# Can EMTs administer medications while not on shift?



## Slushster (Oct 17, 2016)

Im a relatively new EMT now working in PA on a BLS 911 ambulance at my university. A few weeks ago my friend found an .3mg EpiPen at his fraternity after a party and tried to find the person who had lost it. After finding no success, he gave it to me and I tried to find the rightful owner. At this point, there is little hope the Pen will be claimed. My question is whether or not an off duty EMT can administer drugs such as Narcan and Epi during a spotted medical emergency. Please let me know where the line is drawn!
Thanks!!!


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## luke_31 (Oct 17, 2016)

Don't do it. Pushing medications off duty is practicing medicine without a license. You don't want to get into that kind of trouble.


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## Slushster (Oct 17, 2016)

luke_31 said:


> Don't do it. Pushing medications off duty is practicing medicine without a license. You don't want to get into that kind of trouble.



Got it. So in order to actually practice medicine you have to be working with an agency?


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## luke_31 (Oct 17, 2016)

You have to be working with an agency and licensed and accredited to perform the procedure. Essentially what you are looking for is that it is in your protocols to perform the procedure or administer the medication.  Also that your company carries the medications that you can administer or you are allowed to use the patient's medications.


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## NysEms2117 (Oct 17, 2016)

That will be a legal disaster. Maybe just maybe if you say your untrained, and use an epi pen. But don't announce everything personally I just wouldent do it. But that's because I'm excessively cautious with laws


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## Slushster (Oct 17, 2016)

How about this: If anyone is in anaphylaxis Ill call an ambulance! 
This seems like the best approach. 
Thanks for all the responses guys!


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## NysEms2117 (Oct 17, 2016)

Slushster said:


> How about this: If anyone is in anaphylaxis Ill call an ambulance!
> This seems like the best approach.
> Thanks for all the responses guys!


If its a true emergency i become an idiot that "can only read directions", i have NO outside knowledge of anything i would be doing. Example epi-pen "pull cap, hold hand around barrel, put in leg" nothing else, i dont check anything after i dont do any of that.


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## EpiEMS (Oct 17, 2016)

Slushster said:


> My question is whether or not an off duty EMT can administer drugs such as Narcan and Epi during a spotted medical emergency.



Generally speaking, if you're not on-duty, you have no duty to act. However, you are subject to the Good Samaritan law of your state (again, in general - PA does have one). I can't speak to medications, frankly.



NysEms2117 said:


> If its a true emergency i become an idiot that "can only read directions", i have NO outside knowledge of anything i would be doing. Example epi-pen "pull cap, hold hand around barrel, put in leg" nothing else, i dont check anything after i dont do any of that.



This is an interesting line of argumentation - an EpiPen (for example), is pretty easy to use, and its use is commonly taught in first aid courses. Assisting with  or administering a prescribed EpiPen  is, of course, different from administering one that is not the "patient's"...


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## NysEms2117 (Oct 17, 2016)

EpiEMS said:


> This is an interesting line of argumentation - an EpiPen (for example), is pretty easy to use, and its use is commonly taught in first aid courses. Assisting with or administering a prescribed EpiPen is, of course, different from administering one that is not the "patient's"...


I personally am always on the SUPER CAUTIOUS side of the law, whenever it comes to a gray area, now that people sue each other for fun. 10 years ago, if i was my current age, i would help somebody because i know they will see the "good intentions" side of it.


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## EpiEMS (Oct 17, 2016)

NysEms2117 said:


> I personally am always on the SUPER CAUTIOUS side of the law, whenever it comes to a gray area, now that people sue each other for fun. 10 years ago, if i was my current age, i would help somebody because i know they will see the "good intentions" side of it.



No disagreement - I used to be much more gung ho, but I am concerned that I'm overly cautious these days. 

With respect to EpiPens, here's a good little read. A list of state laws concerning naloxone can be found here.


