Still Alarm Outside Your Jutisdiction

[Akulahawk]

Unless I've been granted some form of reciprocity, if I'm outside an area where I'm authorized to do ALS, I'll function at a BLS level, call 911, and turn over to the local EMS people once they arrive on scene.

 

[JPINFV]

Unless I've been granted some form of reciprocity, if I'm outside an area where I'm authorized to do ALS, I'll function at a BLS level, call 911, and turn over to the local EMS people once they arrive on scene.

So, you witness a cardiac arrest (who didn't see this scenario happening?). Your monitor does not function as an AED. You would delay converting a lethal rhythm because you're outside of your jurisdiction?

 

[Akulahawk]

So, you witness a cardiac arrest (who didn't see this scenario happening?). Your monitor does not function as an AED. You would delay converting a lethal rhythm because you're outside of your jurisdiction?

Would I delay that? No. Would I have to delay other ALS interventions? Yes. I'll take the blame for CPR + Sparky... beyond that, I'm not about to get my License yanked because I got convicted for practicing medicine without a license... all because I'm not Licensed to perform ALS in that area/state.

Do I like that idea? Not one bit.

 

[JPINFV]

There's never anything to like about scenarios like these. However I view it as being an EMT or paramedic on an airplane (however, granted, airlines have online med control, but they aren't your online med control). I could present many more scenarios that I'm sure you'd end up agreeing to provide ALS interventions (say, anaphlaxis with an extended paramedic response time? How about Albuterol for reactive airway emergencies? How long are you going to withhold D50 from a patient in hypoglycemia? Magill forceps and FBAOs?). I guarantee you, though, that the general public isn't going to care that you're 'on the wrong side of the county line,' nor the jury at your civil trial if there's a bad outcome that could have been adverted and any EMS agency or office who is going to raise a stink about an out of area, region, or state ambulance providing care to the best of their abilities on a still alarm doesn't care about the citizens who they are supposed to be protecting. To give a perfect example, even though they were EMTs, the patient and the public didn't care that the primary job of those two FDNY dispatchers was dispatching and not field work.

 

[CAOX3]

I do what I was trained to do. Its going to be worse for everything involved including the patient (remember them) when they realize a fully staffed ambulance was in the parking lot eating their chicken nuggets but didnt act because of a line drawn in the sand by some bureaucrat.

Then again I dont I dont do my job in fear of litigation.

 

[DrParasite]

hopefully you have a GPS, and put in nearest hospital lol

do what you got to do. does someone need help? looks like it. can you help? looks like it.

book answer? call the AHJ, stabilize as best you can until they get there.

my answer? do what you got to do, call your medical director as protocol dictates (during a call or afterwards to advise him/her), tell your boss what you did when you get back to your area (probably write an incident report to explain why you did what you did), transport to the hospital, and don't get lost.

 

[jjesusfreak01]

That would be true, except ambulance services aren't supposed to accept calls originating in counties that they aren't licensed in.

I'm referring to a situation in which you happen to find yourself at a scene, not one where you accept a call outside your area. (Except in an MCI, the counties surrounding mine would never dispatch an out of county truck to a call, and if they did, they would need to do it through our dispatch)

You don't do very many long distance transfers, do you?

Nope, we have lots of good hospitals in the immediate area. People roll in, walk out.

 

[medicwilliams19822010]

Well its not my district or area but i'm on duty so i would have to treat the Siezing Patient as my own until the local district E.M.S.A. Arrives on scene. And I would have to start siezure protocol and get the patient on board our rig or unit and continue treatment until the Local EMSA arrives. And apon their arrival I would bring the local E.M.S.A. / incident commander / captain up to speed on patients conditions and other vital Information. As well as what protocol we used and then sign patient over to the local area E.M.S.A.

 

[Veneficus]

I have to ask...

Is this a problem in any other place except California?

 

[JPINFV]

Is this a problem in any other place except California?

Any place near state lines. When I worked in Massachusetts we had a dialysis patient who lived in Mass and had his dialysis in Rhode Island. We posted down there for the duration of his treatment (very small company and this patient had a habit of ending his treatment early) and it was a very real probability that someone could have come up to us while we were posting (which, looking at the map, was normally just on the RI side of the state line) or eating breakfast (Danny's Breakfast Place in Woonsocket has wonderful food at an awesome price). Similarly, any company that does long distance transports past state lines. I know that the company I worked for in California would end up with a transport going to Nevada a few times a year (these crews were assigned in advance). I imagine that there was a very real risk for them as well, especially if they ended up grabbing a motel room for the night.

 

[Veneficus]

Any place near state lines. When I worked in Massachusetts we had a dialysis patient who lived in Mass and had his dialysis in Rhode Island. We posted down there for the duration of his treatment (very small company and this patient had a habit of ending his treatment early) and it was a very real probability that someone could have come up to us while we were posting (which, looking at the map, was normally just on the RI side of the state line) or eating breakfast (Danny's Breakfast Place in Woonsocket has wonderful food at an awesome price). Similarly, any company that does long distance transports past state lines. I know that the company I worked for in California would end up with a transport going to Nevada a few times a year (these crews were assigned in advance). I imagine that there was a very real risk for them as well, especially if they ended up grabbing a motel room for the night.

The providers didn't have to have a cert for the second state or was there automatic reciprocity?

 

[JPINFV]

For the CA->NV trips: never as we had absolutely no intention of ever picking up patients in NV.

For MA->RI, my understanding is that return transports are treated differently than initial transports.

 

[Simusid]

We routinely transport patients across the border from MA into RI. One scenario is that we could witness an MVA on the highway during our return trip and would be the first responders on scene. I've been told that we would work at BLS level until the locals arrive. If ALS is required, one option is to have the RI dispatcher request mutual aid since we have an agreement in place. Then we can actually take the call.

