California Good Samaritan Law and ALS?

[TimRaven]

Hi guys, I am new to this forum.

This question troubles me since I got my EMT-B a few years ago.
Currently I am not working for EMS system, so I am probably considered as a lay rescuer.
I had trainings from PHTLS, ACLS and CLS. (or called EMT-Tactical in some places) A lot of contents were ALS based.


I always wonder, is there an actual law prohibiting off-duty/unemployed EMS from performing necessary ALS intervention in California?

There were some instructors told me that I absolutely can not perform ALS off-duty regardless situation, consent or relationship with the patient, even if the patient would otherwise dies.
But I can't find this on California Health and Safety Code Section 1799.102, or Good Samaritan Law.

Say, if I encountered a patient in remote trail with late stage tension pneumothorax, and ALS is not available. What kind criminal or civil consequence could I face if I dart the patient with his/her consent? (assume there is no negligence in treatment.)

 

[gw812]

I would consider it practicing medicine without a license. Unless your are under medical direction you are a LAY RESCUER and work under that scope. Which means CPR, pressure on wounds, hold c spine and call 911. Was drilled into us constantly in school.

 

[TimRaven]

I would consider it practicing medicine without a license. Unless your are under medical direction you are a LAY RESCUER and work under that scope. Which means CPR, pressure on wounds, hold c spine and call 911. Was drilled into us constantly in school.

I was taught that too in EMT, but I have also seen lay rescuers packed wound with hemostatic agents or (correctly) use commercial tourniquets. (likely retired vet with TCCC trainings.)
But never heard anyone was persecuted or even investigated for doing so. Thus I was wondering if there were laws actually define what are illegal to practice?

 

[gw812]

Those are noninvasive actions. Lay rescuers are cool there. Dart a chest? NO. Administer a drug (other than help with an epi pen or inhaler already prescribed)? NO. Drop a tube? NO.

The applicable laws would be those that govern licensing practitioners.

 

[TimRaven]

Those are noninvasive actions. Lay rescuers are cool there. Dart a chest? NO. Administer a drug (other than help with an epi pen or inhaler already prescribed)? NO. Drop a tube? NO.

I must be confused then, I thought packing wound was considered invasive and an ALS.
At least I was never taught this (other than direct pressure, elevation, pressure points and TQ as last resort) in EMT-B until I got PHTLS later.



Ok, so I found California codes for practicing medicine without license, but there are exceptions to emergency situations.

2058. (a) Nothing in this chapter prohibits service in the case of
emergency, or the domestic administration of family remedies.
(b) Nothing in this chapter shall be construed to prohibit
obtaining a blood specimen by skin puncture for the purpose of
performing blood glucose testing for the purposes of monitoring a
minor child in accordance with paragraph (6) of subdivision (b) of
Section 1241.

Since I don't know about laws, I wonder how should we interpret this section?

 

[Underoath87]

I'd be more concerned with potential civil suits than a criminal trial (unless you kill them outright).

 

[mycrofft]

This really is asking for legal advice. (Oh there goes another warning).

From what I've heard and observed over the eons, if you actually save someone (and are not just jumping in all code 3 where it isn't needed) you can be forgiven a lot. If you go trolling for saves such as equipping your car and monitoring emergency radio, or frequenting places where you anticipate "action", you are going to start getting sideways of the real providers. If you do anything wrong or right and someone decides to sue you, and you are doing stuff beyond first aid, you might be looking at losing the house.

The intent of having prehospital etches is to have them, while working under authority and control, running on protocols and calling Medical Control if the protocols aren't working (and not to stay and play, just get them sturdy enough to survive the trip to the hospital). Not to saturate an area with undirected but technically trained people.

 

[TimRaven]

The intent of having prehospital etches is to have them, while working under authority and control, running on protocols and calling Medical Control if the protocols aren't working (and not to stay and play, just get them sturdy enough to survive the trip to the hospital). Not to saturate an area with undirected but technically trained people.

I fully understand the background.
Only reason I asked because I was taking wilderness update course recently, and BLS skills often wanting in this area.

Like when instructors told us if a patient developed a tension pneumothorax in back country, he was likely to die, and there was nothing we could do.
And that got me thinking...only if I could use ALS skills. (hence the scenario on the top post)

Just a few questions for thought:
What would you do if you encountered a patient with ALS needs in back country environment? Would you risk it?
What if the patient was your friend or family member? Would your decision be different?

 

[mycrofft]

There used to be laws against medical practitioners working on family members because the outcomes are so poor in multiple ways.

People needing ALS without prompt transport are usually going to die.

As for what I'd do, I'd do my best. Anything more specific is wishing what I'd do.

And if you want to think about medical emergencies way out there, think about altitude sickness, trauma, sudden acute gastroenteritis, food poisoning, dehydration with attendant constipation and other s/s.

 

[TimRaven]

There used to be laws against medical practitioners working on family members because the outcomes are so poor in multiple ways.

People needing ALS without prompt transport are usually going to die.

As for what I'd do, I'd do my best. Anything more specific is wishing what I'd do.

And if you want to think about medical emergencies way out there, think about altitude sickness, trauma, sudden acute gastroenteritis, food poisoning, dehydration with attendant constipation and other s/s.

Thank you for the advice.
Hope I will never need to consider ALS other than trainings.

