# Needing to Vent



## crazycajun (Apr 27, 2011)

I don't normally complain about much. I usually tend to do my job and keep to myself. But tonight was one of the worst off duty experiences I have ever had. A friend called needing some help in a neighboring county. On my way I came across an MVC that had just happened. 68 yo male driving an early 80's caprice ran into a stationary tractor in a blind curve traveling 55 mph. Quick assessment showed rapid shallow breathing, BP 170 over 100 and elevated pulse at 120 bpm. Small lacerations to the face with a chief complaint of severe neck pain. I immediately slid in behind him and manually brought his neck to neutral keeping him stabilized until further assistance arrived. First on scene was a volunteer FF for the local FD. He was in a rescue unit so I assumed he had supplies. I informed him I was an EMT in the next county and gave him a quick rundown. I asked for a c collar and spine board to secure the patient so we could begin trying to get his feet free from the brake pedal. (collapsed on top of feet trapping them). The first thing this kid tells me is that I need to get away from his scene! I was speechless at first but held my composure and again asked for the things I needed. I told him once again that I was a certified EMT and my duty was to take care of the patient. He then proceeded to tell me that he didn't care if I was the president! This was his scene and I needed to leave or he would have me arrested. I then got rather upset and against my nature I let him have a few choice words I don't normally use and told him to call whoever he needed because I wasn't leaving the patient. He then walked away and sat in his truck until other members of his department and EMS arrived about 10 mins later. Fortunately I knew both the medics on the wagon and I was able to get what I needed. Once the patient was secure I turned him over to the medics and found the kids captain on scene. I told him what had happened and all he would say is that these guys are volunteers and if he upsets them they would leave the department. My question to him was, Is this really the type of people you want in your department? His answer was he takes what he can get. I can't believe people like this are allowed in any type of community service. I can only hope another patient doesn't suffer at the hands of these idiots.


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## mycrofft (Apr 27, 2011)

*He should have taken control of the scene and you should have let him.*

Once he was there the pt was "his". However, he could have instructed you to hold C spine.
PS: If you were he, would you take the unsupported word of a stranger sitting holding C spine on your pt and giving you orders?


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## DrParasite (Apr 27, 2011)

*look at it from his point of view*



crazycajun said:


> My question to him was, Is this really the type of people you want in your department?


http://easterniowanewsnow.com/2011/04/01/impersonator-arrested/reding/

http://communitynewspapergroup.com/...newspapers/news/doc4d4828a108a5f597812923.txt

The two above links are recent cases of people impersonating EMS people.  

Maybe he went about it the wrong way, but if the roles were reversed, what would you do?  how would you know that the person in the car wasn't just impersonating an EMT?  you don't know him, he doesn't know you, and you are just a guy who claims to be an EMT.

anytime I stop at a scene, once the AHJ shows up, it's their call.  they want me to say?  cool.  they want me to go?  cool.  either way, it's their scene, not mine.  

losing your cool doesn't help the situation.  if anything, it gives you even less credibility, because you go from a helpful bystander to a potentially dangerous bystander who is interfering with the AHJ's operations.  if he wants to be a D bag, and tells you to GTFO, do it.  it's his scene.

btw, if you stop at my scene to help out, once I arrive, if I say you leave, you better leave.  if you start cursing at me, you are leaving in handcuffs.  If I don't know you, than I am not going to let you do anything, because, quite honestly, I don't know you, and you could be a kook who is just pretending to be an emergency responder.  I don't care if you are a fire chief in the next county, an EMT, paramedic, or flight nurse who has been doing this for 20 years, unless I know you, odds are once I arrive, it is my scene, and if I say you go, you better go.   I might have you continue to hold C-spine (only so I don't have to), but i might not, it all depends on the situation.  but either way, it's my call, and because I am the AHJ, you should be listening to me, because it is now my scene and my patient.

don't take it personally, it has nothing to do with you, it has to do with all the other kooks who pretend to be fellow emergency services people and really aren't have ruined it for those of us who are good intentioned and actually trained


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## Sasha (Apr 27, 2011)

Dude you're lucky you didn't get arrested.


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## foxfire (Apr 27, 2011)

Not to take sides or anything but, once the EMS personnel called to the scene arrive they are in charge of pt care. You were acting in the good Samaritan role and thus had no control over pt care. Instead of saying What you needed,  inform the responding crew of what happened and ask if they would like your assistance. If they don't then your job is done.


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## ffemt8978 (Apr 27, 2011)

DrParasite said:


> http://easterniowanewsnow.com/2011/04/01/impersonator-arrested/reding/
> 
> http://communitynewspapergroup.com/...newspapers/news/doc4d4828a108a5f597812923.txt
> 
> ...



Spot on post.


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## JPINFV (Apr 27, 2011)

In general, the only person who's going to be allowed to take over care is a physician, and that's normally done with online medical control and plenty of identification. Unless you're a doc, give report, ask if you can help. If told to get lost, hand over manual c-spine and leave.


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## Scott33 (Apr 28, 2011)

How and where did you park and secure your vehicle at the scene, and at what point did you release manual c-spine stabilization to take his BP and pulse?

Regardless, egos do tend to run riot in these situations and they make for a common theme on these forums. But how many times have we also read scoffing posts about the persistent off duty nurse, who just so happened to be first on scene at an MVC? "How did I know she was a nurse?"..."I bet she was an HCA"..."you should have seen the look on her face when I told her to fetch me the KED"..."It didn't seem like she had trauma training, so I took charge"...etc, etc [yawn]. Was your situation really any different from the responding crew's point of view? How about from a legal standpoint? 

Fact is, you were relying on the crew not only having to take your word as to your credentials, but also having a genuine need for you to be there. If they didn't want you on (their) scene, you should have been on your way. Period. 

It's been said before - if a provider is going to stop at witnessed or near-witnessed MVCs, not only should they be crystal clear as to what _duty of care_ means when _off duty_, but they should also be prepared to stand down when asked to do so by the responding crew.


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## the_negro_puppy (Apr 28, 2011)

More reason not to stop and just keep driving. Why run the risk of personal injury, getting sued or being abused by on duty personal.


