What WOULD you do, off duty?

[thatJeffguy]

A lot of posts about "off-duty" actions; from the decision to carry a (jump kit, backboard, LOX, MICU), the actions one might or might not perform off duty and the legal ramifications of those actions.

What would any of you do in a given situation when you are clearly "off-duty"? Do any of you find that the term "clearly off duty" doesn't apply to you?


If you're on the street and witness a pedestrian/vehicle, what would you do? Would you act differently if you had specific gear with you? What gear and what actions?

What about being in a public place and witnessing a cardiac arrest?

An assault victim?

A wounded FF/EMS/PD?



I used to think that I'd love to grab my "medic" bag, jump into the scene and start fixing everyone up. A few posts on the issue by the more respected forum members changed my mind a bit.

I'd be hesitant to go "hands-on" a patient at a scene I wasn't dispatched to or that didn't involve family or friends. If I noticed a non life threatening injury on a conscious patient I could provide instruction for them to apply pressure. If they were unconscious or unable to provide the basic "ABC's", I'd consider intervening. A gloved hand over a sucking chest wound, CPR, a head-tilt-chin-lift, gauze (gauze, and more gauze) to a life-threatening bleed... I can see myself doing those things.

I doubt I'd act to remove a person from a specific situation. I wouldn't try to drag someone away from a vehicle or out of a compromised situation. Whatever "duty to act" exists I'm bound to act by protocol. The absolute first protocol in my little book is SCENE SAFETY and if the scene ain't safe then I'm in the wrong place and I need to leave post haste.

CPR on a stranger? Ideally I'd be doing compressions, making sure someone was calling 911 and directing a family member or friend of the patient to perform rescue breathing. I'm not sure how likely I'd be to get involved if I wasn't the first bystander "on scene" and other providers were pumping/breathing.

Any thoughts on this would be greatly appreciated! If you can cite your protocols that'd be even better!

 

[firetender]

What can you live with?

Without getting into debates about specifics what I'd have to say is were I to come on to a situation where I perceived someone's life was in jeopardy, I'd do what I could to preserve that life within the limits of my ability to protect myself.

It's fair to say I would do something. It's also fair to say at some point I could say "No!". The prayer, of course is that saying no would not mean the life would be lost. But it could be a choice I'd have to make to preserve my own.

Ultimately, I wouldn't know how much work I would take to assess my own safety vs. the possibility of changing the course of a life until I was there.

 

[Shishkabob]

If you're on the street and witness a pedestrian/vehicle

I witness pedestrians AND vehicles all the time... is that not normal?

In all seriousness, I have in the past, and will in the future, do what I can to the extent that I legally and ethically can if someone requires help, so long as it doesn't put me in danger. It's just my personal choice. Not a hero complex, not a "I'm going to save the world", but I've always been the one to help people when needed, expected to or not.

 

[abckidsmom]

In all seriousness, I have in the past, and will in the future, do what I can to the extent that I legally and ethically can if someone requires help, so long as it doesn't put me in danger. It's just my personal choice. Not a hero complex, not a "I'm going to save the world", but I've always been the one to help people when needed, expected to or not.

This is me. I have kids who are almost always with me, so I don't usually even consider stepping in to help with something if we're on the road or out with just me and them.

At church, at girl scouts, at the park, anywhere where the kids and I are completely safe and I can ask them to sit quietly while I do something that takes my attention from them, I can help out. Also, there's usually a mom friend there in that situation.

I carry a BLS bag in my van. I have an ambu bag and a BLS airway kit. At times I wish I had a laryngoscope and magill's...but I don't usually.

Just last week, my 3yo face planted and bit through his tongue and busted his lip...blood was everywhere! I was so proud of my oldest who, at 7, was able to go out of the office that we were in to the parking lot and get my bag, and bring it back very quickly. She's a drama queen, but that one can level her head right off in a pinch.

I mostly carry the bag intending to use it on my own family or people we're with, but everyone knows that I'm the one with bandaids.

If my husband was in the car and we came upon a traffic-stopping accident, we have and would continue to help out if we felt safe doing so.

 

[medicRob]

While I am not a firefighter, I am affiliated with my local department and as such, I can perform any EMT-Paramedic skill seen fit since I am on the EMT list. However, I must have the appropriate equipment and resources available for any skill I perform. However, I will only do a few interventions on scene before ALS arrives. These are mostly BLS skills.

 

[AtlantaEMT]

Before I got into EMS and learned all about the legality of everything I always figured I'd probably do what I can to help someone out in the general public. I know if something happend to me and an off-duty EMT/Paramedic saw it and had the skills in their head and equipment in their trunk to save my life then I'd want that person to help me. Even if they intubate me or shove a combitube down my throat to save my life. Kind of one of those "if you know how to help then help" type deals.

