Question on scenario and who takes charge?

[CodeBru1984]

While the AEMT has the higher scope of practice, because the AEMT isn't on duty, the on-duty EMT crew has scene authority. That means that the EMT crew can accept or reject the offer of assistance. In my local area, if I am "affiliated" with an ALS provider, I'm explicitly authorized to provide full ALS scope while off-duty. Here's where things get interesting: should an on-duty BLS 911 rig show up, I can legally turn the patient over to the BLS crew without an issue as long as I am not turning the patient over to them with something that they're not allowed to monitor. Can a BLS crew monitor a patient that's intubated? Yes. A patient that's got a line of NS going? Yes. A chest tube that I placed? Yep.

The reality is that I'm going to provide BLS-only care, turn the patient over to the on-duty crew, and beat feet. I have other things to do with my time than be stuck in an ambulance providing care when the on-duty crew is capable of handling things and (more importantly) arranging for further care... even if they're BLS-only.

I wasn't aware that in Ca if your are "affiliated" with an ALS provider that one has an explicit authority to provide full ALS scope of practice off duty. Is this a new policy? From my understanding, Ca EMS providers (EMT/Paramedic) have no duty to act off duty.

 

[Medic496]

CA Paramedics while off duty may not practice ALS. A paramedic must be accredited, work for an approved ALS provider, and be on duty. Even if the medic is going to go help with disaster relief, the paramedic must be being sent by the employer with the full compliment of equipment. No running around starting lines on everyone just because we can.

 

[Akulahawk]

CA Paramedics while off duty may not practice ALS. A paramedic must be accredited, work for an approved ALS provider, and be on duty. Even if the medic is going to go help with disaster relief, the paramedic must be being sent by the employer with the full compliment of equipment. No running around starting lines on everyone just because we can.

Generally this is true. Sacramento County explicitly authorizes off-duty ALS. However, each Paramedic must be affiliated with a Paramedic Provider and have a current accreditation. Here's the catch: Off-duty possession of ALS equipment is controlled. Paramedics can't just assemble a full-bore kit with meds "just because." They must have county EMS permission to do that.

That being said, should said Paramedic stumble upon all the equipment necessary, he or she could use all that equipment in providing care. One of the reasons why Sacramento County has the provision for ALS off-duty is because it's entirely possible that an event occurs somewhere and an off-duty paramedic just happens to be there and offers to assist. This way more ALS hands are available early on while on-duty paramedics are still en-route to the scene. One odd wrinkle is that off-duty paramedics aren't required to ride-in with unstable patients that they cared for as the primary paramedic. They can just turn the patient over to an on-duty paramedic and leave the scene.

Yes, this is very odd and unusual, but it's how Sacramento built it's system. Most of the time, a Paramedic can only provide ALS services while on-duty... otherwise they're only allowed to provide BLS only care. Of course, any Paramedic can provide that level care at any time, even if no longer working, because it's essentially first-aid.

 

[Akulahawk]

I wasn't aware that in Ca if your are "affiliated" with an ALS provider that one has an explicit authority to provide full ALS scope of practice off duty. Is this a new policy? From my understanding, Ca EMS providers (EMT/Paramedic) have no duty to act off duty.

Off-duty ALS is pretty unique to Sacramento County. It's been this way for at least 12 years.

Paramedics must be affiliated with a Paramedic Provider to provide any ALS services, even if on-duty. So, if you're a paramedic but you work for a BLS provider, you may only provide BLS care. Off-duty, paramedics are generally authorized to provide BLS care only.

 

[CodeBru1984]

Off-duty ALS is pretty unique to Sacramento County. It's been this way for at least 12 years.

Paramedics must be affiliated with a Paramedic Provider to provide any ALS services, even if on-duty. So, if you're a paramedic but you work for a BLS provider, you may only provide BLS care. Off-duty, paramedics are generally authorized to provide BLS care only.

I got my start in EMS in Sacramento County back in 2002 and even I wasn't aware of that... Learn something new everyday.

 

[Akulahawk]

I got my start in EMS in Sacramento County back in 2002 and even I wasn't aware of that... Learn something new everyday.

That's something that's very specific to paramedic providers, so BLS providers wouldn't have to know about that provision because it doesn't apply to them, and it's not something they'd ever have to deal with as a Basic.

We do have some large areas that are covered by volunteers, so that off-duty provision of ALS and possession of ALS equipment (outside of advanced airways) is something that won't go away for quite some time.

 

[CodeBru1984]

That's something that's very specific to paramedic providers, so BLS providers wouldn't have to know about that provision because it doesn't apply to them, and it's not something they'd ever have to deal with as a Basic.

We do have some large areas that are covered by volunteers, so that off-duty provision of ALS and possession of ALS equipment (outside of advanced airways) is something that won't go away for quite some time.

They can't posses advanced airway equipment off duty?

 

[medic17]

I don't know the law in your state but by us all medically trained personnel must give assistance if required (duty to act). I asked the instructor (an EMT-A) in one of the EMT-B courses I helped out in and he said that here it's his decision if he wants to take over or not but he wulde not if he can so as not to confuse the team.

 

[Akulahawk]

They can't posses advanced airway equipment off duty?

All Sacramento County Paramedics canpossess advanced airway equipment off duty. That equipment may be personally owned, or it could be issued to them. It's all the other stuff (like code meds, IV catheters, Defib that's not an AED for own use, and the like) that they prohibit. Think of it like this: Airway kit? Good to go. ALS jump kit? Not so much, unless specifically authorized by the county to possess that stuff. No off-duty Paramedic is authorized to possess controlled substances (think "narcotics") as part of an "off-duty" kit, if authorized to possess an ALS kit while off-duty.

What do I mean by the ALS jump kit? Simple: think of it as an ambulance in a bag. You put that kit on a BLS truck and hop on board and suddenly you've emergently created an ALS ambulance minus the controlled "narcs." Yes, that "kit" could include monitors and the like too.