Where you taught when you can exceed the legal limits to your practice?

[mycrofft]

It is not uncommon to hear EMT's, Medical First Responders, etc., expound on what they can or would do "if the situation warrants it". I have heard or read many measures, including drugs, IV access, open chest heart massage, improvised cricothyrotomy, improvised restraint measures, Caesarean section delivery, traction to relocate broken bones in an urban setting...you get the drift and probably can add some.

The rationales are that access to the usual higher levels of medical care is going to be delayed, or will be unavailable due to some murky apocalyptic disaster scenario, blizzard, etc.

Please indicate whether or not your instructors, supervisors, or the culture of your EMS service have overtly or tacitly (wink wink) encouraged you to exceed your legal scope in extremis, and leave a note as well.

 

[VFlutter]

In my current EMT class, my teacher has brought up this many times and his opinion is "One life is not worth a career".

 

[46Young]

In my current EMT class, my teacher has brought up this many times and his opinion is "One life is not worth a career".

This^

Sure, you may have saved the pt, but now you're out of a job, your family suffers, you can no longer work in the field, and you may face litigation regardless from the pt or their family member when they realize that you overstepped your legal bounds and can be sued. That's if you do it correctly. What happens if you perform the procedure incorrectly?

If you want to be a doctor, then go be a doctor. A paramedic is not a "street doctor."

 

[mycrofft]

But are/were you seriously exposed to the concept?

I agree, and not entirely on the basis of losing my job; a true professional has to be ready to quit, retire, or get fired to protect the profession and thereby the patient. The reason protocols and laws are passed is (ususally) because something (especially something which seems intuitively "good") was found to be bad, and they want to keep it from happening again.

 

[Veneficus]

Mycrofft,

Not sure if you know, but if an instructor teaches students to do things outside of the normal scope or recognized medical practices, they can be held legally responsible when it is traced back to them.

Among the instructors I work with, great care is taken to not only point out never to exceed scope or recognized practice, but also to make sure it is not implied.

As has been demonstrated in the past in such instances like the NJ Csection, physican permission is not an affirmative defense to exceeding scope. (We point that out very overtly as well especially since my home state switched from giving local medical control considerable latitude in determinning practice to rigid state level standards )

Unfortunately, a majority of the experienced providers in the area were taught under the auspice that the physician can delegate any authority, so among the noneducators that mentality is rampant.

In my opinion and having witnessed providers going beyond scope on several occasions, it is a disaster waiting to happen. The only reason it hasn't exploded in a very legal and public way is because the outcomes were good.

But I am sure many would agree, the law of averages will eventually catch up and the "selective" documentation is not going to provide cover the day something goes wrong.

 

[MassEMT-B]

They stressed in my class to not go outside your scope of practice. On a side not when I first read it, I thought it said exceed the speed limit .

 

[Zodiac]

Stepping outside of my legal boundaries for any reason just isn't worth losing my license, job, or worse.

 

[lampnyter]

Here EMTs cant do BGL. I have seen many EMTs take a BGL.

 

[subliminal1284]

Here EMTs cant do BGL. I have seen many EMTs take a BGL.

Do them everyday here, part of the standard vital signs for us.

 

[AnthonyM83]

It was originally taught to me that in some states, the local medical director decides the limits of your scope and can direct you to do something outside your normal scope through online medical control. It was also taught that in many/most states, the local medical director defines your scope, BUT ONLY within the framework the state medical director's limits and framework.

They did bring up the ethical issue, but provided no answer or hints or nudgings.

I know of another school that brings up similar c-sections...one where medics were rewarded and another where they were punished (by the public that is...intra-agency wise different story). The point is to emphasize that you never know what the outcome will be (with the implication of "don't risk it").

And yes, everything an instructor/school says has potential to come back to them. This has been the standard in many fields for a long time (and I think it's just reaching EMS more recently)....the whole "based on my training ______"

 

[Archymomma]

It was stressed to us NOT to go beyond our training. Beyond what our state would allow.

In CO I was an IV certified EMT, MO does not have that certification. There is no way I'm jeopardizing my License by placing an IV while working in MO.
In CO we could not take a blood glucose w/o the IV certification (main reason I got it) in MO an EMT can take one.

 

[46Young]

My medic school I/C and my senior partners when I first got out in the field all said to follow the protocols to the letter until you get comfortable out in the field. This was in NYC, where it's follow the protocol, and then there were medical control options to choose from. That's it. Never was it suggested to freelance, and ask for off the wall stuff that you picked up on an internet forum or something.

Where I work now, we have only a few OLMC options. Almost all our stuff is standing orders. We have what we call "extraordinary care" that we can get permission for. the caveat is that it must be in our scope, and we have to have been trained in that procedure. For example, I could call for permission to perform a surgical cric, which is within our scope, instead of a needle cric, which is in our standing orders. I've been trained to do it, but the next guy hasn't. I can call for it; he can not.

 

[Archymomma]

I know of another school that brings up similar c-sections...one where medics were rewarded and another where they were punished (by the public that is...intra-agency wise different story). The point is to emphasize that you never know what the outcome will be (with the implication of "don't risk it").

I find it very interesting that C-sections are the only surgery procedure that is mentioned in this situation. Why would a c/s be acceptable and not an appendectomy? C-sections are major abdominal surgery. I've had 2 - there is no way I would want an unqualified person cutting into me. I cannot envision any circumstance where this would be acceptable.

 

[LucidResq]

I find it very interesting that C-sections are the only surgery procedure that is mentioned in this situation. Why would a c/s be acceptable and not an appendectomy? C-sections are major abdominal surgery. I've had 2 - there is no way I would want an unqualified person cutting into me. I cannot envision any circumstance where this would be acceptable.

Mom is dead, if you don't get baby out then baby will die too, and base physician is giving you the ok.

I'm not justifying what they did in any way, shape or form, but those are, apparently, the circumstances that led two NJ medics to perform one.

 

[AnthonyM83]

I find it very interesting that C-sections are the only surgery procedure that is mentioned in this situation. Why would a c/s be acceptable and not an appendectomy? C-sections are major abdominal surgery. I've had 2 - there is no way I would want an unqualified person cutting into me. I cannot envision any circumstance where this would be acceptable.

Easy. They only bring up c section stories because its a one hour lecture and with breakout groups and class discussion that you can only discuss a few topics...there are countless surgeries to choose from.

Also as Lucid said, this one means certain death for the baby. And there are two similar news items to compare to show how same circumstance can have different outcomes for you. Also simply x section scenario is clearer. dx cardiac arrest of mom versus dx appendicitis..plus urgency. etc... makes for a better teaching example than say a nose job surgery..

 

[lampnyter]

Do them everyday here, part of the standard vital signs for us.

But is it in your scope?

 

[DesertMedic66]

Here EMTs cant do BGL. I have seen many EMTs take a BGL.

For us its in our scope to "read" the meter. We can poke their their finger as an EMT. But when the medic starts an IV we can take the "flash" blood to read the BGL.

 

[lampnyter]

For us its in our scope to "read" the meter. We can poke their their finger as an EMT. But when the medic starts an IV we can take the "flash" blood to read the BGL.

Thats what i do. Usually when a bgl is needed, an IV is started anyways.

 

[Smoke14]

You left one option off the poll, while under direct medical control.

 

[lampnyter]

You left one option off the poll, while under direct medical control.

You cant go out of your scope if a doctor says to.