# Twofer: Off-duty action



## mycrofft (Aug 5, 2010)

Preface: This is another of those threads asking for something besides opinion. I used SEARCH and read a lot of "I think", "Someone told me once", and "You should have used SEARCH". NO MEAT. SO, the following; and please, give us citations, URL's etc. List the applicable state County or special services district this material comes from.

SCENARIO ONE: Jan Smith belongs to a geology club. When they are going on field trips off the beaten path, she customarily comes along as "the first aid person". The fact is known to the organizers, thanks to Jan, that she is a Paramedic certified in her state and county.
One day another member slips down a slope, comes to rest complaining of back and neck pain and sharp pain in his thigh. Jan goes back to her car with two others, returns with a Hare traction splint, KED, long spine board, and cervical collar, which she applies in the proper fashion. When her co-member starts complaining of pain, she comes back with her kit and administers a pain medication. Twenty minutes later a local ambulance arrives and collects the stricken member.

SCENARIO TWO: Jan Smith is on her way home from her Rock Club meeting and sees a two car accident. Jan gets out of her car, identifies herself as a paramedic, starts triaging victims, and finds one in his car complaining of neck and back pain as well as mid-thigh severe pain. The incident progresses thereafter as above, including twenty minute wait for the local ambulance to arrive.

GIVEN three things: she received no money, the treatments were found to be appropriate, and Jan did not use any means to find the motorist, she truly merely happened upon him.

Was she in the right to exceed basic first aid in these instances? *Please, no "I think" , just the facts.*


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## firecoins (Aug 5, 2010)

No!  She is not right to exceed past basic first aid.  

She is not a doctor with a medical license.  She is not working under another MD's license.  Once she brings PROFESSIONAL medical supplies, she has moved beyond first aid.  Once you beging using professional materials, its a whole new ball game.  Basic first aid only.

Administering pain meds is a HUGE no, no.  The other stuff she might be able to get away with without raising a finger.


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## mycrofft (Aug 5, 2010)

*(dupe post)*

Litela Maneuver. See below for post.


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## mycrofft (Aug 5, 2010)

*And your bases are....?*

Big "I forgot" here. 
I forgot to say she lives in "your" (any reader's) County and the incidents happened there too.


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## Lifeguards For Life (Aug 5, 2010)

mycrofft said:


> Preface: This is another of those threads asking for something besides opinion. I used SEARCH and read a lot of "I think", "Someone told me once", and "You should have used SEARCH". NO MEAT. SO, the following; and please, give us citations, URL's etc. List the applicable state County or special services district this material comes from.
> 
> SCENARIO ONE: Jan Smith belongs to a geology club. When they are going on field trips off the beaten path, she customarily comes along as "the first aid person". The fact is known to the organizers, thanks to Jan, that she is a Paramedic certified in her state and county.
> One day another member slips down a slope, comes to rest complaining of back and neck pain and sharp pain in his thigh. Jan goes back to her car with two others, returns with a Hare traction splint, KED, long spine board, and cervical collar, which she applies in the proper fashion. When her co-member starts complaining of pain, she comes back with her kit and administers a pain medication. Twenty minutes later a local ambulance arrives and collects the stricken member.
> ...





> An off-duty paramedic may perform any procedure or administer medications authorized by KRS 311A.170, or this administrative regulation, at any location within the Commonwealth subject to the written approval of, and limitations set forth by the paramedic’s medical director and, if appropriate, the paramedic’s employer; or the paramedic may render care subject to the limitations of their scope of practice at any location, if ordered to do so by a duly licensed physician. A paramedic performing skills or procedures outside of the normal response area for the paramedic shall accompany and assist with or continue treatment for the patient until the patient is accepted by a receiving hospital, an ALS ground or licensed ALS air ambulance provider, or care is transferred to another licensed paramedic, hospital emergency department, RN, advanced registered nurse practitioner, or physician.


-http://www.lrc.state.ky.us/kar/202/007/701.htm

      202 KAR 7:701. Scope of practice matters.



      RELATES TO: KRS 311A.135, 311A.140, 311A.160, 311A.165, 311A.170, 311A.175

      STATUTORY AUTHORITY: KRS 311A.020, 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, 311A.170

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 311A.025, 311A.030, 311A.135, 311A.140, 311A.160, 311A.165, and 311A.170 require the board to promulgate administrative regulations relating to the scope of practice for individuals certified or licensed by the board. This administrative regulation establishes those scopes of practi

(this is from Kentucky State Legislature, not sure which county or jurisdiction) http://www.lrc.state.ky.us/


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## mycrofft (Aug 5, 2010)

*Great!*

Much like an off-duty policeman, although the line about "subject to written permission". Thanks!