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## NysEms2117 (Oct 17, 2016)

EpiEMS said:


> No disagreement - I used to be much more gung ho, but I am concerned that I'm overly cautious these days.
> 
> With respect to EpiPens, here's a good little read. A list of state laws concerning naloxone can be found here.


in respect to NY, there are conflicting laws, but they are so buried i dont think anybody even realizes it lol


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## EpiEMS (Oct 18, 2016)

NysEms2117 said:


> in respect to NY, there are conflicting laws, but they are so buried i dont think anybody even realizes it lol


Yeah, I have no clue about NYS requirements, myself. I would note NYS Public Health Law Section 3013(4): "A certified first responder, emergency medical technician or advanced emergency medical technician, whether or not he or she is acting on behalf of an ambulance service, or advanced life support first response service, who voluntarily and without the expectation of monetary compensation renders medical assistance in an emergency to a person who is unconscious, ill or injured shall not be liable for damages alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such medical assistance in an emergency *unless it is established that such injuries were or such death was caused by gross negligence* on the part of such certified first responder, emergency medical technician or advanced emergency medical technician." (Underlining and bolding are mine.)


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## dutemplar (Oct 18, 2016)

If it is a publicly owned (emergency cache of some sort), or the patient's own medication and needs assistance with it, usually a Good Samaritan style law offers reasonable protection provided you act in good faith and do not display a gross negligence.

However, if you have "stuff" in your personal jump bag, that usually flies about as well as a 12ga out of a .22 barrel.  Places get persnickety with "Practicing Medicine Without A License" and establishing how people acquired, dispensed, and used medications.

Personally, being from PA, I'd just keep the EpiPen around for house parties next to the salted peanuts or find out a friend who needed to replace theirs...


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## bakertaylor28 (Oct 29, 2016)

dutemplar said:


> If it is a publicly owned (emergency cache of some sort), or the patient's own medication and needs assistance with it, usually a Good Samaritan style law offers reasonable protection provided you act in good faith and do not display a gross negligence.
> 
> However, if you have "stuff" in your personal jump bag, that usually flies about as well as a 12ga out of a .22 barrel.  Places get persnickety with "Practicing Medicine Without A License" and establishing how people acquired, dispensed, and used medications.
> 
> Personally, being from PA, I'd just keep the EpiPen around for house parties next to the salted peanuts or find out a friend who needed to replace theirs...


Actually, the government won't dare make such an argument in a court of law. If it does it essentially dismantles BLS, because merely having BLS certification is NOT a license to practice medicine- and as such even while on the job, BLS personnel are still subject to the same legal principles- regardless of whether or not their on the clock.  

The law in most states also makes it a crime (usually a felony) for any person to knowingly obstruct an EMT or paramedic in the performance of their duty, while acting in official capacity. The federal circuit courts have held that official capacity does not end merely because you punch your time card. Rather, official capacity rests on credential. Thats like saying a police officer can't make arrests off the clock. It just doesn't work that way.


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## FLdoc2011 (Oct 30, 2016)

NysEms2117 said:


> If its a true emergency i become an idiot that "can only read directions", i have NO outside knowledge of anything i would be doing. Example epi-pen "pull cap, hold hand around barrel, put in leg" nothing else, i dont check anything after i dont do any of that.



Be careful of this type of thinking as generally you would be expected to act in accordance with your level of training.   

Obviously would need to check with your state laws for specifics but even if you are acting in a voluntary manner and covered y a Good Samaritan law would still be expected to act within your training/knowledge level.


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## NysEms2117 (Oct 30, 2016)

FLdoc2011 said:


> Be careful of this type of thinking as generally you would be expected to act in accordance with your level of training.


NYS has no mandatory duty to act, so anything i would be doing is as a civilian, not an off duty EMT/paramedic/ whatever healthcare provider you are. In NYS it is ethical, not mandatory. To be completely honest i probably would not even announce myself as an EMT, i would just be "the brave soul" that actually does the action on the future patient. Also if you'd like the protocols(as per state regulations) i think it is Public Health Article 30, section 3000.


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## FLdoc2011 (Oct 30, 2016)

NysEms2117 said:


> NYS has no mandatory duty to act, so anything i would be doing is as a civilian, not an off duty EMT/paramedic/ whatever healthcare provider you are. In NYS it is ethical, not mandatory. To be completely honest i probably would not even announce myself as an EMT, i would just be "the brave soul" that actually does the action on the future patient. Also if you'd like the protocols(as per state regulations) i think it is Public Health Article 30, section 3000.