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## CAOX3 (Apr 28, 2011)

The first attempt I make is always polite, I thank them for stopping and we can take it from here, It could escalate from there if need be but it really never has.

Of course I could act like a douche, tell everyone to beat it, get lost because Im in charge and this is my scene but I like to think Im more professional then that.


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## truetiger (Apr 28, 2011)

This may sound cold but its great advice. It's not your emergency. You have nothing to gain and everything to lose. Call it in and keep driving. You also failed to recognize two major scene safety issues. You entered a scene before it was secure and a vehicle before it was stabilized. I bet the odds are much higher someone hits that vehicle a 2nd time on that blind curve than your taking c-spine makes a difference.


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## Sandog (Apr 28, 2011)

In all fairness to the OP, once he responded to the incident he had a duty to act, and as such he had an obligation to continue care and not turn over care until a provider of equal or higher level reported on scene. One could argue that just being a vollie FD is not sufficient to validate EMS credentials as many vollie FD's are not EMS trained. One could further argue that if the OP just left his patient to the vollie after rendering care, that he failed in his duty to act if he did not ensure the vollie crew had the proper credentials. The patient belongs to the first responder until he or she turns over care to a provider and that first responder is not obligated to leave just because someone has a set of Nomex.

The oncoming vollie FD crew member should have approached the scene in a way such that they identified themselves as EMT/P such and such and ask for a quick briefing, not "Hey, get lost".


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## Sasha (Apr 28, 2011)

As a good samaritan he only functions as a first responder meaning the vollie fd is equal or greater.


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## Sandog (Apr 28, 2011)

Sasha said:


> As a good samaritan he only functions as a first responder meaning the vollie fd is equal or greater.



No, once he responds as a Good Samaritan and if he performs duties as an EMT, he has a duty to act as an EMT, and one can not assume that vollie FD has equal or greater training. The OP would be in his rights and obligations to request credentials from the vollie if he so found it warranted. If he was arrested, the case would never had made it to court.


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## Sasha (Apr 28, 2011)

No as a good samaritan you function as a first responder. 

He does not have a right to request the credentials of the responding units. They have the equipment to treat the patient, he doesn't. It's the responding FR/EMTs scene and they have every right to tell him to back the eff off.


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## Sasha (Apr 28, 2011)

the_negro_puppy said:


> More reason not to stop and just keep driving. Why run the risk of personal injury, getting sued or being abused by on duty personal.



Why is it always a black guy eating popcorn?


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## crazycajun (Apr 28, 2011)

Just to clarify some things. I got vitals when I first arrived on scene due to approximate age of patient and the fact he was wearing an emergency alert bracelet. The patient starting complaining of neck pain as I was finishing BP and that is when I put him in c spine. My POV was parked at a 45 degree angle with flashing strobes (gift from wife) approximately 300 ft from the scene. Patient vehicle was off roadway due to impact and in a safe area and I am trained (mandatory) in extrication. I had been at my EMS department most of the day getting ready for an upcoming event that I am working so I was in a county EMS t-shirt and my jump bag (issued by county with their logo) was on scene with me in plain view. The vollie (according to the medic on the wagon) has been in the FD for a couple of months and is currently in FR training. (my opinion is he shouldn't be in a rescue unit if he is not trained) In South Carolina according to DHEC who oversees EMS scene control goes to the highest ranking officer either on or off duty without regards to county as we are state certified. Many of the rural FD's here have issues with EMS for a number of reasons. Mostly due to them being volunteer and we are paid. This kid knew full and well (as he admitted to others on the scene) that I was an EMT. His problem with me? I was from another county. BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.


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## crazycajun (Apr 28, 2011)

Also, my ID badge is clipped on my jump bag which was on scene and the vollie was standing next to it.


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## Sasha (Apr 28, 2011)

> BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.



If you're off duty in South Carolina, you don't have a duty to act.


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## crazycajun (Apr 28, 2011)

Sasha said:


> No as a good samaritan you function as a first responder.
> 
> He does not have a right to request the credentials of the responding units. They have the equipment to treat the patient, he doesn't. It's the responding FR/EMTs scene and they have every right to tell him to back the eff off.



Sasha this may be true in your state but not here. Anytime either on or off duty without regards to county I stop at an MVC I must act in official capacity.


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## crazycajun (Apr 28, 2011)

Sasha said:


> If you're off duty in South Carolina, you don't have a duty to act.



If no one is at the scene and there is potential life threatening injury you are required to act. DHEC EMS policy.


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## Scott33 (Apr 28, 2011)

Any official state reference to back up those claims? Would this duty to act include when you have a car full of children and flammable goods?

See the problem?


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## reaper (Apr 28, 2011)

No you do not have a duty to act in SC.  In SC the FD has full control over all scenes. 
It is ok to stop and help. But learn your laws first.


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## Veneficus (Apr 28, 2011)

*Choose your battles.*

In my experience, the behavior of the VFD described by the OP is very much the norm.

Obviously not everyone is like that, and there are some outstanding ones, but they seem the exception rather than the rule.

Best thing to do is initiate civilian camouflage.

Have no markings on your vehicle, no lights, etc. Do not wear identifying outwear. Do not have a unique looking vehicle.

Rubber neck a little, to give the impression of a non responder as you drive by without stopping.


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## medicRob (Apr 28, 2011)

crazycajun said:


> BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.



I have reviewed the South Carolina EMS Act, DHEC Regulation 61-7, and a few other documents. I have yet to see a single law which says you have "duty to act" when off-duty. 

SC Bill 3710: EMS Act
http://www.scstatehouse.gov/sess118_2009-2010/bills/3710.htm

DHEC Regulation 61-7
http://www.scdhec.gov/administration/regs/docs/61-7.pdf


Also, Sasha is correct. You can only function as a first responder unless you are on the medical director's list for that county 911 service (ex: Current Employee), you are part of a volunteer or paid agency where you function as an EMT with the authority to do so granted by your service.

Until you provide me with a proper citation or a link to South Carolina Code that exclusively says you, as an off-duty (keyword) EMS Provider have duty and responsibility to act at the scene of an accident you drive by, I am going to have to put up the BS flag.


