# Is suggesting medication allowed?



## Starbase89 (Oct 8, 2009)

I know as a Basic I am not allowed to give medication (aside from very few specified.) If I were to find a kid having an allergic reaction, would it be wrong/out of scope of practice to say "you might want to give him/her some Benadryl." Is that equivalent to giving medication in the eyes of the law?


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## MCGLYNN_EMTP (Oct 8, 2009)

If they are having a true allergic reaction that is worth treating such as anaphylactic patients....Your best thing to suggest is "you might want to call 9-1-1" or you might want to bring them to the hospital....Benadryl will help but the best thing to counter it would be if the patient had their own Epi-pen or if someone could give the patient epi subQ or IV a higher dose of benadryl than that parrent could probably give the kid...if the reaction has bronchoconstricion / spasm associated a neb treatment could help and solu-medrol wouldnt hurt either...but you need a paramedic or the ER for this to happen so......
The best actions IMO would be...
see if they have an epi-pen for the kid and have them administer it if availlable and have them call 911 for an ambulance..

as for the laws on that....I'm not quite sure...im just an ambulance driver


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## Lifeguards For Life (Oct 8, 2009)

Starbase89 said:


> I know as a Basic I am not allowed to give medication (aside from very few specified.) If I were to find a kid having an allergic reaction, would it be wrong/out of scope of practice to say "you might want to give him/her some Benadryl." Is that equivalent to giving medication in the eyes of the law?



If that is the standard of care in your area. while in all reality some benadryl probably would not hurt, if the parent had already given it to him. If a child is having an allergic reaction, and the parent deems it serious enough to call 911 the child needs to be taken to be evaluated by a physician, as you can not properly anticipate complications of the allergic reaction within the next hour, or even within the next couple minutes.
As far as the parent giving benadryl, they would have to give it enterally, which is not absorbed by the body fast enough. even administering diphenhydramine intra muscularly has an onset of 15-30 minutes. 
Worst case scenario if you were to "prescribe" benadryl and this scenario were to end up in court, i think most courts would find this is not the normal response of someone of equal training and ability.


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## Summit (Oct 8, 2009)

Off duty you can give whatever good advice you want as long as you don't identify yourself as a medical authority.

And people can sue you for WHATEVER they want.


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## Akulahawk (Oct 8, 2009)

Sometimes if you remember to ask the patient if they have an Epi-pen... they might remember that they have it and self-medicate...

That might be all that is needed... do you have medication that you take when this happens? Have you taken it? Where is it? 

That kind of thing. Now if it's something new... you're not asking about existing meds... you're suggesting... which may be taken as you prescribing something...

Treacherous ground you walk on... Lawsuits can be plenty, for any reason. Careful, you must be...


(Dagnabbit... I just channeled Yoda...  )


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## MCGLYNN_EMTP (Oct 8, 2009)

Yeah I agree...Just ask if they have medication that they take when this occurs... but these days...you can get sued for ANYTHING and EVERYTHING.


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## SurgeWSE (Oct 9, 2009)

MCGLYNN_EMTP said:


> you can get sued for ANYTHING and EVERYTHING.



This is key.  If you avoid everything in life that someone might sue you for, you'll never leave the house.  Instead focus on making your treatment decisions defensible.  That is to say, if someone chose to sue you for something, you'd be in a good position to defend your actions in court.

If you're confident in your assessment and that the recommended treatment is correct, you'd have no problem defending this recommendation.  If you're not comfortable recommending a treatment, don't.  Benadryl or a Proventil MDI are fairly harmless, but other home meds may not be.  Just stay within reason and stay away from recommending something that you don't fully understand.  Don't do something silly like telling someone with chest pain who's pale and diaphoretic with home rx for NTG to "put a few of these under your tongue," (I've worked the aftermath of someone's decision to use those words).