I don't know if we could legally hand over ALS care from a MA medic to an RI cardiac though.

 

[jjesusfreak01]

We routinely transport patients across the border from MA into RI. One scenario is that we could witness an MVA on the highway during our return trip and would be the first responders on scene. I've been told that we would work at BLS level until the locals arrive. If ALS is required, one option is to have the RI dispatcher request mutual aid since we have an agreement in place. Then we can actually take the call.

I don't know if we could legally hand over ALS care from a MA medic to an RI cardiac though.

Hmm, in my complete inexperience, I would say that if it's an ALS level call, you would probably need the medics staying with the patient unless...the cardiac scope of practice included everything necessary to care for the patient. I have been looking over the protocols for RI, and while it looks like the EMT-Cs can do almost all of the treatments used for cardiac patients, they are still somewhat limited.

Were I faced with that odd situation, I would have the EMTs on scene call their medical director. If they MD was ok with the transfer to the cardiacs, then all is well.

 

[exodus]

Call BH and simply get online orders for any procedures...

 

[JPINFV]

You know... calling base hospital doesn't really change the fact that you're "responding" to a still alarm (responding doesn't really feel like the right verb) in an area you aren't licensed to operate in, which is what the entire conundrum is. The medical director isn't going to have any additional information about what the official policy and/or law is (besides, you can't be ordered to violate state law anyways). As I mentioned earlier, this is one of the issues that separate EMS from a professional and a technical trade. Are you going to rely on your judgment to decide what your actions are going to be based on your training, understanding of both the letter and application of the law, and the situation at hand, or are you going to follow a check list (which includes playing the 'phone a friend' card in the "I'm afraid to make a decision, so I want to put the liability on someone else" card).

I've already shown earlier how "Well, no ALS because..." card gets thrown out of the window when legitimate, time critical, life threatening pathologies are present. Should it be expected that paramedics operating outside of their area operate at their fullest? Probably not. There's a difference between someone needing an intervention -now- and someone who would get the IV/Monitor/Transport just in case treatment. If we're already waiting on the primary paramedic responders to respond, it makes sense putting off some interventions. However I can't think of a single reason why someone would put off an immediately life saving intervention.

 

[exodus]

You know... calling base hospital doesn't really change the fact that you're "responding" to a still alarm (responding doesn't really feel like the right verb) in an area you aren't licensed to operate in, which is what the entire conundrum is. The medical director isn't going to have any additional information about what the official policy and/or law is (besides, you can't be ordered to violate state law anyways). As I mentioned earlier, this is one of the issues that separate EMS from a professional and a technical trade. Are you going to rely on your judgment to decide what your actions are going to be based on your training, understanding of both the letter and application of the law, and the situation at hand, or are you going to follow a check list (which includes playing the 'phone a friend' card in the "I'm afraid to make a decision, so I want to put the liability on someone else" card).

I've already shown earlier how "Well, no ALS because..." card gets thrown out of the window when legitimate, time critical, life threatening pathologies are present. Should it be expected that paramedics operating outside of their area operate at their fullest? Probably not. There's a difference between someone needing an intervention -now- and someone who would get the IV/Monitor/Transport just in case treatment. If we're already waiting on the primary paramedic responders to respond, it makes sense putting off some interventions. However I can't think of a single reason why someone would put off an immediately life saving intervention.

Sorry i should have clarified.. Call the *local* and get orders from that doc. That way you are operating under his license.

 

[JPINFV]

That's assuming you have the ability to contact (or even know the procedure for obtaining medical control) a local base hospital.

Edit: Also, how long are you going to work on establishing base hospital contact while your patient is actively dying (I'm not trying to be overly dramatic, but if the patient isn't actively dying, there's little need to not wait on local resources).

 

[CAOX3]

I dont even get the question. I read post after post on this site about decking out your car with all the coolest strobes, stickers and lights then packing it with as much gear as possible, risk your lives off duty at MVAs you on site.

But while on duty someone drops and everyone quoting area regulations and limitations.

If im on duty and confronted with a medical emergency, I will act as if I was dispatched to it and that includes transporting if I have to wait for the vollies to mount up. If you or your chief have a problem you can contact my service, medical director or whoever else floats your boat.

Liability is the last thing on my mind, I am on duty, Im being paid and its about patinet care. Ill notify you that where in your area and on scene at a medical emergency. I can wait a reasonable amount of time but Im not delaying any time sensitive complaint because your on a power trip.

 

[Simusid]

I dont even get the question. I read post after post on this site about decking out your car with all the coolest strobes, stickers and lights then packing it with as much gear as possible, risk your lives off duty at MVAs you on site.

But while on duty someone drops and everyone quoting area regulations and limitations.

If im on duty and confronted with a medical emergency, I will act as if I was dispatched to it and that includes transporting if I have to wait for the vollies to mount up. If you or your chief have a problem you can contact my service, medical director or whoever else floats your boat.

Liability is the last thing on my mind, I am on duty, Im being paid and its about patinet care. Ill notify you that where in your area and on scene at a medical emergency. I can wait a reasonable amount of time but Im not delaying any time sensitive complaint because your on a power trip.

I don't disagree with you when operating at the Basic level. But I do think there is a serious and realistic liability to an ALS responder that takes this same attitude. Using my example above of a MA medic who is out of their service area in RI, I'm pretty sure that the RI cardiac and MA medic protocols overlap a lot but I would be willing to bet that there are procedures that the Medic may do that the cardiac may not. (note my careful use of "may" instead of "can")

"Scope of Practice" was covered on day one or two of my Basic class and this is clearly an example of being outside of it.