# Off-Duty Scope of practice in Pennsylvania



## pghboy2011 (May 4, 2012)

So, this is was a scenario thrown out, and the conversation is actually getting a little dumb, it's similar to a dog chasing its tail....

Here's the situation....

An EMT-B, who is not employed by any service, comes across a woman laying on the ground. ABC's are good, and she has a good mental status, etc, etc, the only issue is that her face is bloody from a fall (she was beat up by her domestic-partner, and left there). The EMT pulls a towel from his car trunk, and has her hold to the wound. 

He tells the patient that he'd like to call for an ambulance, and she says, "No, I'll figure out a way to get to the hospital, I'll take the hospital bill, but I'd like to avoid the ambulance bill, I don't have a lot of money." 

Fearing she won't be able to get there, he takes her to the hospital in his own vehicle, and they both go about their lives....

Was the EMT acting out of his scope of practice for transporting without direct medical command because he wasn't working, or was he covered because she met none of the criteria for requiring ALS back-up, or for needing to call medical command? (If anyone needs quick reference to these protocols, BLS 210, and 901)

(One argument was, he's wrong because he couldn't stablize C-Spine, but the counter argument was...she refused to allow an ambulance to be called, so, c-spine was compromised regardless)

with that being said, can anyone provide me with some kind of reference for off-duty scope of practice for EMT-B's, or would it just stick with our standard protocols?


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## Veneficus (May 4, 2012)

it sounds like the EMT is question was acting as nothing more than a concerned citizen.


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## Medic Tim (May 4, 2012)

Veneficus said:


> it sounds like the EMT is question was acting as nothing more than a concerned citizen.



+1

There was no duty to act and nothing was done above what a first aider or concerned citizen would do.


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## pghboy2011 (May 4, 2012)

Veneficus said:


> it sounds like the EMT is question was acting as nothing more than a concerned citizen.



I totally agree, I see no breach of anything, but then someone brought up, and it's valid, that the good samaritan act typically doesn't apply to licensed (or in our case, certified) medical practitioners.

The biggest advocate against the EMT is an ER Nurse, who went off about the EMT acting as a licensed physican, he was diagnosing, he should have his numbers revoked... It's like...Chill...he applied pressure, and took the victim to the ER, no diagnosis. So really, the EMT is in no wrong, correct?


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## Veneficus (May 4, 2012)

pghboy2011 said:


> I totally agree, I see no breach of anything, but then someone brought up, and it's valid, that the good samaritan act typically doesn't apply to licensed (or in our case, certified) medical practitioners.?



Actually in every state I am familiar with it does. So long as you do the best you can with what you have.




pghboy2011 said:


> The biggest advocate against the EMT is an ER Nurse, who went off about the EMT acting as a licensed physican, he was diagnosing, he should have his numbers revoked... It's like...Chill...he applied pressure, and took the victim to the ER, no diagnosis. So really, the EMT is in no wrong, correct?



It doesn't sound like you were acting like a physician to me. 

Said EMT stopped bleeding and gave somebody a ride to the hospital. No special training for that required. No special medical knowledge/skill involved.

Now if said EMT sutured up her scalp, there might be some trouble.

Sounds like the nurse was just being an ***.


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## bstone (May 4, 2012)

There's no duty to act unless there is by statute.


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## pghboy2011 (May 4, 2012)

Yes, the nurse, whom I generally have a terrific amount of respect for, tends to be inches from the deep end, and frequently falls off haha. She would never admit this, but I don't think she actually has any real respect for EMS

Thanks for your input so far, everyone! I really appreciate it!


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## ffemt8978 (May 4, 2012)

pghboy2011 said:


> I totally agree, I see no breach of anything, but then someone brought up, and it's valid, that the good samaritan act typically doesn't apply to licensed (or in our case, certified) medical practitioners
> 
> The biggest advocate against the EMT is an ER Nurse, who went off about the EMT acting as a licensed physican, he was diagnosing, he should have his numbers revoked... It's like...Chill...he applied pressure, and took the victim to the ER, no diagnosis. So really, the EMT is in no wrong, correct?



PA's Good Samaritan Law does apply to licensed/certified medical practitioners.
http://www.concentric.net/~Maxfax/files/law2.htm


> CHAPTER 83. PARTICULAR RIGHTS AND IMMUNITIES
> 
> § 8331. Medical good Samaritan civil immunity.
> 
> ...



As to the ER nurse, how is he "diagnosing" if the patient refuses treatment/transport?  But here's a little secret for you...EMS diagnoses all the time, we just call it something different.