It's true you would be covered under that acting in a voluntary manner but it doesn't protect you (or anyone for that matter) if you commit gross negligence,  and since we're trained providers we automatically know more than the general public and could theoretically be held for gross negligence if we did something that a lay person may not be.    I'm not saying it's a duty to act, it's not, but it's also not an excuse to act like you know nothing at all IF you choose to help.    If you come across a car wreck with obvious trauma nd attempt to pull a person out of the car assuming they aren't in imminent peril from staying in the car, then a general lay person may not know not to move them or what precautions to take but you do and would be expected to act that way.


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## FLdoc2011 (Oct 30, 2016)

Also, just to be clear,  I'm also not saying that we would be expected to carry certain equipment or medications to be able to give off-duty.    

As a physician IF I choose to stop I would give whatever care I could with what was available which would likely just be notifying EMS and comforting the patient.   BUT I certainly would not pretend like I know nothing and not use my medical training/knowledge


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## bakertaylor28 (Oct 30, 2016)

NysEms2117 said:


> NYS has no mandatory duty to act, so anything i would be doing is as a civilian, not an off duty EMT/paramedic/ whatever healthcare provider you are. In NYS it is ethical, not mandatory. To be completely honest i probably would not even announce myself as an EMT, i would just be "the brave soul" that actually does the action on the future patient. Also if you'd like the protocols(as per state regulations) i think it is Public Health Article 30, section 3000.



Not so much as mandatory duty, its more along the lines of your constructive *right* to act. And even if the state doesn't explicitly have a mandatory duty to act, failure to reasonably act could be seen as criminal negligence. (because even if someone isn't trained at all they must still take the minimum steps that any reasonable person would know to take, such as activating the EMS system, etc.) The flip side is that what is considered "reasonable" under the case law takes into account a persons level of training, and what is available on scene. 

Minimally these days CPR equipment should be on scene in most places. I mean there's about ZERO chance someone's getting CPR from me without a BVM being on hand, unless I know this person well enough to trust that their probably NOT a bio threat. This is why I think that every BLS trained individual should be carrying a pocket BVM. They're surprisingly small enough, yet will give full functionality as their standard traditional types. (even though the masks on them suck)


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## NysEms2117 (Oct 30, 2016)

Well the thing is if I ever was in a situation like that. Unless the person was going to die within the next minute I wouldent do anything aside from call 911. I also think it's a little different being a physician and an EMT. I do understand both of your points though. Although I don't think any of those cases would even stand a remote chance in court


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## FLdoc2011 (Oct 30, 2016)

bakertaylor28 said:


> Not so much as mandatory duty, its more along the lines of your constructive *right* to act. And even if the state doesn't explicitly have a mandatory duty to act, failure to reasonably act could be seen as criminal negligence. (because even if someone isn't trained at all they must still take the minimum steps that any reasonable person would know to take, such as activating the EMS system, etc.) The flip side is that what is considered "reasonable" under the case law takes into account a persons level of training, and what is available on scene.
> 
> Minimally these days CPR equipment should be on scene in most places. I mean there's about ZERO chance someone's getting CPR from me without a BVM being on hand, unless I know this person well enough to trust that their probably NOT a bio threat. This is why I think that every BLS trained individual should be carrying a pocket BVM. They're surprisingly small enough, yet will give full functionality as their standard traditional types. (even though the masks on them suck)



I think you're crossing over into what a lot of us probably think is that it's ethical to help if you can but that's a different topic.  I'm purely talking about what's spelled out in law.     Certainly not spelled out that we must carry even basic equipment or stop/help at all.


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## bakertaylor28 (Oct 30, 2016)

NysEms2117 said:


> That will be a legal disaster. Maybe just maybe if you say your untrained, and use an epi pen. But don't announce everything personally I just wouldent do it. But that's because I'm excessively cautious with laws



Vs. withholding the epi and allowing anaphalaxis to progress? are you kidding? Forgoing epi even a short time when dealing with clear symptoms of anaphalaxis is ASKING AND BEGGING for a full arrest- or at least the need for an advanced airway on the most difficult possible terms. 

The thing to remember is that anaphalaxis can progress extremely quickly to a full arrest- sometimes in a matter of a few minutes.