However after going to school I'd be real hesitant to help anyone except family and close friends more than just general CPR. Does it suck for the good people who will die because an off duty medic was too scared to help because their buddy is now serving fries for saving someone's life and then getting sued by them? Yep, but that's how we have to act in today's sue happy society.

 

[medicRob]

Before I got into EMS and learned all about the legality of everything I always figured I'd probably do what I can to help someone out in the general public. I know if something happend to me and an off-duty EMT/Paramedic saw it and had the skills in their head and equipment in their trunk to save my life then I'd want that person to help me. Even if they intubate me or shove a combitube down my throat to save my life. Kind of one of those "if you know how to help then help" type deals.

However after going to school I'd be real hesitant to help anyone except family and close friends more than just general CPR. Does it suck for the good people who will die because an off duty medic was too scared to help because their buddy is now serving fries for saving someone's life and then getting sued by them? Yep, but that's how we have to act in today's sue happy society.

I have no problem dropping a dual lumen airway in the cardiac arrest patient so long as I have the airway, a BVM, some 02, tube lube, and the syringes to inflate the balloons. I also have no problem high-fiving someone out of cardiac arrest.

 

[reaper]

Before I got into EMS and learned all about the legality of everything I always figured I'd probably do what I can to help someone out in the general public. I know if something happend to me and an off-duty EMT/Paramedic saw it and had the skills in their head and equipment in their trunk to save my life then I'd want that person to help me. Even if they intubate me or shove a combitube down my throat to save my life. Kind of one of those "if you know how to help then help" type deals.

However after going to school I'd be real hesitant to help anyone except family and close friends more than just general CPR. Does it suck for the good people who will die because an off duty medic was too scared to help because their buddy is now serving fries for saving someone's life and then getting sued by them? Yep, but that's how we have to act in today's sue happy society.

Another example of instructors using scare tactics on students.

 

[Saytuck99]

I usually do not jump into these debates, but from a legal perspective, and again it depends on states and protocols etc...if you happen on the scene and you provide care up to your level of training and with the equipment you have you are ok. However, you must know the law. In NY, Suffolk County specifically, as an ALS provider who is "credentialed" within the County, you may only operate within your district or outside of your district at the request of another department. In other words, if you happen on an accident in another town your are not legally allowed to perform any ALS skills to help. However, you can provide BLS per NY state regulations as long as you have the appropriate equipment. ( There are other rules about what you can and cannot carry in your personal vehicle also)

So it all depends, but remember in most states there is no right to sue for being alive. If it was me...and it was a choice of dying or someone helping me...I would hope that out of the 5500 providers on Long Island..someone would stop and help...

 

[adamjh3]

If the scene is safe for myself and my friends/family/whoever I might be with, then I will probably stop and help, mostly bleeding control or verbal instructions while waiting for ALS. I carry a stocked bag that's too large to be considered a first aid kit but too small to be considered a jump bag in the trunk of my car (I didn't purchase it on my own, it was given to me by a school I volunteered for) but that has only come out for myself, my family, and friends.

Pedestrian vs Vehicle? Probably not doing much more than calling 911

Cardiac arrest? Continuous chest compressions until ALS gets there

Assault victim? Keep walking, you don't know if the assailant is going to come back and finish the job

Wounded FF/EMS/PD Depends on the circumstances, they likely already have help coming, and if the situation's dangerous enough for them to get hurt, it's dangerous enough for me to get hurt.

 

[AtlantaEMT]

Another example of instructors using scare tactics on students.

Is it scare tactics? I'm interested to know.

Suppose an off-duty paramedic has everything short of a drug box in their truck (for whatever reason) and they stop to help someone. They end up intubating that person and using a BVM on them and let's say they even shock them with his very own personal AED. The patient ends up dying. Can your head end up on the chopping block because of that?

 

[medicRob]

Is it scare tactics? I'm interested to know.

Suppose an off-duty paramedic has everything short of a drug box in their truck (for whatever reason) and they stop to help someone. They end up intubating that person and using a BVM on them and let's say they even shock them with his very own personal AED. The patient ends up dying. Can your head end up on the chopping block because of that?

Did you perform to your standard of care?

Did you act within your scope of practice?

Did you delay the patient's care or were you caring for them until proper
help arrived?

Did the patient die because of your interventions or were they going to die anyways?

Did John Doe die because I put a tube in his trachea or because he ate so many cheeseburgers a week that his heart simply gave up?