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## JonTullos (Oct 9, 2009)

My rule of thumb is:  If I can't give it, I don't suggest it.  It's outside of my scope of practice to give anything besides something like InstaGlucose, etc. so why am I going to suggest someone take a med that I can't give?  Lawsuits, I want to avoid them as much as possible.

Now that said, I will not hesitate to tell someone they either need to go see their doctor or go to the hospital (if it's a true emergency).  Surely that wouldn't get me sued.


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## BossyCow (Oct 9, 2009)

I call medical control and tell them that the patient has benedryl or whatever and get their okey-dokey. That way if there's an issue, it was the doc's call but if its going to help, the meds get a head start. But my average transport time is 30 minutes and my MPD is extremely supportive.


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## firetender (Oct 9, 2009)

It's more of a situation-by-situation thing with there being only one question to answer: "If I withhold my best estimate of an action to take to relieve pain and suffering, will I be able to live with it?"


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## SoldierMedic (Oct 9, 2009)

My rule of thumb is: If I can't give it, I don't suggest it. It's outside of my scope of practice to give anything besides something like InstaGlucose, etc.

^^^

Solid advice... and the gentleman suggesting you contact medical control for anything they may have is a good idea. Best bet is simply advise going to the hospital.


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## DV_EMT (Oct 9, 2009)

ABSOLUTELY NOT!!!!! Even as a state and national pharmacy tech. You can by no means reccomend any medication. EVER. Period. The only professionals who CAN reccomend medications are Pharmacist and Doctors. Nurses are iffy and kinda can. As a basic or even a medic.... Absolutelty not. You can be sued, fired, and even lose your licence. So don't do it!!!

Sorry to come off so harsh. But having been in pharmacy for so long... It's just pounded into your head


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## Seaglass (Oct 9, 2009)

JonTullos said:


> My rule of thumb is:  If I can't give it, I don't suggest it.  It's outside of my scope of practice to give anything besides something like InstaGlucose, etc. so why am I going to suggest someone take a med that I can't give?  Lawsuits, I want to avoid them as much as possible.



This, mostly. Two places I work allow me to give out handouts to patients who refuse care or don't meet transport criteria for certain conditions. Those handouts recommend all sorts of stuff. But they're legally coming from PAs and doctors, not me...


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## Aidey (Oct 9, 2009)

I will give advice, but I rarely, rarely, rarely ever name a specific medication. For example, on something like a cold and flu who doesn't want to go to the hospital I may tell the pt something like this. 

 "You need to stay hydrated, and eat which will help. You may also want to see if there are any over the counter medications that can help your symptoms, like cough syrup or something to reduce your fever. Make sure that any medication you take won't interact with any medications you are taking. Also make sure that you don't take multiple things with the same medication in them, for example don't take a cough syrup and a pill that both have tylenol in them. If you have any questions or concerns about taking over the counter medications call your doctor's office or speak with the pharmacist at the store." 


Disclaimer: Obviously before telling a person this I will have at the very least gotten a list of their meds, allergies and medical history, so I'm not just telling this to someone without knowing anything about them.


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## John E (Oct 10, 2009)

*DV EMt...*

Can you point to the law in California that specifically states that I can't recommend a legally obtained, over the counter medication to someone who asks me for my opinion?

John E.


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## DV_EMT (Oct 10, 2009)

John E said:


> Can you point to the law in California that specifically states that I can't recommend a legally obtained, over the counter medication to someone who asks me for my opinion?
> 
> John E.




