First Aid Tx vs Scope of Practice

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NightMedic1

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Hi Guys,
Hope you're all enjoying the season!

I have an interesting, if complicated situation at my workplace. All I can say is that it is in Oregon, and it's an industrial setting.

So I wear several hats, and they're getting a little mixed up. I could use your help in figuring things out!

So part of my job is to respond to in-house emergencies. I'm an Oregon and National Paramedic, but I am limited to a BLS scope of practice due to the company not wanting to pay ALS priced insurance.

However, I also do a lot of occupational health stuff; audio, UA, stuff like that.

Here's the part where I'm having trouble: First Aid. Much of the job is general first aid - not emergent, no protocols - but I'm still a Medic. (I have 3 EMTs under me also.) In the first aid capacity, they want us handing out ibuprofen, pepto-bismol, benadryl tabs, aleve, tylenol; even tetricaine numbing eye drops so that we can use magenets to pull out slag and shavings.

None of this is in the Oregon scopes, however all of it is non Rx meds at non Rx doses.

This is all equivalent to mobile healthcare protocols that are specifically for mobile healthcare trained providers, wildland fire fighting and national disaster response. These don't seem to be contingent upon the Oregon or NREMT scopes, and say not to exceed your scope... but none of the meds are in the scopes.

Am I just over thinking the hell out of this? Is it such that anyone in any capacity at any time can dispense non Rx medications at non Rx doses?

All of your input and help is greatly appreciated! Thanks in advance :-)
 
Pretty much over thinking it in my non legal perspective.

Many moons ago, I used to do event standbys. I had a tackle box laden with all the items you mentioned and more. All of it was OTC goods. If anyone came to my stand requiring those things, they simply went to the box and took whatever they wanted. Technically I was no dispensing it, I was merely making OTC meds available to grown adults who would purchase and use on their own if they were not at said event.

I would write what they took if they told me, but other than that I gave no advice (officially).

From the employer's perspective, at least they have people reporting to the medic/clinic and I am sure you maintain a FAR as dictated by OSHA. Got to keep those recordables down and keep everything on first aid level as much as possible. However tetracaine use does constitute a recordable, so I am unsure how they get around that one.

Anyways, I personally see no big issue with what you got going on but again I am not legal, nor am I in Oregon.
 
I have the same issues when doing standby events. I often have a big box of OTC meds like you mentioned, but because they are not explicitly included in by scope of practice I have felt a little conflicted about just handing them out.

But I figure if I know how and what the medication is doing, and I'm handing out responsible doses, then there's no way in hell that I can really get in trouble for giving it out. It's all available to people if they were to grab a box of it at the store, so if the general public can be trusted to buy and use it themselves, then it's got to be pretty hard to screw it up.
 
Make sure that you're not suggesting that someone take a specific OTC for a specific reason. You can certainly advise people what you have available for them to use and make a note of what was taken so that you have some idea what kind of usage your program is getting as far as medication use.

The tetracaine, well, that is a bit more difficult to deal with. Being that it's basically a closed medical system, if the company has an industrial Physician, it may be somewhat permissible to get the Physician to instruct the staff and sign off on that particular med and use of magnets to remove ferrous materials that are in the eye.

Might be good to run that by a lawyer that knows industrial medicine.
 
So part of my job is to respond to in-house emergencies. I'm an Oregon and National Paramedic, but I am limited to a BLS scope of practice due to the company not wanting to pay ALS priced insurance.

However, I also do a lot of occupational health stuff; audio, UA, stuff like that.

Here's the part where I'm having trouble: First Aid. Much of the job is general first aid - not emergent, no protocols - but I'm still a Medic. (I have 3 EMTs under me also.) In the first aid capacity, they want us handing out ibuprofen, pepto-bismol, benadryl tabs, aleve, tylenol; even tetricaine numbing eye drops so that we can use magenets to pull out slag and shavings.

None of this is in the Oregon scopes, however all of it is non Rx meds at non Rx doses.


1. Working below the level of your license is always sketchy. You may have requirements to report substandard care or feel compelled to render care above your employment level. Employers love this, getting service for free. They may also be ignorant. Sports leagues and scouting chapters are bad for this.

2. GO read your state laws about your license or certificate as a paramedic . Also read the part about audiology techs, lab techs, and "other occupational stuff" techs needing certification. Also look into the need for medical control and record keeping. Finally, if you are doing drug testing, there may be other considerations; knowing how to establish, document and maintain a chain of custody is one aspect.

3. If it is not in your scopes then you cannot do it. Technical scopes are inclusive (they list what you can do) not exclusive (you can do anything except what they tell you not to).

Nothing to prevent the employer from putting out the little industrial packets of Advil and etc. for workers to take; or, if there is, it is up to the employer to check that out.

And using tetracaine without MD: how are you getting it? It's Rx. I think there's a dental tetracaine gel, and there are veterinary one you might get over the feed store counter. Illegal and risky for the patient and for you.

Here are some considerations about using tetracainem (wikipedia "Topical Anesthetics"):
AND I QUOTE (hahaha)
Abuse when used for ocular pain relief[edit]

When used excessively, topical anesthetics can cause severe and irreversible damage to corneal tissues[4][5][6][7][8] and even loss of the eye.[9] The abuse of topical anesthetics often creates challenges for correct diagnosis in that it is a relatively uncommon entity that may initially present as a chronic keratitis masquerading as acanthamoeba keratitis or other infectious keratitis.[4][5][7][9][10] When a keratitis is unresponsive to treatment and associated with strong ocular pain, topical anesthetic abuse should be considered,[7] and a history of psychiatric disorders and other substance abuse have been implicated as important factors in the diagnosis.[4][9][10] Because of the potential for abuse, clinicians have been warned about the possibility of theft and advised against prescribing topical anesthetics for therapeutic purposes.[5][9]
 
Hey guys,
Thanks for your info!

I apologize that I wasn't more clear with some of the details. It's not as shady as it sounds lol :cool:

I work with a PA in the office and there is a medical direction physician overseeing the program. I have obtained/will obtain all the required occupational training and certifications such as NIOSH and CAOCH for spirometry and audiology.

Since our scopes are inclusive (and it's quite clear) I've just been trying to figure out what provisions exist for first aid care in other capacities. There's actually standing orders and authorized medication protocols for things like Mylanta, pseudoephedrine, fluorescein sodium ophthalmic strips and other random stuff like Aleve. My understanding of the Oregon scopes are that as a medic I can administer any meds I have training and protocols for, so that's cool... But the 3 basics I have working under me don't have the same provision.

I know what we can do under our scope - I'm just looking for other provisions that allow us to do what we do that aren't related to our ems certs.

Thanks for your help!
 
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