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## akflightmedic (Apr 28, 2011)

crazycajun said:


> If no one is at the scene and there is potential life threatening injury you are required to act. DHEC EMS policy.



 

Pretty funny words there...make a law up as you type?

How would you know if there is a potential life threatening injury if you never stopped?

If you never stopped, how would anyone know you were supposed to?

Logic Fail...

And yes my EMS career started in South Carolina...


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## firecoins (Apr 28, 2011)

If 911 is called and your not on a responding vehicle, your not suppossed to be there.  When those who are on the responding vehicle show up, they are in charge.   Yes this guy sounded like an idiot threateneing to arrest you. 

I have stopped at accidents and had certain potential problems. All ended amicably but may not have if I didn't handle it right.  

Overzealous cops have been a problem. They thought I was  involved in the accident or that my vehicle in their way. State troopers are alot less kind than other cops. You do not want to get into an argument with a trooper.   

Overzealous FFs and EMS personnel have been a problem. They tried to backboard me. I had to convince them I was a bystander.  That was after I helped 3 ambulance crews backboard the 3 actual patients. 

The biggest problem has been overzealous citizens running around like a chicken with their head cutoff pulling patients in all sorts of directions with no reguard for c-spine. I have simply left such scenes without as much as a word.

You stop at your own risk.


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## crazycajun (Apr 28, 2011)

According to the meetings in both Feb and March at DHEC, EMT's and Paramedics are obligated to provide medical care regardless of county in an emergency situation even while off duty if the incident is life threatening. The question was asked how would you know if it is life threatening and DHEC stated that we are obligated to check. During a break someone asked what would happen if we don't stop. They were told that we need to remember this is an employ at will state and walked away.


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## medicRob (Apr 28, 2011)

crazycajun said:


> According to the meetings in both Feb and March at DHEC, EMT's and Paramedics are obligated to provide medical care regardless of county in an emergency situation even while off duty if the incident is life threatening. The question was asked how would you know if it is life threatening and DHEC stated that we are obligated to check. During a break someone asked what would happen if we don't stop. They were told that we need to remember this is an employ at will state and walked away.



You forgot to include your source. Also, are you saying that you are basing your assumption on duty to act on second-hand information that may or may not have been said, informally off the record as someone was walking away? You seriously need to review EMS Law.


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## Scott33 (Apr 28, 2011)

As above.

Until you can provide a reference for what you claim, it is nothing more than hearsay.


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## reaper (Apr 28, 2011)

Sorry DHEC would never state that. It is not in policy or law. I know for a fact.


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## Veneficus (Apr 28, 2011)

akflightmedic said:


> Logic Fail...




That is a great phrase, I am going to have to start using it.


However, there are a great many logic fails in EMS, so I wouldn't use that as the measure of BS or not.

I know of nowhere in any part of the US that requires an off duty responder to act as part of a states (or any other) law, ordinance, code, etc.

I know a handful municipals that require their employees to respond off duty within the jurisdictional limits. All of those services are fire based EMS and all of those services have a off duty recall caviat as part of the employment agreement.

They are also represented by a union (IAFF) and that caviat has been accepted for as long as anyone I know there can remember.


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## Sasha (Apr 28, 2011)

crazycajun said:


> According to the meetings in both Feb and March at DHEC, EMT's and Paramedics are obligated to provide medical care regardless of county in an emergency situation even while off duty if the incident is life threatening. The question was asked how would you know if it is life threatening and DHEC stated that we are obligated to check. During a break someone asked what would happen if we don't stop. They were told that we need to remember this is an employ at will state and walked away.



South Carolina does not have a duty to act, when you're off duty.


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## BedpanCommando (Apr 28, 2011)

This is why I no longer stop when off duty.


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## Emt512 (Apr 28, 2011)

Okay so doesnt all ems have some kind of identification they are supposed to carry at all times? Especially when your first responding? Also what if the emt- intermediate started some advanced skills and the volly firefighter responder shows up? In Texas most( 80%.. Seriously) volly fire Dept. Are emt- b's any how? I mean I would understand if you are on the same skill level or the responder was higher educated... but if a basic showed up and told anyone that took longer then a three month course to leave a scene, there is a serous flaw somewhere at the exspense of the people who we are trying to help.


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## Tommerag (Apr 28, 2011)

Emt512 said:


> Okay so doesnt all ems have some kind of identification they are supposed to carry at all times? Especially when your first responding? Also what if the emt- intermediate started some advanced skills and the volly firefighter responder shows up? In Texas most( 80%.. Seriously) volly fire Dept. Are emt- b's any how? I mean I would understand if you are on the same skill level or the responder was higher educated... but if a basic showed up and told anyone that took longer then a three month course to leave a scene, there is a serous flaw somewhere at the exspense of the people who we are trying to help.



First if an EMT-I, etc stops at a scene and starts some type of ALS skill and they are off duty they can get into trouble for that one. If its not your call and you stop to help it is not your scene, whether you have more training or not. You are a bystander as it has already been stated. Just because you are the first person there doesn't mean you are in control.


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## medicRob (Apr 28, 2011)

Emt512 said:


> Okay so doesnt all ems have some kind of identification they are supposed to carry at all times? Especially when your first responding? Also what if the emt- intermediate started some advanced skills and the volly firefighter responder shows up? In Texas most( 80%.. Seriously) volly fire Dept. Are emt- b's any how? I mean I would understand if you are on the same skill level or the responder was higher educated... but if a basic showed up and told anyone that took longer then a three month course to leave a scene, there is a serous flaw somewhere at the exspense of the people who we are trying to help.



Why would you be doing anything more than holding c-spine or BLS skills when you are off duty? There is no point in advanced level skills when you don't have the proper equipment. 

Also, we have wallet cards that the state gives us (NR doesnt mean jack as far as ability to practice in a state goes). However, we are not required to carry them when working. If you come up on a scene and for some reason or another you feel you need to stop to give aid to another provider (not exactly sure why you would), be sure to have your card handy, you are not an EMT until I see a non-expired dept of health board of EMS card with the same name on it that is on your driver's license bearing a photo of you, even then, you will more than likely end up holding c-spine if anything.