Yes I can:

From the Ca Pharmacy Law Book


4051. Conduct Limited to Pharmacist; Conduct Authorized by Pharmacist
(a)
Except as otherwise provided in this chapter, it is unlawful for any person to manufacture, compound, furnish, sell, or dispense any dangerous drug or dangerous device, or to dispense or compound any prescription pursuant to Section 4040 of a prescriber unless he or she is a pharmacist under this chapter.
(b)
Notwithstanding any other law, a pharmacist may authorize the initiation of a prescription, pursuant to Section 4052, and otherwise provide clinical advice or information or patient consultation if all of the following conditions are met:
(1)
The clinical advice or information or patient consultation is provided to a health care professional or to a patient.
(2)
The pharmacist has access to prescription, patient profile, or other relevant medical information for purposes of patient and clinical consultation and advice.
(3)
Access to the information described in paragraph (2) is secure from unauthorized access and use.



http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf

....and depending on your county. I highly doubt it says that you can "recommend" medications as a basic. As a basic... or even a RX tech for that matter.... you have no where near the knowledge of Pharmacology that a pharmacist has.


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## JPINFV (Oct 10, 2009)

^
1. No where in part A of your quote prohibits advice.

2. Unless the clerk at the 7-11 is a pharmacy, I'm going to take a leap and say that over the counter medications are not considered a "dangerous drug." 


That said, especially as a basic, I'd be more than hesitant on recommending a medication to a patient. Want to recommend OTC medications to family and friends, sure why not? Just because you're a basic doesn't mean you have to refrain from word of mouth suggestions like everyone else. When treating a patient, you should shy away from providing patient education in areas you aren't educated in. For example, the last thing you want to do is try to explain why you advised a parent to administer aspirin to a child with a cold.


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## John E (Oct 10, 2009)

*Thanks for the reference but...*

theres nothing in the law/regulation that you quoted that refers to an EMT giving advice when it's been solicited by a patient or did I miss that part?

I would also suggest that the law/regulation that you quote applies to pharmacists and pharmacy technicians who dispense prescription drugs, not to an EMT who's asked a question by a patient. The fact that you're quoting the "Ca Pharmacy Law Book" I believe lends credence to my argument, not to yours.

The county in which I work doesn't prohibit my freedom of speech so far as I know. If someone asks me a question about a legally obtained over the counter medication, I can give my opinion about it. I can't prescribe or administer it.

John E.


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## JPINFV (Oct 11, 2009)

Freedom of speech isn't going to protect you from malpractice lawsuit if some patient takes your *medical advice* and has an adverse reaction to a medication you suggested.


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## John E (Oct 11, 2009)

*We weren't talking about malpractice...*

in the first place, secondly, as someone else so succintly put it you can be sued by anyone for anything. 

Look it's real simple, if a patient asks me I'll say that I use Benadryl for allergies, I don't tell them to take it, I don't prescribe it nor do I offer it to them. Contrary to some people's comments, even EMT's are allowed to share opinions with their patients.

I'm beginning to remember why I quit posting here in the first place. (Not aimed at you JPINV)

John E.


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## DV_EMT (Oct 11, 2009)

I guarente. That you, as a basic or even a medic can not give direction to take an OTC. Period. Go ask any pharmacist if any tech can legally "recommend" ANY medication OTC or RX and they"ll tell you no. What I pulled from the law was only a fraction of the multitude of pages of pharmacy law. If you want to find out if a basic or medic can "recommend" or "consult" on a medication. Check your local standing protocol.


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## John E (Oct 11, 2009)

*Sigh...*

first off, I don't answer to pharmacists, nor do pharmacists make the rules about what an EMT can or can't do.

Secondly, if you can find where I wrote that I was directing anyone to take anything, please post it.

Third, I don't need to check with any standing protocol to know that if a person asks me for my opinion I can give it. There's a difference between offering an opinion and dispensing a dangerous drug. If someone asks me if I like Benadryl, I can most assuredly say what I think. 

The laws that govern pharmacist technicians don't apply to EMT's. Nor do the ones that govern pharmacists.

When asked, you quoted a source that only pertains to rules governing pharmacists, I don't really care how much more of those rules you can quote or cut and paste as they don't apply to me or to any other EMT.

They may very well apply to you since you stated that you're a Pharmacy Technician, that's all well and good but that doesn't mean that you or any other Pharmacy Technician can mandate what I can or can't discuss with a patient.

