# BLS doing ALS skills illegal?  Immoral?  Unethical?



## MMiz (Dec 22, 2005)

As many know, I'm trying to start an EMS club.  Part of this would be demonstrating lots of "cool" stuff for the students.

Because I'm at the BLS level, I can only stick a combitube down Rescue Randy's throat so many times before it gets old.

Would it be _wrong_ for me to demonstrate ALS skills?  Is there a legal or ethical issue?

Could I hook someone up to an EKG on the LifePak 12?
How about tube 'ole Randy?

Just something I was thinking about that I thought others may have some feelings about.


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## TTLWHKR (Dec 22, 2005)

Train em so they know how to assist the medic. Other wise he's basically alone with an observer.


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## MMiz (Dec 22, 2005)

TTLWHKR said:
			
		

> Train em so they know how to assist the medic. Other wise he's basically alone with an observer.



This is more for me than for them.  I'm thinking is it unethical for me to be showing these skills.


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## squid (Dec 22, 2005)

Are you saying you can only provide BLS, but you know ALS stuff? And are you actually teaching these kids, or just hanging out and talking about EMS? I'm assuming you're teaching the kids at least first aid or something.

Here's what I'm thinking as a teacher. There are some pretty fussy rules about what you're allowed to teach and even say to student in an EMT class or such, but I think an exciting scenario might be fun. Perhaps you could do an occaional demo day where you announce very clearly that you are not instructing, but that people with much more training than they have can do all kinds of nifty things, and then get a couple of friends to run a megacode simulation or something so the kids can see what it's like when everyone works together at a fast pace. Because they will think it's *cool.*

In other words, I think if you draw extremely clear boundaries about what you're actually teaching them and what you're just showing them, you could do a few more advanced techniques in your class.


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## emtbuff (Dec 22, 2005)

I agree with Squid as long as you make it well known that this is for demonstration only and that they should in no way attempt to do what you are about to do you should be fine.  I also like the megacode demo as that will show how team work is part of our everyday life and the importance of it.  

Actually I was thinking of comeing up with something small for when we have to do our kindergarten tours as to just stand there and talk.   As I think they would like a demonstration more.


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## Wingnut (Dec 23, 2005)

I agree. I forsee no problem in showing them ALS as long as you tell them that it's not something you or them can actually do in the field. In fact I think it's wise of you to show them, if they ever did get in a situation where they'd use thier skills, it would help them to know what to expect from the medic and the basic procedures. It may even make it a little less intimidating. You could have it be "Be a medic day". Have a little lecture about the rules etc., then have some fun with it.


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## Jon (Dec 24, 2005)

I agree, and really like the "have a medic come in and run a megacode" idea.

But if you hooked yourself up to a LP12 to show what a heartbeat REALLY looks like... that might be cool.  Of couse, if you looked at each kid, what if you found something abnormal??? how would you handle that???


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## AnthonyM83 (Dec 24, 2005)

Is there anything wrong with it?
If you're teaching a skill, then yes.
If you're a giving a demonstration, then no.


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## CaptainPanic (Dec 25, 2005)

I have an idea - train them in CPR, BVM, NPAs, OPAs, etc, then build up to having them walk in and blindside them with a code scenario. This teaches them to work as a team, think on their feet, and the importance of knowing these skills. Whether it is BLS or ALS a code is a code and you have to do your best within your training limits to save a persons life and its no less of a "rush" reagardless of whether it is combitube or intubation.

Good Luck.

-CP


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## nyc.ems (Jan 2, 2006)

bls can only provide the level of care that they learn.to provide als service will be hard.....1-because you dont the equipment on bls buses,2-if any thing happens you just went over your scope of practice...you can get in trouble;either licensed taken away  or jail time...


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## MMiz (Jan 2, 2006)

nyc.ems said:
			
		

> bls can only provide the level of care that they learn.to provide als service will be hard.....1-because you dont the equipment on bls buses,2-if any thing happens you just went over your scope of practice...you can get in trouble;either licensed taken away  or jail time...



You're absolutely right.  I was talking more along the lines of whether it was okay to demonstrate ALS skills to my students (7th grade) even though I'm only an EMT.

I really like my students, but I'm not feeling the whole jail time thing :glare:


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## FFEMT1764 (Jan 3, 2006)

Gee, I'm glad someone started this one...my service recently had and issue with this...seems someone acted beyond their scope of practice...now we have a wonderful "internal" investigation going on...I'm just waiting for my turn before the interrogators as it seems they are talking to everyone who has recently worked with this person......I wish that for once I wouldn't get stuck with the brand new fresh off probation basics that have a para-god complex...