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## Veneficus (Apr 28, 2011)

medicRob said:


> Why would you be doing anything more than holding c-spine or BLS skills when you are off duty? There is no point in advanced level skills when you don't have the proper equipment.
> 
> Also, we have wallet cards that the state gives us (NR doesnt mean jack as far as ability to practice in a state goes). However, we are not required to carry them when working. If you come up on a scene and for some reason or another you feel you need to stop to give aid to another provider (not exactly sure why you would), be sure to have your card handy, you are not an EMT until I see a non-expired dept of health board of EMS card with the same name on it that is on your driver's license bearing a photo of you, even then, you will more than likely end up holding c-spine if anything.



If I am not mistaken, TN is one of the few states that automatically recognize out of state credentials in extraordinary situations.

I understand the law was specifically put in place for disaster situations, but is not specifically limited to such from various disaster related conversations I have had elsewhere.

Do you have more accurate insight on this?


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## Emt512 (Apr 28, 2011)

medicRob said:


> Why would you be doing anything more than holding c-spine or BLS skills when you are off duty? There is no point in advanced level skills when you don't have the proper equipment.
> 
> Also, we have wallet cards that the state gives us (NR doesnt mean jack as far as ability to practice in a state goes). However, we are not required to carry them when working. If you come up on a scene and for some reason or another you feel you need to stop to give aid to another provider (not exactly sure why you would), be sure to have your card handy, you are not an EMT until I see a non-expired dept of health board of EMS card with the same name on it that is on your driver's license bearing a photo of you, even then, you will more than likely end up holding c-spine if anything.



Well not sure where you guys are from but in good ole Texas .. Lol... Last time I checked you are suppose to carry you Texas dept of health card at all times when working .. Also I thought that


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## Emt512 (Apr 28, 2011)

medicRob said:


> Why would you be doing anything more than holding c-spine or BLS skills when you are off duty? There is no point in advanced level skills when you don't have the proper equipment.
> 
> Also, we have wallet cards that the state gives us (NR doesnt mean jack as far as ability to practice in a state goes). However, we are not required to carry them when working. If you come up on a scene and for some reason or another you feel you need to stop to give aid to another provider (not exactly sure why you would), be sure to have your card handy, you are not an EMT until I see a non-expired dept of health board of EMS card with the same name on it that is on your driver's license bearing a photo of you, even then, you will more than likely end up holding c-spine if anything.



Well not sure where you guys are from but in good ole Texas .. Lol... Last time I checked you are suppose to carry you Texas dept of health card at all times when working .. Also I thought that the guy had a jump bag ... how far can first responders can go in treatment ? Outside and inside their jurisdiction ?


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## Emt512 (Apr 28, 2011)

So no need to carry ems identification in TN?


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## medicRob (Apr 28, 2011)

Emt512 said:


> Well not sure where you guys are from but in good ole Texas .. Lol... Last time I checked you are suppose to carry you Texas dept of health card at all times when working .. Also I thought that the guy had a jump bag ... how far can first responders can go in treatment ? Outside and inside their jurisdiction ?



First Responders are very low level BLS (Oxygen, Bandaging, Splinting, C spine). They do not initiate nor manage IV's or push medications. Some states allow first responder to assist with a patient's epi pen, and some even allow the first responder to assist a patient with NTG, that's about it. 

Re: The State Card

So you mean to tell me the state of Texas will penalize you if you are caught working an EMS shift without your card in your wallet even though your uniform, you showing up in the ambulance, your name tag, and your call number all identify you as an EMS provider? 

There's a big difference between a state issuing you a card (which they all do) and actually requiring that you carry it at all times. I put mine in my wallet, so it is with me at all times. However, when I arrive on the scene while on shift with my service, I don't have to present that to anyone, my uniform, the helicopter I landed in, and my sexy name tag with the wings pretty much give it away.


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## DesertMedic66 (Apr 28, 2011)

Emt512 said:


> Well not sure where you guys are from but in good ole Texas .. Lol... Last time I checked you are suppose to carry you Texas dept of health card at all times when working .. Also I thought that the guy had a jump bag ... how far can first responders can go in treatment ? Outside and inside their jurisdiction ?



Cali we are to carry our cards at all times while on duty. Highway Patrol has came up and asked for our cards while we are posting a couple of times. Along with sups.  But off duty we don't have to carry them. 

As for helping off duty we have just been told we can do anything within our scope of practice as long as the patient needs it and we have the equipment to do it.


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## medicRob (Apr 28, 2011)

Emt512 said:


> So no need to carry ems identification in TN?



Well, we carry our state cards with us, but not once in my career have I ever been asked to show my card when arriving. Then again, I don't just stop off on the side of the road while I am not on duty and play EMS at accident scenes. Whenever I am on a scene, I am there in official capacity. 

Whenever I renew my licenses, I provide a copy of my card to my employer which is scanned and put on file, same with ACLS, PALS, BLS, etc.


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## medicRob (Apr 28, 2011)

Veneficus said:


> If I am not mistaken, TN is one of the few states that automatically recognize out of state credentials in extraordinary situations.
> 
> I understand the law was specifically put in place for disaster situations, but is not specifically limited to such from various disaster related conversations I have had elsewhere.
> 
> Do you have more accurate insight on this?




Well, the board of nursing has agreed to let 8jimi8 come work bonnaroo (but that falls under us being a compact licensure state).. that's pretty crazy. 

When I spoke of license cards, I was speaking strictly with regard to those who are on shift with an ambulance service or HEMS arriving to a scene they were dispatched too, not off duty EMTs. If you want to stop at a scene when off duty, be prepared to show that card. When you are arriving in the ambulance to the scene you were dispatched too, I see no reason why it would hurt for you to not have your card with you. Most of us carry our cards in our wallets anyways, so they are always with us. 

I am part of the TN Disaster Response team, and I honestly don't know how that applies in disaster, I'll have to check up on that.


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## JPINFV (Apr 28, 2011)

Sasha said:


> Why is it always a black guy eating popcorn?


How dare you question the almighty Gus!


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## JPINFV (Apr 28, 2011)

crazycajun said:


> BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.