Please feel free to continue posting irrelevant rules, I'm done, you may have the last word.


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## JPINFV (Oct 11, 2009)

John E said:


> Secondly, if you can find where I wrote that I was directing anyone to take anything, please post it.



Would you accept that the difference between suggesting, recommending, and directing a patient to take an over the counter medicine from the patient perspective in a patient-provider relationship is a very fine line?


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## Aidey (Oct 11, 2009)

I used to work occupational medicine, and we were responsible for OTC medications. The industry regulations state that no worker can take a medication without first clearing it with the on site medic, unless they have a MDs note on file with the company. So if you have a headache, or a cold, or a cough, you have go to see the medic. This was to prevent some heavy machine operator from taking a bunch of Nyquil or something before going on shift. It was essentially another safety mechanism to make sure the workers were not impaired in any way, either by the medication, or because they were too sick to work and trying to hide it. 

While working in this setting, I as a Paramedic routinely "prescribed" OTC medications to patients. They could name request things, or they could say "I have a cough and a fever, what can you give me" and I would grab the meds. I could not recommend they do anything outside of the manufacturers recommended dosage except for specific cases that were pre-approved (eg Ibuprofen 800mg for pain). 

I worked both alone, with other paramedics and with EMTs doing this. The paramedics were the only people allowed to dispense the medication if it wasn't asked for by name. If someone came in and said "I have a headache, can I have some tylenol?" the EMT was allowed to give it to them. They could not choose a medication for the patient, but the paramedics could. 

Anyway, that being said, I would advise any EMT B to check with their MD sponsor on their feelings on the subject before suggesting any OTC medication when acting in an official capacity. Whether you think you are or not, you would be opening yourself up to a lot of issues, especially if your MD isn't willing to back you up because you were suggesting things without him having a clue. 

It's one thing to tell your sister "Yeah, mucinex works really well" and another to tell the same thing to a patient who called 911.


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## DV_EMT (Oct 11, 2009)

John E said:


> Secondly, if you can find where I wrote that I was directing anyone to take anything, please post it.
> 
> Third, I don't need to check with any standing protocol to know that if a person asks me for *my opinion* I can give it. *There's a difference between offering an opinion and dispensing a dangerous drug.* If someone asks me if I like Benadryl, I can most assuredly say what *I* think.
> 
> ...



The key word here is* I*. If you... as a basic.. Recommend/Consult/Tell/(insert adjective here) someone what *"TO" *take then its (99% sure )illegal and you are liable. If someone comes up to the rig and asks you... "hey my hand is swollen from a bee sting, what can I do for it" and you Reply, "take some benadryl". YOU are now a. On the hook for a lawsuit. and b. are (once again 99% sure) illegally recommending a medication based on NO medical History or Allergies. heck... they may not have any history or NKDA but... then UH OH... they have an allergic reaction to you the red dye in the benadryl. Or how bout a sickle cell anemia patient... and you recommend ASA and... BAM... a bleeder. 

Now...Saying to a PT ... If *I* had your symptoms....  *I* would take (x and y medication)... your in the clear. B*ut telling a PT what to take*.... NO matter if your a Basic/Rx tech/ Phlebotamist/ RRT/ or anything but a Nurse/Doctor/RPH... your not allowed.

And finally... Don't get all High and Mighty thinking that your so far superior than the rest of us. Yeah, sure, I've been in Pharmacy for 4 1/2 years and, Yeah I have a tech license. I sure as heck am not a pharmacist and I'm definately not a lawyer. I don't know the exact codes of pharmacy law verbatum and I gave you a link to PHARMACY LAW and PHARMACY PROTOCOL. If you want to research it for basic/medics in your area... look it up! Im telling you what I know from Standing Orders as a Basic in MY county and The State of California Pharmacy Law. If you don't like what I gave you... tough cookies. I gave you what I KNOW and thats the best response i can give you.

aside from that... have a nice night everyone else.


