Scope of Practice and Online Medical Control

[WuLabsWuTecH]

Recently, a lot has changed in both my state and our departmental protocols. As the standing orders get revised, some things are missing or just overlooked. For example, when rewriting the chest pain protocol, they accidentally left of 12 lead EKG transmission as a basic skill (even though it still is). My question is this, if I call up a hospital as a squad, and they ask me for an EKG, as long as I get a physician to order it as online medical control, legally speaking I'm still ok right? This happened the other night, and while I knew it wasn't in our protocol, I asked them to order it as online medical control. It was a moot point as by the time we got around to it we were a minute out and they just did it after I transferred care.

So I guess more broadly, as long as you stay within your State's scope of practice, you can stray outside your standing orders because online medical control takes precedence right?

This is of course assuming that there are not SOGs to the contrary (for example, even though it is in our state scope, we have an SOG that states under no circumstances, including with online verbal direction, should basics use Epi off of the truck).

Thanks!
-WU

 

[jjesusfreak01]

Recently, a lot has changed in both my state and our departmental protocols. As the standing orders get revised, some things are missing or just overlooked. For example, when rewriting the chest pain protocol, they accidentally left of 12 lead EKG transmission as a basic skill (even though it still is). My question is this, if I call up a hospital as a squad, and they ask me for an EKG, as long as I get a physician to order it as online medical control, legally speaking I'm still ok right? This happened the other night, and while I knew it wasn't in our protocol, I asked them to order it as online medical control. It was a moot point as by the time we got around to it we were a minute out and they just did it after I transferred care.

So I guess more broadly, as long as you stay within your State's scope of practice, you can stray outside your standing orders because online medical control takes precedence right?

This is of course assuming that there are not SOGs to the contrary (for example, even though it is in our state scope, we have an SOG that states under no circumstances, including with online verbal direction, should basics use Epi off of the truck).

Thanks!
-WU

In general, OLMC can order you to perform any procedure within your scope of practice. That said, acquiring and transmitting a 12 lead is a diagnostic procedure, not a treatment. You aren't allowed to act on any interpretation you might make of the 12 lead, but there's not a problem taking the 12 lead itself.

What I would advise is just asking a supervisor whether or not they would like you to take and transmit 12 leads, regardless of the protocol, because although I don't believe there is any legal liability in doing them, they may not want you doing it for whatever reason, and it may unduly annoy someone.

 

[Aidey]

The whole point of OLMC is to allow you to perform something outside your designated scope of practice or protocols. For example, using a medication you normally carry for a use not covered in your protocols. Magnesium for asthma is one that comes to mind.

Without knowing the laws of the state you are in, I would guess that it is ok to transmit the 12 lead with OLMC direction. Especially since it was in the protocols, and was left out as a mistake, it wasn't purposely taken out.

 

[JPINFV]

The whole point of OLMC is to allow you to perform something outside your designated scope of practice or protocols. For example, using a medication you normally carry for a use not covered in your protocols. Magnesium for asthma is one that comes to mind.

OLMC can provide advice and consent for operating outside of your protocols, but not necessarily scope of practice. Often the "physician on scene" policies specifically say that the supplies are supposed to be given to the physician, but the physician can't order the paraemedic to provide care outside of his scope. Similarly there was the case about a decade ago (I think) of 2 paramedics getting busted after acting on OLMC orders to do a c-section.

Without knowing the laws of the state you are in, I would guess that it is ok to transmit the 12 lead with OLMC direction. Especially since it was in the protocols, and was left out as a mistake, it wasn't purposely taken out.

This is key. In California, for example, I think there's enough wiggle room with the scope of practice to at least put up a good defense for simple acquisition of a 12 lead by an EMT. Your laws may vary.

 

[Aidey]

If I remember right (and I might not be since that case was a while ago) those medics got in trouble because a c-section was so far out of their scope it was unreasonable to expect them to be able to perform it properly with online direction.

If a surgical crich is outside of scope, but a needle crich is in scope, I bet OLMC for a surgical crich would be deemed acceptable.

Or, a personal example. Our protocols that cover inter-hospital transfers allow you to take any medication (excluding a few specifically named) that you have had training on. Per my employer a 5 minute chat with the sending MD meets the requirement as long as you are comfortable with the medication. Antibiotics and insulin aren't within my scope, but the talk counts as online medical direction.