All the more reason not to have anything that IDs yourself as an EMT on your car.


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## dmc2007 (Apr 28, 2011)

medicRob said:


> So you mean to tell me the state of Texas will penalize you if you are caught working an EMS shift without your card in your wallet even though your uniform, you showing up in the ambulance, your name tag, and your call number all identify you as an EMS provider?



I'm pretty sure MA and NY require you to carry them as well.


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## DrParasite (Apr 28, 2011)

crazycajun said:


> I had been at my EMS department most of the day getting ready for an upcoming event that I am working so I was in a county EMS t-shirt and my jump bag (issued by county with their logo) was on scene with me in plain view.


omg, you have a county T-shirt?  I have an FDNY T-shirt, doesn't make me an FDNY Firefighter. 

 also jump Kits can be purchased galls Galls.  If you had told me you were in your work uniform (button down shirt or embroidered uniform shirt with uniform pants), I would give you a little more leeway, but in a county t-shirt?  c'mon.


crazycajun said:


> The vollie (according to the medic on the wagon) has been in the FD for a couple of months and is currently in FR training. (my opinion is he shouldn't be in a rescue unit if he is not trained)


doesn't matter what you think, or what his training was.  you are a civilian, he is the professional who is arriving in the AHJ's apparatus.  it's still his scene. 





crazycajun said:


> In South Carolina according to DHEC who oversees EMS scene control goes to the highest ranking officer either on or off duty without regards to county as we are state certified.


interesting.... so if i show up to a building collapse with people trapped, in civilian clothes, because I heard it on the scanner, and I'm a paramedic, I'm in charge if no other paramedics are there?  I can boss the fire and rescue crews around, as well as all the BLS crews?  cool 


crazycajun said:


> Many of the rural FD's here have issues with EMS for a number of reasons. Mostly due to them being volunteer and we are paid. This kid knew full and well (as he admitted to others on the scene) that I was an EMT. His problem with me? I was from another county. BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.


who cares, the kid was a douche.  it was still his scene, and if he asks you to leave, you should leave.


crazycajun said:


> According to the meetings in both Feb and March at DHEC, EMT's and Paramedics are obligated to provide medical care regardless of county in an emergency situation even while off duty if the incident is life threatening. The question was asked how would you know if it is life threatening and DHEC stated that we are obligated to check. During a break someone asked what would happen if we don't stop. They were told that we need to remember this is an employ at will state and walked away.


I don't really buy that, but it might be true.  but the more important question, has anyone actually be punished by the DOH for not stopping?



dmc2007 said:


> I'm pretty sure MA and NY require you to carry them as well.


I have heard of NJ DOH doing spot inspections at the hospital as well.



Emt512 said:


> Okay so doesnt all ems have some kind of identification they are supposed to carry at all times? Especially when your first responding? Also what if the emt- intermediate started some advanced skills and the volly firefighter responder shows up? In Texas most( 80%.. Seriously) volly fire Dept. Are emt- b's any how? I mean I would understand if you are on the same skill level or the responder was higher educated... but if a basic showed up and told anyone that took longer then a three month course to leave a scene, there is a serous flaw somewhere at the exspense of the people who we are trying to help.


how much ALS equipment do you carry in your POV?  I guess if the EMT-I has intubated the patient or started IVs with running fluids or pushed meds they should stay, but I'm pretty sure most 1) are smart enough not to do that 2) would get fired by their medical director for doing that and 3) don't carry enough equipment in their pov to do that.  but in theory it could happen.



Sandog said:


> In all fairness to the OP, once he responded to the incident he had a duty to act, and as such he had an obligation to continue care and not turn over care until a provider of equal or higher level reported on scene.


ehhh, that's a stretched, but other have discussed the whole duty to act thing. 





Sandog said:


> One could argue that just being a vollie FD is not sufficient to validate EMS credentials as many vollie FD's are not EMS trained.


hmmmm, one person climbs off the local fire truck, in gear, while the other is in a non-local county EMS t-shirt claiming to be an EMT.... 





Sandog said:


> One could further argue that if the OP just left his patient to the vollie after rendering care, that he failed in his duty to act if he did not ensure the vollie crew had the proper credentials.


wow.  doesn't the fact that he pulled in a fire truck mean anything?  or that he exited in uniform?   this can be pretty funny: "officer, i just caught this man trying to rob the store, i'm off duty from the next county over in a t-shirt, before I turn him over to you, despite the fact that you have a police officers uniform and exited a police car, can I see your ID, to prove that you are in fact a police officer in this town"?

btw, if you are EVER in my town, and I get off a fire truck, ambulance, or any department vehicle, in uniform (yes, AHJ's turnout gear counts), and you ask for MY ID, I will respond with quite a few choice words that would be censored here.  I don't care if you are a paramedic, cop, doctor, or holy spirit.  that's just stupidity that wouldn't be tolerated.


Sandog said:


> The patient belongs to the first responder until he or she turns over care to a provider and that first responder is not obligated to leave just because someone has a set of Nomex.


  no, the patient belongs to the first responder until the AHJ shows up.  once the AHJ's representative shows up, the first responders job is done.


Sandog said:


> The oncoming vollie FD crew member should have approached the scene in a way such that they identified themselves as EMT/P such and such and ask for a quick briefing, not "Hey, get lost".


The responder was a douche, this is there is no disagreement.  however, once that douche shows up in a department vehicle it's his patient, and if he tells you to get lost, than you better get lost.  it's his scene.

I think I see where this thread is going.  OP comes for validation that he was right in his actions.  Overall community consensus is that he was wrong, and vocally tells him so.  OP does not find the validation that he was looking for in that he was right and that the other guy was wrong, so he keeps throwing additional reasons to support the claim that he was right and the other guy was wrong, despite the fact that his underlying logic is faulty.  So while he was initially looking for a place to vent, he found a knowledgeable group who is gonna tell him he was in the wrong, and he is gonna deny he was wrong and refuse to admit that he was the one who was not int he right, despite what the majority of the community says.  I think this thread has run it's course from the OP's point of view.