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## Jon (Jan 3, 2006)

Did you hear about the PA EMT who put a "-P" on his card, got a job as a medic, did the job, and now turned his EMT cert in after being found out???


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## FFEMT1764 (Jan 3, 2006)

OMG and that is scary moreso because the agency that hired him didnt verify with the state that he was a medic...every service around here always calls the state before hiring someone


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## nyc.ems (Jan 4, 2006)

there are too many quick draw-migraws out here!! there is one thing we need to learn if were're ever giong to make as an emt-b...which is know who we are.we are not cops, fire fighters,als,(maybe investigaters depending where you work..new york is wild like that)we are EMTs.too many emts that get in trouble for nonsense.if emts want to do more go take the test for cops,ff,etc.let's get out there and have fun...our main goal is to make it home after every shift.....


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## CaptainPanic (Jan 4, 2006)

Sheesh - I applied at MEMS and they want to know everything about you including what color your butt is.

They do state and FBI background checks, they want to you give a small questionnaire to yout former employers that ask questions like - whats this person on time, were they absent from work alot?, what was the reason for termination. blah blah blah. Which I think is a good thing, it weeds out those who wouldnt be good workers before the interview process, and as big as they are they have a very efficient hiring process which seems to work. Now I just hope all of my former employers have said good things about me and hopefully I will get a call back for an interview.

-CP


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## FFEMT1764 (Jan 4, 2006)

Alot of places are requiring FBI and state checks now, especially post 9-11...sure wouldnt want a terrorist to take a bus and fill it with c4 now would we.


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## Jon (Jan 4, 2006)

CaptainPanic said:
			
		

> Sheesh - I applied at MEMS and they want to know everything about you including what color your butt is.
> 
> They do state and FBI background checks, they want to you give a small questionnaire to yout former employers that ask questions like - whats this person on time, were they absent from work alot?, what was the reason for termination. blah blah blah. Which I think is a good thing, it weeds out those who wouldnt be good workers before the interview process, and as big as they are they have a very efficient hiring process which seems to work. Now I just hope all of my former employers have said good things about me and hopefully I will get a call back for an interview.
> 
> -CP


The one ambulance Co. I worked for that I left, at a time not of my choosing - they have a policy on references. They will verify Hire and Termination Dates, and that the employee was employed. Nothing more.

I explain this everytime I apply for a job. I also explain WHY I do not work there anymore (I would work an 16hour shift, get 4-5 hours of sleep, then work another 18+ hour shift, because they begged for folks to stay over). When I was late to work too many times on the second day, they fired me because of a "pattern of tardiness."  . I was late because I stayed 18 hours for a 10 hour day.


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## coloradoemt (Jan 4, 2006)

MMiz said:
			
		

> This is more for me than for them. I'm thinking is it unethical for me to be showing these skills.


 
As an instructer myself I believe it is only unethical to show someone how to perform the skills you are talking about the wrong way. And don't let them think they are going to get to perform these skills either.


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## FFEMT1764 (Jan 4, 2006)

Exactly..if they get the idea in their head that they can do it they will complain when they can't.


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## coloradoemt (Jan 8, 2006)

FFEMT1764 said:
			
		

> Exactly..if they get the idea in their head that they can do it they will complain when they can't.


 
I could care less if they complain about it. I just would not want them working ouside their scope and then blaming their FI for the mix up. 

I would be willing to bet that in rural american EMS folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport, or even more simple than that, save their life.h34r:


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## FFEMT1764 (Jan 8, 2006)

coloradoemt said:
			
		

> I would be willing to bet that in rural american EMS folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport, or even more simple than that, save their life.h34r:


 
That may be true in your part of the country, but here in SC if you go outside your scope of practice the state takes your cert away, either for a short suspension or they take it away permanently, and forward that info the the NREMT...they take these violations very seriuosly here...you screw up you pay the price...and by doing this we maintain our providers statewide at a higher level and have a better standard of care because of it.


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## coloradoemt (Jan 8, 2006)

What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated etc. do ya give the basic a shot or let the pt die?? I was not referring to rampant disregard for protocols or scope of practice. Nor was I saying it does happen.


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## FFEMT1764 (Jan 8, 2006)

coloradoemt said:
			
		

> What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated  do ya give the basic a shot.


 
Basic's can intubate in SC...so here that would not be an issue...but I don't think I would let someone that doesnt know hoe to perform a skill make an attempt at it...but I have no problem letting my basic partner's attempt intubation prior to me sticking my nose in there and looking...after all 90% of the pt we tube are already in arrest...so why not give them a shot...if they cant get it in 1 or 2 tries, then I ask them to move and I take a shot at it...