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## FLdoc2011 (Oct 30, 2016)

NysEms2117 said:


> Well the thing is if I ever was in a situation like that. Unless the person was going to die within the next minute I wouldent do anything aside from call 911. I also think it's a little different being a physician and an EMT. I do understand both of your points though. Although I don't think any of those cases would even stand a remote chance in court



I agree and that's what I would do as well.   And you never want to be a test case.   I have seen mention of some case studies and one where a civilian pulled a person from a car possibly aggravating their injuries and was sued,  I don't think anything came of it but still, what a hassle. 

In basic, use reasonable/common sense based on what you know.  No need to play "dumb".


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## NysEms2117 (Oct 30, 2016)

bakertaylor28 said:


> Vs. withholding the epi and allowing anaphalaxis to progress? are you kidding? Forgoing epi even a short time when dealing with clear symptoms of anaphalaxis is ASKING AND BEGGING for a full arrest- or at least the need for an advanced airway on the most difficult possible terms.
> 
> The thing to remember is that anaphalaxis can progress extremely quickly to a full arrest- sometimes in a matter of a few minutes.



I don't even know what this is in reference too. I said I would use the epi-pen provided nobody else stepped up 


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## FLdoc2011 (Oct 30, 2016)

NysEms2117 said:


> I don't even know what this is in reference too. I said I would use the epi-pen provided nobody else stepped up
> 
> 
> Sent from my iPhone using Tapatalk



Yea I'm not sure what he's getting at with some of these posts.  

Honestly unless I've witnessed the event, am by myself and no other help is available I don't get involved beyond calling 911.   Usually I have my family with me and am not stopping or even for the slightest second potentially exposing my family to some risk. 

Thankfully I haven't come across an in-flight emergency yet....


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## NysEms2117 (Oct 30, 2016)

FLdoc2011 said:


> In basic, use reasonable/common sense based on what you know.  No need to play "dumb".



Yes sir/ma'am 


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## NysEms2117 (Oct 30, 2016)

FLdoc2011 said:


> Yea I'm not sure what he's getting at with some of these posts.
> 
> Honestly unless I've witnessed the event, am by myself and no other help is available I don't get involved beyond calling 911.   Usually I have my family with me and am not stopping or even for the slightest second potentially exposing my family to some risk.
> 
> Thankfully I haven't come across an in-flight emergency yet....



This x100000 except the whole flight thing. I cannot justify putting my family in harms way.


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## FLdoc2011 (Oct 30, 2016)

NysEms2117 said:


> This x100000 except the whole flight thing. I cannot justify putting my family in harms way.
> 
> 
> Sent from my iPhone using Tapatalk



Exactly.


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## bakertaylor28 (Oct 30, 2016)

FLdoc2011 said:


> I think you're crossing over into what a lot of us probably think is that it's ethical to help if you can but that's a different topic.  I'm purely talking about what's spelled out in law.     Certainly not spelled out that we must carry even basic equipment or stop/help at all.



Right, but the common law and case law controls the statutory law. The definition of "Gross Negligence" at common law is "lacking even the slightest care, that a reasonable and prudent person would take"- and the case law has made clear that that definition is subject to a person's documented level of training. You also have to understand that most jurors will side with EMS personel providing treatment- because when you think about it, I seriously DOUBT anyone is really going to CARE about the technicalities of things when their laying on the ground in bad shape at best and fixing to die at worst- I just don't see someone Asking me If I'm on the clock or questioning my credentials in a technical way, in light of such circumstances. Hence, legal liability isn't an issue unless you do something so incredibly stupid that every one of us would be wondering which short bus dropped you off at the scene kind of thing.


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## NysEms2117 (Oct 30, 2016)

Thanks for your input, but I think when it comes to the law I'll do my own interpreting .


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## FLdoc2011 (Oct 30, 2016)

bakertaylor28 said:


> Right, but the common law and case law controls the statutory law. The definition of "Gross Negligence" at common law is "lacking even the slightest care, that a reasonable and prudent person would take"- and the case law has made clear that that definition is subject to a person's documented level of training. You also have to understand that most jurors will side with EMS personel providing treatment- because when you think about it, I seriously DOUBT anyone is really going to CARE about the technicalities of things when their laying on the ground in bad shape at best and fixing to die at worst- I just don't see someone Asking me If I'm on the clock or questioning my credentials in a technical way, in light of such circumstances. Hence, legal liability isn't an issue unless you do something so incredibly stupid that every one of us would be wondering which short bus dropped you off at the scene kind of thing.



