California Good Samaritan Law and ALS?

[mycrofft]

So I'm outside Camp Granada (where I might be eaten by a bear)

I think realistically one needs to learn more about summoning emergency transport out and setting up for that (satellite phone, how to clear a helispot, signaling, how to make ad hoc transport to get where you can be rescued) and practice safety measures (never go without enough of party to get any one of the members out if totally a basket case) than to stock up on ALS stuff. If seconds count, then in the backwoods you're probably dead. (Chest darts and tourniquets maybe being exceptions).

Urban setting: response times are short. Weigh that agains the expense and responsibility of being a freestanding ALS provider without portfolio.

 

[Akulahawk]

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.

Basically, if you're not employed by an ALS provider in Sacramento County, you can only provide BLS level care as a Good Sam. The "funny" part is that once you're accredited and employed by an ALS provider, there's nothing that says you have to be working as a medic. Until they changed their re-accreditation policy, I was continuously accredited until last year.

Once I'm done with nursing school, I'm going to look for part time work as a medic. Why? Something to do that brings in extra $$$ while I search for an RN job.

 

[mycrofft]

There is a separate re-iteration of the Good Samaritan Law for California which specifically exempts licensed health care professionals from suit (MD, RN, etc) with same exemptions from suit and same standards offered to layperson and tech passers-by.

 

[Akulahawk]

There is a separate re-iteration of the Good Samaritan Law for California which specifically exempts licensed health care professionals from suit (MD, RN, etc) with same exemptions from suit and same standards offered to layperson and tech passers-by.

Indeed there is... and IIRC they also "expanded" the protections to include "rescue" actions because of a single lawsuit that got news attention...

 

[SeeNoMore]

I think it should also be remembered that ALS does not consist of simply learning cool skills over the course of a day long class. It is widely agreed that existing Paramedic educational standards are woefully inadequate. Every provider I respect (Paramedic, Nurse, RT , MD) has consitently worked to advance their education and experience. There are many nuances to both the decision to use and physically implement "ALS skills". With due respect to the OP , are you that confident that you will make good treatment choices based on EMT-B + ACLS etc? And even if you are the exception to the rule , what about the rest of your fellows? We need to act like professionals. There are many ways in which you can render needed and appropriate assistance (CPR, Emotional support, calling 911, basic first aid) or act within your scope as a wilderness EMT but deciding to utilize ALS interventions as you have described is impossible for me to understand.

EDIT: Also, if you are so sure that an intervention that is outside of your scope of practice is necessary, do some research and advocate for an exception to the rule. This could certainly be the case in rural settings for certain interventions. That way you would (hopefully) be provided specific education and training tailored to your provider level and the situation you work in. There would also (in theory) be ongoign education and clinical oversight of any added interventions. Not that this affects what you do when you randomly encounter people off duty.

 

[mycrofft]

Indeed there is... and IIRC they also "expanded" the protections to include "rescue" actions because of a single lawsuit that got news attention...

YES! The woman sued her friend, who was driving and dragged her out of a car leaking gas, because extrication was not a medical measure. ANd because the victim suffered paraplegia and probably had monumental medical bills.

 

[mycrofft]

OP, here's one of Uncle Mycrofft's Laws:

If you have to think up wrinkles in the law to let you do something, then probably you really ought not to do it.

 

[TimRaven]

EDIT: Also, if you are so sure that an intervention that is outside of your scope of practice is necessary, do some research and advocate for an exception to the rule. This could certainly be the case in rural settings for certain interventions. That way you would (hopefully) be provided specific education and training tailored to your provider level and the situation you work in. There would also (in theory) be ongoign education and clinical oversight of any added interventions. Not that this affects what you do when you randomly encounter people off duty.

There is a reason I chose needle decompression,
not other ALS intervention in the OP scenario.

This skill is very common among military and certain LE agencies nowadays, and more agencies are adopting it into their trainings.

If police officers and soldiers with 32 hours training a year can properly identify tension pneumo and dart patients,
I don't see why better trained, equipped and experienced EMT-Bs or EMT-Is cannot.

I do believe that there will be a change in civilian EMS guideline and scope soon,
just like TQ or hemostatic agents we saw in the past decade.

 

[SeeNoMore]

There is a reason I chose needle decompression,
not other ALS intervention in the OP scenario.

This skill is very common among military and certain LE agencies nowadays, and more agencies are adopting it into their trainings.

If police officers and soldiers with 32 hours training a year can properly identify tension pneumo and dart patients,
I don't see why better trained, equipped and experienced EMT-Bs or EMT-Is cannot.

I do believe that there will be a change in civilian EMS guideline and scope soon,
just like TQ or hemostatic agents we saw in the past decade.

I have no issue with changes in BLS scope of practice that are evidence based , especially in areas in which ALS response is not readily available and trauma/specialty hospitals are not close.

Again, this is different than what a bystander or off duty provider is engaged in. The two ideas are sort of intertwined in the thread.

 

[Handsome Robb]

There is a reason I chose needle decompression,
not other ALS intervention in the OP scenario.

This skill is very common among military and certain LE agencies nowadays, and more agencies are adopting it into their trainings.

If police officers and soldiers with 32 hours training a year can properly identify tension pneumo and dart patients,
I don't see why better trained, equipped and experienced EMT-Bs or EMT-Is cannot.

I do believe that there will be a change in civilian EMS guideline and scope soon,
just like TQ or hemostatic agents we saw in the past decade.

I learned how to do needle decompressions in my intermediate class. It is not in our EMT-I/AEMT scope of practice at my agency.