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## pghboy2011 (May 4, 2012)

bstone said:


> There's no duty to act unless there is by statute.



There was no reference to duty to act, and just because duty to act doesn't apply, doesn't mean that acting is against the scope of practice off duty


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## Veneficus (May 4, 2012)

pghboy2011 said:


> There was no reference to duty to act, and just because duty to act doesn't apply, doesn't mean that acting is against the scope of practice off duty



I have no idea what that means...


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## pghboy2011 (May 4, 2012)

Veneficus said:


> I have no idea what that means...



Basically, duty to act is a non-issue here


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## pghboy2011 (May 4, 2012)

ffemt8978 said:


> PA's Good Samaritan Law does apply to licensed/certified medical practitioners.
> http://www.concentric.net/~Maxfax/files/law2.htm
> 
> 
> As to the ER nurse, how is he "diagnosing" if the patient refuses treatment/transport?  But here's a little secret for you...EMS diagnoses all the time, we just call it something different.



Thank you SO much for posting that, I hadn't been able to find that. Now, unless I'm reading that wrong, where does transporting the patient fit into this? I didn't see anything to allude to anything, but, I may have overlooked it.

The "diagnosis" came into play because the patient didn't refuse treatment, she refused an ambulance because she didn't want to pay for it, but, agreed to go to the hospital if the EMT took her...SO, the "diagnosis" was "determining the patient was fit for transport without contacting medical command..." I'm like.."Helloooo? A) We sort of do it everyday. B)Protocols. Enough said." It would be a disaster if every EMT-B, EMT-P were calling medical command..."Are we allowed to transport this patient? Pretty pleaseeeeee?" You'd think she'd get that as an ER nurse...


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## Milla3P (May 4, 2012)

"I don't want an ambulance" does not tie the hands of an off duty / unemployed provider. 

Call 911, have the boys in blue and the guys on the truck sort it out. 

If anything, it would be morally negligent to not call the police after finding a female that says she was beaten up by her boyfriend. Scumbag deserves some cuffs.


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## pghboy2011 (May 4, 2012)

Milla3P said:


> "I don't want an ambulance" does not tie the hands of an off duty / unemployed provider.
> 
> Call 911, have the boys in blue and the guys on the truck sort it out.
> 
> If anything, it would be morally negligent to not call the police after finding a female that says she was beaten up by her boyfriend. Scumbag deserves some cuffs.




Thanks for the input, I was always trained to (and I imagine how it's reported varies between areas) report abuse, negligence, etc, etc, to the ER staff, and that's a practice that I've always lived by in my work, just document, and report, granted this guy couldn't document exactly, but, that's why, when assessing the situation, my mind doesn't instantly jump to "call the police". You're correct in saying that the EMT's hands aren't tied, but, here's logic I can think up, instead of pulling a truck offline to not be used, and that all goes back to how vehemently she was against the rig, I wasn't there, so I don't know, it was probably just easier to get her in the car, because, on the rig, the treatment would likely be the same, unless they chose to apply a more legit dressing, or whatever...and the end result is the exact same, she ends up at the hospital, so the big question is, was he actually wrong for doing that. 
Again, thanks for the reply, it's not on par with my thoughts, but still a good way to deal with it.


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## Veneficus (May 4, 2012)

I think all the technical jargon here is getting blown way out of proportion.

An off duty (or unemployed) EMT is just some normal citizen.

They do not have the duty to respond, render aid(especially requiring equipment they do not or especially should not have), transport, or notify anyone of anything.

Sometimes getting police involved is one of the worst things that can happen to a person. I know it shouldn't be, but often, especially in the lower ends of society, it is. 

This lady said she didn't want an ambulance. If she is in sound mind, her reasons why are not important. There is a right of self determination. That includes seeking medical care.

In this particular case, the lady apparently wanted to minimize the economic impact.

The cost of medicine in the US, including EMS, is not affordable to some people. They must choose which care they receive and how much.

The lady accepted a ride to the hospital. Mission accomplished.


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## musicislife (May 4, 2012)

If you carry a kit in your car, and are trained, can you perform some BLS procedures (airway if unresponsive, bandages, splinting, ect)?


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## Medic Tim (May 4, 2012)

musicislife said:


> If you carry a kit in your car, and are trained, can you perform some BLS procedures (airway if unresponsive, bandages, splinting, ect)?



yes, you would be protected under this states good samaritan law.


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