Legal liability is always an issue, you'll find out soon enough.    Yea at that particular moment the victim may not care but a few weeks later when they're trying to figure out how they can get some money out of the incident then you can bet they'll be looking for any possible avenue.   

If I'm even at a point where I'm relying on a juror to decide (even if they side with me and I did everything right) then my life has already been turned upside down.


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## bakertaylor28 (Oct 30, 2016)

FLdoc2011 said:


> Legal liability is always an issue, you'll find out soon enough.    Yea at that particular moment the victim may not care but a few weeks later when they're trying to figure out how they can get some money out of the incident then you can bet they'll be looking for any possible avenue.
> 
> If I'm even at a point where I'm relying on a juror to decide (even if they side with me and I did everything right) then my life has already been turned upside down.



Yes, and filing a lawsuit under such pretenses runs on the borderline illegal in most states- could be considered vexatious litigation- which the courts tend not to be fond of at the very least. Not only that- but any more, medical malpractice type litigation is NOT a get-rich quick scheme- it takes a considerable investment of cash to file these types of cases. The reason why, is because plaintiff has burden of proof, which means plaintiff has to pay the initial hefty fees for expert witnesses before their even allowed to file. Otherwise, the courts have a tendency to dismiss the case as mere conclusory allegations. This has been part of the med-malpractice overhaul in the last 20 years or so- nowdays with anything medical, in most states, you have to have an expert from the same field as the named defendant agreeing that there was negligence, before the courts will even allow you to file. 

Of course, in my particular state, I can't be sued for medical malpractice- because of the fact that I am recieving education with a state university teaching hospital. This is because Kentucky's immunity laws extend to anyone whom is in any way affiliated with a hospital owned and operated by the state. Therefore, at this point, I don't even have to worry about liability- I have to worry about the hospital admins, the attendings, and the state regulatory agencies.


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## StCEMT (Oct 30, 2016)

bakertaylor28 said:


> Minimally these days CPR equipment should be on scene in most places. I mean there's about ZERO chance someone's getting CPR from me without a BVM being on hand, unless I know this person well enough to trust that their probably NOT a bio threat. QUOTE]
> Does this include compressions?


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## bakertaylor28 (Oct 30, 2016)

Uh, use some common sense. I was NOT talking about compressions. Though compressions certainly aren't going to get you far in such circumstances.


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## StCEMT (Oct 30, 2016)

bakertaylor28 said:


> Uh, use some common sense. I was NOT talking about compressions. Though compressions certainly aren't going to get you far in such circumstances.


All I had to go off of what was you said and in that you said "....there's about ZERO chance someone's getting CPR from me....", which is why I asked for clarification. Compressions are kinda important and 0 CPR= 0 compressions to me.


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## bakertaylor28 (Oct 31, 2016)

StCEMT said:


> All I had to go off of what was you said and in that you said "....there's about ZERO chance someone's getting CPR from me....", which is why I asked for clarification. Compressions are kinda important and 0 CPR= 0 compressions to me.


Well gee, If I have to be THAT specific. The point I was making was that unless we're dating I'm NOT kissing you... CPR or not. :-D After All thats what the BVM is for...smh


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## Tigger (Oct 31, 2016)

bakertaylor28 said:


> Not so much as mandatory duty, its more along the lines of your constructive *right* to act. And even if the state doesn't explicitly have a mandatory duty to act, failure to reasonably act could be seen as criminal negligence. (because even if someone isn't trained at all they must still take the minimum steps that any reasonable person would know to take, such as activating the EMS system, etc.) The flip side is that what is considered "reasonable" under the case law takes into account a persons level of training, and what is available on scene.
> 
> Minimally these days CPR equipment should be on scene in most places. I mean there's about ZERO chance someone's getting CPR from me without a BVM being on hand, unless I know this person well enough to trust that their probably NOT a bio threat. This is why I think that every BLS trained individual should be carrying a pocket BVM. They're surprisingly small enough, yet will give full functionality as their standard traditional types. (even though the masks on them suck)


I think you should stick to doctoring over lawyering.