There are a few places out there that have a very advanced scope of practice for their EMT-Bs and Is. Presidio County EMS being the one that comes to mind. They have an intense program. I believe their EMT-Bs can decompress a chest with specific parameters met. It may even be on standing orders, I can't remember. I read something about it somewhere recently, I'll see if I can find it.

 

[TRSpeed]

Good luck finding anything on them . I look for protocols but always come up empty.

 

[Meursault]

If police officers and soldiers with 32 hours training a year can properly identify tension pneumo and dart patients,

There's some doubt about that; I haven't looked into it much, but I'd start with this blog post from someone who also posts here.

I don't see why better trained, equipped and experienced EMT-Bs or EMT-Is cannot.

Almost all EMT-Bs without separate military-derived training aren't trained or competent to identify tension pneumothorax. I'd venture many EMT-Is aren't either, if there are any left. Anyone seen an EMT-I lately?

There's a larger issue you're overlooking and mycrofft tried to steer you toward. Let's say, against all probability, you encounter, correctly identify, and successfully needle a tension pneumothorax in a remote setting. You've now transformed an expectant pt. into one merely in urgent need of a chest tube and a hospital. It works in the military and urban/suburban setting because you generally have a short time to definitive care and resources available to get pts. there; innawoods, you don't. And no, you're not putting in a chest tube in the forest with only a CLS course and YouTube to guide you, even if you wanted to carry all that with you. Legal complications are pretty far down the list of problems in this scenario.

But my backup open thoracotomy plan that uses a bottle of rubbing alcohol, a Cold Steel Trench Hawk, and a Leatherman Fuse is totally viable, right?

 

[mycrofft]

And what percentage of field pneumo decompressions were late deemed unnecessary?

That'll fly in Fallujah, but not in Yosemite or Central Park.

 

[SeeNoMore]

And what percentage of field pneumo decompressions were late deemed unnecessary?

That'll fly in Fallujah, but not in Yosemite or Central Park.

Unnecessary and/or resulting in harm to the patient. I understand Timraven that you are advocating the use of certain techniques when there are not any other good options. If you have a system set up to get these patients somewhere in the near future after you decompress the chest I would be willing to entertain the concept of first line providers of an intermediate level using chest decompresion. I still wonder though how often the interention would be appropriately used and make any difference on pt mortality.

 

[mycrofft]

As I've always said once I thought of it cool, half of what you learn at any level of medical technique and profession is know when to stop, what not to do, and when to call for help.

Just learning how to do something always prejudices you towards doing it. Amazing how many squeaky hinges you find when you have a new can of WD-40 on hand. Or raised nailheads when you have a hammer.

 

[SeeNoMore]

As I've always said once I thought of it cool, half of what you learn at any level of medical technique and profession is know when to stop, what not to do, and when to call for help.

Just learning how to do something always prejudices you towards doing it. Amazing how many squeaky hinges you find when you have a new can of WD-40 on hand. Or raised nailheads when you have a hammer.

It's very true. I think it takes some discipline and certainly education and experience to resist making decisions based on ego or the feeling that "something needs to be done". The flip side of the coin is that it also tempting at times to delay an appropriate intervention due to uncertainty or lack of confidence. Both dangers seem especially elevated when you are discussing adding high risk procedures that are unlikely to be truly needed very often.

 

[Handsome Robb]

There's some doubt about that; I haven't looked into it much, but I'd start with this blog post from someone who also posts here.



Almost all EMT-Bs without separate military-derived training aren't trained or competent to identify tension pneumothorax. I'd venture many EMT-Is aren't either, if there are any left. Anyone seen an EMT-I lately?

There's a larger issue you're overlooking and mycrofft tried to steer you toward. Let's say, against all probability, you encounter, correctly identify, and successfully needle a tension pneumothorax in a remote setting. You've now transformed an expectant pt. into one merely in urgent need of a chest tube and a hospital. It works in the military and urban/suburban setting because you generally have a short time to definitive care and resources available to get pts. there; innawoods, you don't. And no, you're not putting in a chest tube in the forest with only a CLS course and YouTube to guide you, even if you wanted to carry all that with you. Legal complications are pretty far down the list of problems in this scenario.

But my backup open thoracotomy plan that uses a bottle of rubbing alcohol, a Cold Steel Trench Hawk, and a Leatherman Fuse is totally viable, right?

Umm... We use EMT-I/AEMTs as our minimum level to work on a unit. I/P is the county requirement. All our fire departments are ILS except for one which is ALS.

 

[Handsome Robb]

Good luck finding anything on them . I look for protocols but always come up empty.

I could probably get a copy of specific ones if I asked really nicely but not going to do that.

 

[TimRaven]

Thank you guys for all the inputs. I originally came up the the scenario simply out of curiosity of legal/civil consequence, not trying to advocate people carrying ALS equipments with them.


But one more thing I want to point out, tactical medicine is actually closer to wilderness medicine than urban in the sense of transportation.

Even under ideal condition with no hostile presence, patients usually take hours at best to reach definitive care.
Medevac won't land if the LZ was not secured. Sometime the terrain was not suitable at all.
One of my friends waited three days before evacuated to the rear.

Hence the study of prolonged TQ use in the field, early IV/IO access and advocating use of Hextend or other volume expander in the recent TCCC guidelines.

 

[mycrofft]

The current shooting war in SW Asia, like each war before it, has presented many learning points, some of which will be used.

Here's hoping your friend has come out of it in good shape.

A lot of us swerve to address ALS freelancing when this sort of thing is posted because about once a quarter someone signs on as though they are either going to be "the medic" for potentially risky family outings, or be prepared to respond at any time…which is unsafe for most everyone involved.