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## TripperAdam (Jan 8, 2006)

I'm feeling myself on both sides of the fence here:

I think that every student of every level could gain some valuable insight by witnesses protocals above their training; if someone with BLS training were to end up working alongside someone with ALS training, they should know what to expect the medic to do in a real situation. 

The flipside of it is: by having seen this skill, and by probably being very keen to save someones life, a person could easily try and overstep their protocals.
I know that a tiny light in my own head would be blinking away... "try it; you've seen it done before!"

So it's both a benefit and a danger...

I think with your students: still show them... but seriously drive it into their heads why they shouldn't practice what they've seen ("you could get in serious trouble; theres a high chance you could screw up and do more harm than good")


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## ffemt8978 (Jan 8, 2006)

Welcome to our own little corner of dysfunction.

Please be sure to introduce yourself, 'cuz if you don't someone else will play 20 questions with ya'.


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## Flight-LP (Jan 15, 2006)

coloradoemt said:
			
		

> What I was trying to say is this, if an ALS crew is out in the middle of nowhere and the medic can not get the pt intubated etc. do ya give the basic a shot or let the pt die?? I was not referring to rampant disregard for protocols or scope of practice. Nor was I saying it does happen.



No you do not let the basic attempt an intubation. You move on to your failed airway algorithm and drop a Combitube, or LMA if a C-Tube is not available.

If you are presented with a patient situation where you have a "crash airway", i.e. immediate need for an airway, the last thing a medic needs is an uneducated and non qualified basic attempting to work outside of their scope of practice.


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## FFEMT1764 (Jan 16, 2006)

The only thing we have a problem with here is the MFR hold the pt hand and saying its gonna be ok, especially bad if the pt is in arrest...or worse purple and cold!  I dont personally let people do skills that they havent been trained in doing with the exception of placing the limb leads on the monitor, its sorta idiot proof, i.e., RA, LA, RL, LL.


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## trauma1534 (Jan 18, 2006)

Show them how to spike a line... how to tear the tape... where everything would be kept in the jump bag to assist the als provider.  Show them how to get out the IV supplies... the differaneces in the size IV needles... teach them to get the stuff out and ready in case of a code... teach them the difference in a mac and miller blade and how to set up for intubation.  I am ALS and I love it when EMT's know how to assist me.  I don't like to have to stop the treatment of a patient to explain how I want my tape torn for an IV, or spike a line when someone else can do it for me while I am doing the stick.  Teach them things that would help the team work smoother in the truck.  There is nothing wrong with that, I think that should be a part of the EMT curriculim to teach them how to assist us.  There is nothing no worse than to be working on a patient and have an emt in the truck setting there with their thumb up their butts, for lack of better term.  Teach them to listen to breath sounds... teach them to hold c-spine, how to back board, better yet, how to find the back board.  Teach them how to get a c-collor, how to apply spider straps (if you use these...  I happen to think that they are the best thing since sliced bread!!!).  Little things like that can take alot of time and they are learning usefull things as well.  *smiles*


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## firegal920 (Jan 19, 2006)

I agree. Not only does it help, it encourages the "up and coming" to become better team members as well as spark their interest in becoming advanced. After all I have to be able to retire sometime.  B) :blush:


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## TTLWHKR (Jan 19, 2006)

coloradoemt said:
			
		

> I would be willing to bet that in *rural american EMS* folks are afforded the opportunity more often to work outside their scope simply to save a pt who has to endure a long transport


 

I sincerely doubt it, unless they have multiple scopes of practice working out of the rig. I've lived and worked in urban and rural >*A<*merica my whole career. And in my time in rural America, I've never seen work done on a BLS rig outside of their scope of practice.. Simply b/c if your rig is not equipped to do anything advanced, you can't do anything advanced.. However if you run BLS and ILS, but do not always have the ILS crew; I could see someone doing a Monday morning q-back. Even though they may not know what they are doing, b/c seeing someone else do it isn't the same as knowing what the hell you are doing.

I have had medic students in PGH jump in a try to start a line because they "are learning how to do it".. but not signed up to train with out rigs. Sometimes I wish they would have been able to bounce, because it would have been nice to physcially throw them out of the rig. h34r: In this day in age, I'm willing to teach anyone how to do my job.. In a classroom. Not on a live patient. People aren't as stupid as we think, if they get uncomfortable by someone doing a procedure, and ask in the ER.. Boom there goes their career and mine. If they haven't trained for months to do a procedure, and been granted rights to perform by some big-wig, then they aren't doing it on my patient. Not only does the patients life hang in the balance, not there for a little fun with skills training, but my whole career and certifications hang there too.


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