 

[TheLocalMedic]

Just a few questions for thought:
What would you do if you encountered a patient with ALS needs in back country environment? Would you risk it?
What if the patient was your friend or family member? Would your decision be different?

Alright, I'll bite… Regardless of how unlikely this scenario is…

If I was whacker enough to carry ALS gear with me everywhere I went (nope-nope-nope, not a chance) and I encountered some crazy backwoods trauma where the nearest ALS was really far away (like, really really far away) and the person would 100% die without an immediate intervention (i.e. darting a tension pneumo), then I might consider risking it and helping them.

And here are the myriad problems with that:

1. "Where did I get the supplies from? Uh…" guess I better have an explanation for stealing that gear from my employer.

2. If they're that bad off, they're likely to die anyway, and how is it going to look if I performed some ALS treatment on a guy who ends up dying?

3. Practicing medicine without a license = bye bye career.

4. Even if they survive, I'm open to civil and criminal charges and I'm without any legal protection.

***All that and I'm a licensed and certified, actively working paramedic***

You, OP are not a paramedic. You are an EMT who has seen some extra training. So don't even think about it.

 

[TimRaven]

1. "Where did I get the supplies from? Uh…" guess I better have an explanation for stealing that gear from my employer.
.

I don't know, there are a lot of TCCC trained police officers carry their issued med kits even off duty (some were required to).
Maybe their department policy covers them or something, or maybe they took out their needles when off-duty.

 

[Akulahawk]

Sacramento County explicitly authorizes the full ALS scope of practice to be utilized by off-duty properly accredited Sacramento County Paramedics. The catch is that the Paramedic has to be affiliated in some way with an ALS provider to do it. To be able to keep your own full kit, you have to be authorized to do it, but advanced airway gear is perfectly fine.

 

[mycrofft]

Sacramento County explicitly authorizes the full ALS scope of practice to be utilized by off-duty properly accredited Sacramento County Paramedics. The catch is that the Paramedic has to be affiliated in some way with an ALS provider to do it. To be able to keep your own full kit, you have to be authorized to do it, but advanced airway gear is perfectly fine.

So someone without employment as an ALS provider cannot be one off duty.

Wonder if this is in line with their EMSA? They're pretty conservative.

 

[Angel]

Are you asking for yourself? I don't think you can do anything ALS anyway considering you're an EMT; even with the ACLS, PHTLS ect.

 

[Handsome Robb]

I have a kit for when I snowmobile, hike, backpack, mountain bike, so on and so forth with my family and close friends who're basically family. I will gladly hand over my card for one of them. Hell I'll hand deliver it with a smile on my face if it means saving a family member or friend's life.

Not for a complete stranger. Sorry. I've been burned too many times, gotta look out for number one.

 

[Handsome Robb]

Are you asking for yourself? I don't think you can do anything ALS anyway considering you're an EMT; even with the ACLS, PHTLS ect.

This is very true. Those certs give you knowledge and that's it, not permission to perform those skills, even if you're employed as an EMT.

Also, if you did your EMT "a few years ago" and haven't done any CEUs or revert by testing your certification is probably no longer valid anyways and you'll have to retake the class to be decertified depending on how long it's been lapsed. Without any affiliation with an agency or active EMS experience they might not let you without taking the class.

 

[MonkeyArrow]

Alright, I'll bite… Regardless of how unlikely this scenario is…

If I was whacker enough to carry ALS gear with me everywhere I went (nope-nope-nope, not a chance) and I encountered some crazy backwoods trauma where the nearest ALS was really far away (like, really really far away) and the person would 100% die without an immediate intervention (i.e. darting a tension pneumo), then I might consider risking it and helping them.

And here are the myriad problems with that:

1. "Where did I get the supplies from? Uh…" guess I better have an explanation for stealing that gear from my employer.

2. If they're that bad off, they're likely to die anyway, and how is it going to look if I performed some ALS treatment on a guy who ends up dying?

3. Practicing medicine without a license = bye bye career.

4. Even if they survive, I'm open to civil and criminal charges and I'm without any legal protection.

***All that and I'm a licensed and certified, actively working paramedic***

You, OP are not a paramedic. You are an EMT who has seen some extra training. So don't even think about it.

Certain people do carry medical kits of varying scope while in the backwoods, as your scenario mentions. Therefore, it is not everywhere they go, but merely places where they anticipate injuries with no immediate medical help to be available.

1. There are many online suppliers that you can get ALS supplies from. Just for argument's sake (and because he was talking about tactical medicine), www.rescue-essentials.com

2. The scenario was that you save the person with the ALS intervention. If you dart someone who has a tension pneumo successfully and put an occlusive dressing on it, you might have saved their life, assuming no other injuries are present.

 

[Handsome Robb]

#2 is pretty important.

Somewhat rare to have an isolated tension pnuemo.

 

[MonkeyArrow]

The scenario is a very "isolated" out-there scenario to begin with. But any who, tension pneumo can be a primary life-threatening concern secondary to the bleeding from trauma. If you are skiing (lets say), and fall over hitting your chest on some blunt rocks. You break a few ribs that can puncture your lungs causing the pneumo. There is of course bleeding from the cuts and scrapes but after that, the pneumo will become the (probable) primary concern for this MOI.