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## reaper (Apr 28, 2011)

crazycajun said:


> Just to clarify some things. I got vitals when I first arrived on scene due to approximate age of patient and the fact he was wearing an emergency alert bracelet. The patient starting complaining of neck pain as I was finishing BP and that is when I put him in c spine. My POV was parked at a 45 degree angle with flashing strobes (gift from wife) approximately 300 ft from the scene. Patient vehicle was off roadway due to impact and in a safe area and I am trained (mandatory) in extrication. I had been at my EMS department most of the day getting ready for an upcoming event that I am working so I was in a county EMS t-shirt and my jump bag (issued by county with their logo) was on scene with me in plain view. The vollie (according to the medic on the wagon) has been in the FD for a couple of months and is currently in FR training. (my opinion is he shouldn't be in a rescue unit if he is not trained) In South Carolina according to DHEC who oversees EMS scene control goes to the highest ranking officer either on or off duty without regards to county as we are state certified. Many of the rural FD's here have issues with EMS for a number of reasons. Mostly due to them being volunteer and we are paid. This kid knew full and well (as he admitted to others on the scene) that I was an EMT. His problem with me? I was from another county. BTW, call in an MVC here and/or just pass by and not stop will get you in some pretty deep water if DHEC finds out.



Just so you understand this. In SC FD has scene control always. Does not matter if they are a first responder or a Medic. The scene is theirs. Most FD's don't interfere with medics. The volly was a ****, but still had right to make you leave. Let your ego heal and learn the laws. Makes things go smoother!


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## nwhitney (Apr 28, 2011)

What's AHJ?

If EMT's are an extension of the medical director and work under their license and you're in a different county from where you work, stop to help and are doing skills within your scope could you be working without a "license"?:unsure:


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## dixie_flatline (Apr 28, 2011)

DrParasite said:


> omg, you have a county T-shirt?  I have an FDNY T-shirt, doesn't make me an FDNY Firefighter.



Here in Maryland, county t-shirts ARE our uniform.  We do have button-down powder blues, but they are not really meant to be worn while working (ceremonial only).  If we're on the bus, it's a t-shirt, ****ies, and boots.

I'm a little torn on this one.  Clearly, the kid on the BRT was something of a :censored:, but OP could have handled the situation better perhaps.  If I had stopped and the patient seemed to be emergent, I guess I'd be hesitant to hand the scene over to a lone vollie who isn't even a First Responder (according to the OP the kid is still in class for CFR), but there had to be a more diplomatic way (and Cajun clearly had no legal or jurisdictional leg to stand on).

Also, I believe that I was told that I need to have my Maryland cert card on me at all times, but I've never heard of anyone being "carded".


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## ffemt8978 (Apr 28, 2011)

nwhitney said:


> What's AHJ?



AHJ = Agency Having Jurisdiction


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## nwhitney (Apr 28, 2011)

ffemt8978 said:


> AHJ = Agency Having Jurisdiction



Thanks


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## akflightmedic (Apr 29, 2011)

crazycajun said:


> My POV was parked at a 45 degree angle with flashing strobes (gift from wife) approximately 300 ft from the scene.



I threw this one in just for fun...I do enjoy how you justify the whacker lights since they 'were just a gift'. 




crazycajun said:


> In South Carolina according to DHEC who oversees EMS scene control goes to the highest ranking officer either on or off duty without regards to county as we are state certified.



In all my years of running EMS in SC, I never once had DHEC show up to oversee scene control. What I did have was departmental and jurisdictional policies dictating what was acceptable and not. 

And you are absolutely wrong. NO off duty officer from another county will ever take command of my scene, never. The legal implications alone are mind boggling.

You are in serious need of an education in what DHEC does and does not do. Especially when you quoted them as saying remember this is an "at will" state because FYI, the majority of US states are "at will" employment states. You sure are giving them a whole lot of power they do not legally have...but this is usually an action of ignorance (typical in fiefdoms and religions). Get educated my friend and then come back without trying to make excuses for every little thing.

If logical and factual discussion to help you see other perspectives, learn from and grow as a provider is not what you wanted to hear from everyone in response to your vent then I can make a few website suggestions where you would be more welcome as you all pat each other on the back and chest thump. (Wow, that's a 3 line sentence!!)


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## firetender (Apr 29, 2011)

*Did you read what the OP said?*



crazycajun said:


> MVC that had just happened.
> 
> I immediately slid in behind him and manually brought his neck to neutral _*keeping him stabilized until further assistance arrived.
> *_
> ...



Look, Folks, if I come across the scene of an MVA and choose to get involved, begin an assessment, determine that my patient may have a fractured cervical spine and THEN I put my hands on him to stabilize him _*NO ONE IS GOING TO TOUCH THAT PATIENT EXCEPT UNDER MY DIRECTION!*_

If the person who wants to be in charge cannot see that I'm busy doing something important then that tells me they don't know what they're doing and I'll wait, thank you very much, for someone who does! This is exactly what the OP did.

I don't care if it's the Surgeon General (whoever that is!), unless he gets real close and personal and _*builds on what I began*_, I ain't lettin' go, get it?! Under those circumstances, if you know better, then you damn well are gonna prove it to me first.

That is, of course, if I'm absolutely sure I'm on the right track and have covered my bases first. Still, could you picture yourself for one second, once committed to the patient, turning over your support of his neck to NO ONE? I didn't hear the Rescue medic offer ANYTHING.

From what the OP said, his request for the newly arrived Rescue guy to help him in further stabilization was appropriate. I did not hear the Second Responder offer to work in cooperation, rather it was "Get out of here!"

That's not exactly something that would inspire confidence in my patient's future. I would prefer to defend myself against interference rather than have to explain my choice to abandon the patient.

What I heard here was a lot of defense of protocol, without paying heed to what actually was happening. Kind of scary!


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## akflightmedic (Apr 29, 2011)

This is why any knowledgeable/experienced provider who finds themselves alone on scene of a patient requiring c-spine will NOT actually take c-spine precautions. **Clarify...your typical MVC, not one where a patient needs active airway assistance maintained by the provision of c-spine precautions.

When alone and waiting for more assistance, it is best to instruct the patient to not move, to remain still in order to keep yourself (the provider) and your hands free to tend to other situations which may arise.