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## Lifeguards For Life (Aug 5, 2010)

mycrofft said:


> Much like an off-duty policeman. Thanks!



I am looking a little deeper in the US DOT and NHTSA.


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## FLEMTP (Aug 5, 2010)

Im confused... so these scenarios all happened in the county & state in which she works & is licensed/certified as a paramedic? Does she work for the said agency that showed up to take over care from her?

Where I work, as long as I am in the county I work for, I am ok to perform whatever off duty as if I am on duty, provided I do it in the same manner as if I were to be on duty. With that said, I dont have all the equipment handy. If I happened to be on scene when a rig pulls up, im a-ok to do whatever I can do per my guidelines.


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## mycrofft (Aug 5, 2010)

*She is not their employee. She is not on the clock.*

F, citation of law or regs?


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## Smash (Aug 6, 2010)

Mycrofft, I can't cite because I'm on my iPhone and can't remember the relevant sections of law, however: where I work, yes she would be covered and it is appropriate to treat beyond first aid. Furthermore, if she were to happen upon an incident she could call the on duty supervisor and let him/her know that she is there. She would the be entitled to 4 hours overtime pay (although she would need to get the run number off the crew to claim it)

The only thing that I would not be sure about is the 'pain medication'. Tylenol or ibuprofen, sure. Opioids or other restricted medications no because she would not be authorized to carry these unless on duty at work.   

Sorry for lack of citations.


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## mycrofft (Aug 6, 2010)

*Interesting.*

Has anyone else found it nearly impossible to find the legaL citations?

I tried to check our California laws and found a thicket. When I tried to email CalEMSA (I like emails because they create a written record), the five email addresses I tried amongst those listed in their website for contact all came up as invalid.

Example: Board of Registered Nurses here advises that no medication (none) can be subpackaged, administered, or furnished without licensure and a MD's order, even if that order is a valid SOP or standardized procedure pertaining to the individual in a certain setting (i.e., I can't as a registered nurse just go out and follow my work's standardized procedures outside the workplace), but they can't just point me to a law and say "here, read this".

I think many folks will find, once they get digging, that the standards are conflicting, sometimes very counterintuitive (one could say nonsensical)scattered, and in many cases do not match what their employers, coworkers and fellow EMTLIFE participants are telling them.

So far, Lifeguard wins.


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## mycrofft (Aug 6, 2010)

*PS: See "Still Alarm" scenario before ths one.*

I was not thinking of it as I started this, but it is illustrative.


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## firecoins (Aug 6, 2010)

Here is the NYC protocol page.
http://www.nycremsco.org/gop.asp?intCategoryID=2&intArticleID=59

No where in the GOP, BLS or ALS are there protocols for how to operate. I know this because I had to memorize them at one point.  Pretty much it means I am not allowed to operate in an official capacity off duty as a paramedic.  I could do first aid. 

I do not carry equipment with me beyond a first aid kit and I am not getting any of that equipment. 

Therefore, I am NOT allowed to administer pain meds off duty.  If I had narcotics off duty, the federal government may com a knocking with a DEA/FBI swat team. I don't know where the Federal drug laws are listed.


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## mycrofft (Aug 6, 2010)

*'Coins, the black helicopters are your FRIENDS!*

FIRECOINS gets a gold star too.

Just before I left my job I saw the new SOP's and cringed. Then I dug in and found that they were legal in one sense, and illegal in another. Overall, they served the patients, so ethically they were OK.

Maybe SOP's etc. ought to have an appendix with the applicable laws, and start with a disclaimer about when they can be used and why?


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## jjesusfreak01 (Aug 6, 2010)

Related question...since current CPR guidelines indicate giving rescue breaths to apnic victims, would an EMT be ok to have a BVM (w/o supplemental O2) in an off duty jumpbag? I'm asking totally from a legal perspective, ignoring the efficacy of rescue breaths during CPR.


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## firecoins (Aug 6, 2010)

jjesusfreak01 said:


> Related question...since current CPR guidelines indicate giving rescue breaths to apnic victims, would an EMT be ok to have a BVM (w/o supplemental O2) in an off duty jumpbag? I'm asking totally from a legal perspective, ignoring the efficacy of rescue breaths during CPR.



I don't think anyone would fault you if you had one and used it.  But no you shouldn't technically have one.


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