes, im back from france)


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## JPINFV (Jul 23, 2010)

MIkePrekopa said:


> I haven't done any out of state trips (yet), but another company in town has a contract that brings them to NYC, from Scranton PA, fairly often.
> 
> The way I see it, it should go like this (assumed that you are an EMT-P, and out of state):
> mind you this is coming from a new EMT-B
> ...



That's assuming that the 911 operator is able to contact a base hospital.

As I mentioned before, could someone please explain to me the following? If paramedicine is a profession, why do the members insist on acting like technicians?


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## tom (Jul 23, 2010)

JPINFV said:


> That's assuming that the 911 operator is able to contact a base hospital.




lol, i think they should be able to contact hospitals...or at least know someone in the room who can, like a Control -> Hospital Liasion officer


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## JPINFV (Jul 23, 2010)

That's a big assumption still. Where I did the majority of my work, the medical control system had every paramedic assigned to one of 6 base hospitals (with the exception of one city who is under standing orders, but they generally contact one base hospital (which isn't their "resource" hospital) if they need a consult). The connection was done through the sheriff's dispatch center ("Orange County Communications") whereas the 911 operators are done through the city police department and transfered to the fire department as needed. I highly doubt most 911 operators would be able to connect you to one of the base hospitals, if they could even figure out what you were requesting.

Edit: Here's something else to ponder. What sort of physician would be willing to accept this responsibility? If you're a physician, are you really going to accept responsibility for the care rendered by a crew who you don't know, who is admittedly not supposed to be practicing in the area, and you can't verify in a timely manner (remember, unless it's a time sensitive emergency, the entire issue is moot) any information about them? Oh, so you (collective "ZOMG contact medical control group") don't have the intestinal fortitude to do what is proper, but because you're too scared about the repercussions of both providing and withholding care that you want to push the entire decision onto someone else who you have absolutely no professional relationship with? How many people here would take on that responsibility if you were a medical control physician? This is essentially like a company hiring two dudes off a street and taking their word that they have the appropriate education and certifications and doing absolutely nothing to verify anything before putting them on the street.


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## jjesusfreak01 (Jul 23, 2010)

If i'm the medical director in another county/state, and the crew on scene tells me they are a paramedic truck, i'll cover their butt so long as it's legal for me to do so. If they aren't actually qualified then that's totally on them, they probably wouldn't have called mc to ask. 

You look at the situation, realize that this is a very rare occurrence, and then recognize that you are going to catch about 1,000,000 times as much flak if you don't let them help than if you do. The paramedics are already putting their own butts on the line by offering to help, so that should give them a little bit of credibility.


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