Why on earth would I want to commit myself to holding c-spine when there is no other set of hands around? Why on earth would I crawl into a vehicle and not have eyes on scene safety, MY safety?

By doing either of these, I have placed myself into a potential legal or dangerous situation such as what Firetender has described. See how passionately you insist you will NOT release c-spine once taken. For the record, I have released c-spine on numerous occasions due to lack of foresight and the situation demanded it. None of the patients died or became worse as a result.

If you never take c-spine and provide direction to the patient, you are in a much more defensible position than if you take it and then release it.

Holding c-spine is a default BLS maneuver due to the limitations within that scope.


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## firetender (Apr 29, 2011)

akflightmedic said:


> By doing either of these, I have placed myself into a potential legal or dangerous situation such as what Firetender has described. See how passionately you insist you will NOT release c-spine once taken.



Point well taken. 

I projected myself into the situation as described, including making the choice that the OP made, to begin intervention. Though I do not think in terms of liability in such cases, still, committing to a patient is committing to a patient and I would be stuck until a smooth transition is made and someone better equipped takes over.


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## AMF (Apr 29, 2011)

I know most of you are in the south, but up here (NH), you have to stop.  Duty to act.  Esp since FD is neither (in this case) medically trained nor a jurisdictional agency (in the sense that leos are).


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## ffemt8978 (Apr 29, 2011)

AMF said:


> I know most of you are in the south, but up here (NH), you have to stop.  Duty to act.  Esp since FD is neither (in this case) medically trained nor a jurisdictional agency (in the sense that leos are).



Do you have a link to the law that says you have a Duty to Act while not on duty?


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## DrParasite (Apr 29, 2011)

ffemt8978 said:


> Do you have a link to the law that says you have a Duty to Act while not on duty?


the better question is, do you a link to any court case where an EMT or Paramedic was found guilty for not stopping?


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## ffemt8978 (Apr 29, 2011)

DrParasite said:


> the better question is, do you a link to any court case where an EMT or Paramedic was found guilty for not stopping?



Nope, because I'm not the one saying there's a duty to act while off duty.


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## medicRob (Apr 29, 2011)

AMF said:


> I know most of you are in the south, but up here (NH), you have to stop.  Duty to act.  Esp since FD is neither (in this case) medically trained nor a jurisdictional agency (in the sense that leos are).



As I said to the OP, if you can't show code annotated for it, I have to throw up the BS Flag. 





I think it is funny that all of you who claimed that you have duty to act while off duty, have yet to post a single law which states you do. Therefore, if anyone else is going to claim that this is true, post the law that says it from the official website of the state or Michie.


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## DrParasite (Apr 29, 2011)

ffemt8978 said:


> Nope, because I'm not the one saying there's a duty to act while off duty.


that was directed toward AMF (or anyone else who is claiming an off-duty duty to act exists), not you FFEMS8978.


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## CAOX3 (Apr 29, 2011)

I don't usually get involved, with my luck it will be some train wreck, with amputations, posturing, ejection and a crowning ob in the back, so I take out my handy dandy cell phone and dial the magic number.

However I believe some professional courtesy should be extended to a provider who off duty stops to assist, its it going to kill you to be polite.

The problem is, egotistical, arrogant and ignorance are prevalent in EMS to the point where at times a slap up side the head is warranted.

I always thank a provider or bystander who gets involved.  Then again I'm not on a power trip, and I don't get my rocks off insulting good samaritans.


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## abckidsmom (Apr 29, 2011)

AMF said:


> I know most of you are in the south, but up here (NH), you have to stop.  Duty to act.  Esp since FD is neither (in this case) medically trained nor a jurisdictional agency (in the sense that leos are).



Not sure how it works where you are, but all of the departments I've ever worked for that were dispatched by a PSAP had contracts with the locality that gave them jurisdiction.  Even vollies, even stupid vollies....somewhere there's a government agency giving them authority.  

Duty to act starts when you are invited.  That invitation comes in the form of dispatch, which begins the relationship between you and the patient.  Driving down the road and witnessing an accident gives me no duty to act.  I usually have a carload of children with me...how could my certification override my burden to provide them with safety and supervision?  And there is certainly no loophole for extenuating circumstances in a healthcare provider duty to act law;  they either do or do not have the duty to act.


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## ffemt8978 (Apr 29, 2011)

This thread has prompted me to update the Duty to Act thread at the top of this forum


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## Amycus (Apr 29, 2011)

If I show up on scene, and the FD requests me to grab something to take over PT care, i.e. a backboard or collar, I'll do it. 

If someone with a higher level of training does, I'll do it.

If some random guy is going "I'M AN EMT I'M AN EMT GET ME THIS STUFF THIS IS MY PT" I'm going to ask the police to escort them from the scene, in handcuffs if necessary. If you're not on duty and you're not part of the responding company, it's not your PT.


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## medicRob (Apr 29, 2011)

CAOX3 said:


> I don't usually get involved, with my luck it will be some train wreck, with amputations, posturing, ejection and a crowning ob in the back, so I take out my handy dandy cell phone and dial the magic number.
> 
> However I believe some professional courtesy should be extended to a provider who off duty stops to assist, its it going to kill you to be polite.
> 
> ...



Or a bus full of hemophiliac orphans crashing into a glass truck in front of the factor VIII factory.


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## Amycus (Apr 29, 2011)

Small amendment to my post, reading what CAO posted...

If a bystander on scene IS making himself useful, EMT or otherwise, I'm fine with it IF they don't get in the way or start being pushy. The OP sounds like he felt, despite being off duty, it was his scene, which is never the case. However, if someone off duty gives a brief report and then says "I'll keep holding c-spine if you'd like" I'll say "Sure" and thank him, assuming he knows what he's doing


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## Scott33 (Apr 30, 2011)

AMF said:


> I know most of you are in the south, but up here (NH), you have to stop.  Duty to act.  Esp since FD is neither (in this case) medically trained nor a jurisdictional agency (in the sense that leos are).



Link please :glare:


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## CAOX3 (Apr 30, 2011)

There was a list of states with a duty to act  off duty listed on this forum a few years back.