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## Lifeguards For Life (Oct 11, 2009)

neither EMT's or Paramedics have the necessary expertise to go recommending medications, for patients to go and use at their own discretion, when no medical personnel is hovering over them.
By simply administering oxygen to a patient, an EMT is in fact prescribing that drug for them. O2 is a prescribed drug, that each system's medical director authorizes to be given to certain patients. 
There are people out there who do not know the difference between a paramedic and a doctor. As a medical professional, if you were to recommend medications to an uneducated patient, i do believe in some courts of law that could be considered that you prescribed that medication.


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## EMTelite (Oct 21, 2009)

MCGLYNN_EMTP said:


> as for the laws on that....I'm not quite sure...im just an ambulance driver




Love it


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## daedalus (Oct 21, 2009)

John E said:


> theres nothing in the law/regulation that you quoted that refers to an EMT giving advice when it's been solicited by a patient or did I miss that part?
> 
> I would also suggest that the law/regulation that you quote applies to pharmacists and pharmacy technicians who dispense prescription drugs, not to an EMT who's asked a question by a patient. The fact that you're quoting the "Ca Pharmacy Law Book" I believe lends credence to my argument, not to yours.
> 
> ...





In California, I doubt there is a specific law or regulation forbidding you to advise the use of an OTC medication. However, the law provides that practicing medicine without a license is illegal, and the definition of practicing medicine is loose enough to allow prosecutors to fit a lot of things into that category. While it may never be an issue, if a bad outcome were to come from a -Basic giving advice on an OTC drug, it would not be hard to convince a jury that giving medical advice without a medical license constitutes breaking the law. 

Remember that even giving aspirin, while OTC, is still a function delegated to us by our medical director.

Also, while you may not answer to Pharmacists, the laws governing pharmacy may very well apply to you. California law prescribes that only certain types of licensed individuals may recommend a medication, even if it is OTC. Pharmacists and doctors are on that list, but EMTs are not.


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## Chrissy88 (Oct 22, 2009)

Starbase89 said:


> I know as a Basic I am not allowed to give medication (aside from very few specified.) If I were to find a kid having an allergic reaction, would it be wrong/out of scope of practice to say "you might want to give him/her some Benadryl." Is that equivalent to giving medication in the eyes of the law?



We were just discussing this in our last class. Our instructor said ABSOLUTELY NOT, besides the ones that we can administer and assist with, you should NOT risk it, no matter how small. You don't know how the child will react to the medicine, granted it will most likely alleviate the reaction, there's still the possibility of adverse side effects and YOU will be held responsible for it.


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## SA_Medic (Oct 22, 2009)

In South Africa and EMT-B can loose his / her license if they suggest / advise / direct a patient to take any type medication simply because they are not allowed to administer medication.


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## Akulahawk (Oct 22, 2009)

When I've been asked about any meds for a specific condition or if I think someone should seek medication for something, I basically tell the person to check with their physician about whether or not there's a medication that's appropriate for them.


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## SA_Medic (Oct 22, 2009)

Akulahawk said:


> When I've been asked about any meds for a specific condition or if I think someone should seek medication for something, I basically tell the person to check with their physician about whether or not there's a medication that's appropriate for them.



Now that would be the best answer to give. Kudos Akul


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## Akulahawk (Oct 22, 2009)

I've also been known to say that if one medication doesn't work (some take time to take effect and determine efficacy), it's not inappropriate to tell your Doc what's going on. Sometimes, people react to medication differently... so what's appropriate for one person might be completely wrong for another, even with the same disease.

Some stuff works GREAT... but we just don't know entirely well how certain meds interact with other meds and foods and supplements... and so on. Once you get past a few substances, sometimes, nobody knows what will happen.

As to the kudos... thanks! I learned a long time ago to stay away from recommending stuff specifically. Too much trouble can result. For example... if someone's in pain... I'll simply tell them to look into taking pain meds... check with the Doc... and/or consult with a pain management specialist.


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