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## dutemplar (Oct 31, 2016)

bakertaylor28 said:


> Actually, the government won't dare make such an argument in a court of law. If it does it essentially dismantles BLS, because merely having BLS certification is NOT a license to practice medicine- and as such even while on the job, BLS personnel are still subject to the same legal principles- regardless of whether or not their on the clock.
> 
> The law in most states also makes it a crime (usually a felony) for any person to knowingly obstruct an EMT or paramedic in the performance of their duty, while acting in official capacity. The federal circuit courts have held that official capacity does not end merely because you punch your time card. Rather, official capacity rests on credential. Thats like saying a police officer can't make arrests off the clock. It just doesn't work that way.




It's been a 3-5 years now, but two PA medics were de-certed permanently for practicing without a license off duty.  One from Lancaster, and one from Schuylkill County.  I read of another from Maryland, career medic/ff in the city who ended up doing ALS skills riding along on a county unit but without the authority to practice also had his MD cert pulled also, maybe 2.5 years ago now.  I didn't follow up but at least one was explaining why he had an IV and other stuff in his car and looking at theft charges, fired from his company, etc...

Pennsylvania, Title 35 § 8154 (B) Obstruction of EMS is a summary offense. 
http://www.legis.state.pa.us/cfdocs...tl=35&div=00.&chpt=081.&sctn=054.&subsctn=000

Maryland was a summary or lowest misdemeanor,... Most states I am aware of haven't upgraded that to felony.  When actually occurring, it's _theoretically_ possible that assaulting EMS is a felony, but always ends up a summary disturbing the peace charge unless there is serious injury or complications, the DA's are busy and don't give a damn.

Some states vary.  Delaware, for example, from what I recall - any off duty paramedic can be "activated" and become "on duty" but just needs to report it.  Doesn't work if he is in, say, New Jersey though, and they are "on the clock" when activated.  They're also a government model and not a third party, or hospital based type.

It's been my experience the prehospital laws in most states predicate your ability to practice EMS as dependent upon a Medical Director's medical license.  Police and EMS are apples and oranges, and the closest similarly would be could a local Louisiana sheriff make an arrest while on vacation, in a bar, in New York City?  Off duty firefighters can't just hop on a truck in another city and go to a job, pack up and go interior...


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## NysEms2117 (Oct 31, 2016)

dutemplar said:


> Maryland was a summary or lowest misdemeanor,... Most states I am aware of haven't upgraded that to felony.


NYS is bringing it to a class E felony in 2017... Well possession of a hypodermic instrument.(im sure criminal mischief could stick, misconduct, ect ect)
Also give me a few weeks with a case, and i'm pretty sure i can get some charges to stick.
However.... 
"
S 195.16 Obstructing emergency medical services.
  A  person  is guilty of obstructing emergency medical services when he
or she intentionally and  unreasonably  obstructs  the  efforts  of  any
service,  technician,  personnel,  system  or  unit specified in section
three thousand one of the public health law in the performance of  their
duties.
  Obstructing emergency medical services is a class A misdemeanor.
"
Great points though  bravo sir!


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## dutemplar (Nov 1, 2016)

https://www.ena.org/government/State/Documents/StateLawsWorkplaceViolenceSheet.pdf


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## NomadicMedic (Nov 1, 2016)

dutemplar said:


> Some states vary.  Delaware, for example, from what I recall - any off duty paramedic can be "activated" and become "on duty" but just needs to report it.  Doesn't work if he is in, say, New Jersey though, and they are "on the clock" when activated.  They're also a government model and not a third party, or hospital based type.



The activation as a medic is only if you're on the scene of an incident while off duty and the medic on scene needs another set of hands or needs a second paramedic for a DFI.


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## Kevinf (Nov 1, 2016)

dutemplar said:


> It's been a 3-5 years now, but two PA medics were de-certed permanently for practicing without a license off duty.  One from Lancaster, and one from Schuylkill County.



I'm curious about these, some light-weight googling didn't turn up anything useful.


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