I think there maybe was five states or so that mandated action, Florida, Vermont, Minnesota maybe but I can't recall exactly.


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## reaper (Apr 30, 2011)

Florida has no duty to act law.


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## ffemt8978 (Apr 30, 2011)

CAOX3 said:


> There was a list of states with a duty to act  off duty listed on this forum a few years back.
> 
> I think there maybe was five states or so that mandated action, Florida, Vermont, Minnesota maybe but I can't recall exactly.



That list is in this thread, Duty to Act, which is stickied at the top of this forum

http://www.emtlife.com/showthread.php?t=5825

Looking through the thread, the following states have a duty to act law when off duty:  Florida (if part of a government agency), Minnesota, New Mexico, and Vermont.


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## CAOX3 (Apr 30, 2011)

ffemt8978 said:


> That list is in this thread, Duty to Act, which is stickied at the top of this forum
> 
> http://www.emtlife.com/showthread.php?t=5825
> 
> Looking through the thread, the following states have a duty to act law when off duty:  Florida (if part of a government agency), Minnesota, New Mexico, and Vermont.



Ok, I couldn't find it, I thought I was hallucinating.


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## Sasha (Apr 30, 2011)

Fl does not


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## CAOX3 (Apr 30, 2011)

Sasha said:


> Fl does not



It may be law only, I remember when that firefighter was killed off duty when he stopped at an accident to help.  His wife fought for benefits, the court ordered them paid because the firefighter had a "duty to act" because he was in his jurisdiction.

I try'll to find the story.


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## ffemt8978 (Apr 30, 2011)

Sasha said:


> Fl does not



Re-reading the actual law, that may be correct.  However, if they do stop to respond, they are covered by Workman's Comp which means they are on duty.


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## CAOX3 (Apr 30, 2011)

ffemt8978 said:


> Re-reading the actual law, that may be correct.  However, if they do stop to respond, they are covered by Workman's Comp which means they are on duty.



Gotcha, that definitely could be the case.


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## ffemt8978 (Apr 30, 2011)

CAOX3 said:


> It may be law only, I remember when that firefighter was killed off duty when he stopped at an accident to help.  His wife fought for benefits, the court ordered them paid because the firefighter had a "duty to act" because he was in his jurisdiction.
> 
> I try'll to find the story.



http://www.emtlife.com/showthread.php?t=5825 it starts about post 39 in that thread.


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## bstone (Apr 30, 2011)

The moment that the OP touched the patient he became required to continue care until someone of equal or higher training took over. If the volly FF folks are not EMTs then the OP would be required to continue care until that could be provided.

There needs to be a lot more mutual respect for one another. We are professionals and this isn't a pissing contest. While I bet impersonation does happen I don't think we need to suspect that is the case a majority of the time. Let's keep that in mind when we arrive on scene and find someone already helping out. I think helping in this way in a good thing.


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## DesertMedic66 (Apr 30, 2011)

bstone said:


> The moment that the OP touched the patient he became required to continue care until someone of equal or higher training took over. If the volly FF folks are not EMTs then the OP would be required to continue care until that could be provided.
> 
> There needs to be a lot more mutual respect for one another. We are professionals and this isn't a pissing contest. While I bet impersonation does happen I don't think we need to suspect that is the case a majority of the time. Let's keep that in mind when we arrive on scene and find someone already helping out. I think helping in this way in a good thing.



Does that really apply if your off duty as well? I have arrived on scene where a nurse is already helping the patient. Then when we arrive the nurse let's us take over. And they vanish into the background. 

And that whole rule about not giving over care to someone who is of less of training is a little iffy. On those medical calls from the urgent care to the ER, the patient is under the care of a doctor or a nurse in the urgent care. And then they are handing you (a lesser trained person) the patient.


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## bstone (Apr 30, 2011)

I think the rule applies a bit more flexibly if you are off duty. However, t/f care from an EMT to not-yet-FR is unacceptable. From an EMT-I who stops to help to an EMT-B from the fire service is probably fine. I suspect that's the same for an RN who stops to help and an ambulance arrives. From urgent care to ER is allowed as it's inter-facility transport and EMTs work as physician extenders.


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## DesertMedic66 (Apr 30, 2011)

bstone said:


> I think the rule applies a bit more flexibly if you are off duty. However, t/f care from an EMT to not-yet-FR is unacceptable. From an EMT-I who stops to help to an EMT-B from the fire service is probably fine. I suspect that's the same for an RN who stops to help and an ambulance arrives. From urgent care to ER is allowed as it's inter-facility transport and EMTs work as physician extenders.



For me I would ask the crew on scene if they wanted me to stay or leave. All that is protecting me would be the Good S law. Where was the Volly FF is protected thru his company. 

I understand about the rule but everywhere I have read and even during EMT school they said it only applies to if your on duty.


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## Hellsbells (Apr 30, 2011)

What I find ridiculous about this whole scenario is that no actual consideration is being given to the pt, who is the one all parties are supposedly there to help. Imagine being a scared, injured, elderly driver and having the first two people who come to "help" you arguing and yelling at each other about who gets a privledge to render care. Its  really a shocking lack of competence on both sides. 

If I was the victim, I'd tell both on duty and off duty rescuers to leave me alone and id call a taxi.


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## bstone (Apr 30, 2011)

I agree, which is why we have to approach each other with respect and view each other as professionals. If you have a problem then talk about it in private AFTER your patient has been taken care of.


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## nemedic (May 1, 2011)

Hellsbells said:


> If I was the victim, I'd tell both on duty and off duty rescuers to leave me alone and id call a taxi.



Holy Crap, look at that mechanism of injury right there. I want that battery cut and I want C-Spines here right now!

http://www.youtube.com/watch?v=YzYxz_uvtSI


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## JPINFV (May 1, 2011)

Did you try the poke the spine test?


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## nemedic (May 1, 2011)

Twice!!!


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## Aidey (May 1, 2011)

HA! I just showed my partner that video tonight. We had a fire crew try and c-spine a drunk girl who fell off of a chair. She was GCS 15, no complaints of pain and puking her guts out. The reason she tried to stand up was because she thought she was going to throw up.


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