Read:
http://theemtspot.com/2009/06/25/what-is-the-good-samaritan-law

Just remember, once you start CPR you cannot stop it until a physician tells you to do so, the patient exhibits extreme condition incompatible with life (Decapitation, etc 'Not sure why you would start CPR with this one anyways') or a coroner declares the patient deceased on the scene.

 

[abckidsmom]

Is it scare tactics? I'm interested to know.

Suppose an off-duty paramedic has everything short of a drug box in their truck (for whatever reason) and they stop to help someone. They end up intubating that person and using a BVM on them and let's say they even shock them with his very own personal AED. The patient ends up dying. Can your head end up on the chopping block because of that?

In my state, it would depend on the attitude of the Office of EMS rep for operating what amounts to an unlicensed first response vehicle. And it would depend on the medical director, whether he wanted to push that issue, too.

It's a real risk, but it depends on whether you just "happen" to end up on scenes like that. Once or twice in a career, no big. Once or twice a year, maybe a bigger deal.

 

[abckidsmom]

Did you perform to your standard of care?

Did you act within your scope of practice?

Did you delay the patient's care or were you caring for them until proper
help arrived?

Did the patient die because of your interventions or were they going to die anyways?

Did John Doe die because I put a tube in his trachea or because he ate so many cheeseburgers a week that his heart simply gave up?


Read:
http://theemtspot.com/2009/06/25/what-is-the-good-samaritan-law

Just remember, once you start CPR you cannot stop it until a physician tells you to do so, the patient exhibits extreme condition incompatible with life (Decapitation, etc 'Not sure why you would start CPR with this one anyways') or a coroner declares the patient deceased on the scene.

Or you become physically exhausted. No one's standing with a whip...you can stop when you stop.

 

[medicRob]

Or you become physically exhausted. No one's standing with a whip...you can stop when you stop.

Yes, I forgot that one. Sorry, my ADD was ..

ooo a squirrel..

 

[reaper]

Is it scare tactics? I'm interested to know.

Suppose an off-duty paramedic has everything short of a drug box in their truck (for whatever reason) and they stop to help someone. They end up intubating that person and using a BVM on them and let's say they even shock them with his very own personal AED. The patient ends up dying. Can your head end up on the chopping block because of that?

I would not do that off duty anyway. As was stated in another thread. Most Good Samaritan laws cover you for basic care.

You go above that, then you hold yourself liable. But worrying about being sued over everything, is ridiculous.

 

[Akulahawk]

In Sacramento County, a Paramedic, if affiliated in any manner with a Sacramento County ALS agency, may provide the FULL scope of care off-duty, limited only by equipment available. A non-affiliated Paramedic is limited to BLS, Defib, and Advanced Airways. Santa Clara County (and most others that I'm aware of) limit off duty Paramedics to BLS/AED scope or whatever specific scope of practice their EMT-1's have.

 

[abckidsmom]

I just thought of a situation that may complicate this for me. I'm on scene, off-duty, with a critical patient, and a BLS truck pulls up, with no ALS.

In that situation, I'm covered by my medical director to function in that ambulance as an ALS provider, even out of our area (anywhere in the state). We can call our "home" er for medical control to the crew we're assisting. They can call the er for medical control.

How would that go with you BLS providers? Would you let it happen on your ambulance?

 

[firetender]

If I knew you and knew you as competent, I might include you, but either way, since I was legally dispatched to the call, once I'm there, I call the shots.

That means you get watched like a hawk and, unless it truly is a life and death situation requiring intervention that you are equipped to do right there, UNDER THE RECEIVING HOSPITAL'S DIRECTION I most likely wouldn't let you do much...

...and I have responded the same way to MD's on scene as well.

 

[DrParasite]

If you're on the street and witness a pedestrian/vehicle, what would you do? Would you act differently if you had specific gear with you? What gear and what actions?

call 911, hold c-spine and keep patient calm, wait for professionals to arrive

What about being in a public place and witnessing a cardiac arrest?

call 911, basic assessment, chest compressions until help arrives or professionals arrive.

An assault victim?

call 911, keep walking, most people won't die from an assault, and there is too much of a scene safety issue to worry about.

A wounded FF/EMS/PD?

call 911, keep walking. for a wounded FF, there are usually between 2 and 5 other FFs helping him, for EMS, 1 and 2, and PD, often 1 additional person from the agency on scene. Not only that, but they have their own dispatch centers, and if are injured, are probably already calling for help directly.

Now, if I have an entire engine company down, or ambulance crew, or PD unit, then the whole scene safety factors kick in. if something or someone is able to take down all these professionals, do I want to add to the injured count?