Why can't Paramedics act off duty?

Tigger

Dodges Pucks
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Last year I came across a 25 year old who tried to jump the access road at a ski area in BFE Oregon. Skull fracture, prolonged seizure, tib/fib/knee destroyed, ambulated forearm. Everyone in our car was a paramedic but still whaf were we supposed to do without you know…an ambulance. I talked to their dispatch and was like please please launch a helicopter and I think that was our benefit.
 

Akulahawk

EMT-P/ED RN
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Good Sam laws do vary from state to state. The basic idea is to encourage people to voluntarily help someone else who is in an emergency situation by removing any fear of legal or civil liability for acts performed in good faith. It doesn’t give one carte Blanche to do whatever is desired… but rather to give emergency aid. Sticking to BLS level care is pretty much universal in terms of what you’d be covered for, but in some locales that protection could extend to you providing care up to the limit of your training and available supplies as long as what you do isn’t done in a grossly negligent manner. Case in point: Sacramento County (CA) accredited paramedics are expressly authorized their full scope while off-duty. Most aren’t allowed to have fully stocked ALS kits, but should one become (somehow) available at the scene of an emergency, they may do literally anything their protocols authorize. And they’re covered by Good Sam. Where things get interesting is when it comes to persons like me: I’m an ED RN. The county only authorizes BLS level care by me off-duty but theoretically I could do ALS up to my limits and be covered by Good Sam… so I’d be fine on the criminal / civil liability stuff but I’d get into trouble with the BRN and the EMS system for going above BLS. So it’s safest for me to stick with BLS. That being said, should I renew my paramedic accreditation with this county, that opens up the ALS world again. Which I wouldn’t do anyway… too expensive for me to maintain my own full-up ALS kit.

While I’m on-duty, Good Sam doesn’t apply and what I can do is even weirder. BLS at times, above ALS at times and yet never part of the 911 system.
 

DrParasite

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I talked to their dispatch and was like please please launch a helicopter and I think that was our benefit.
honestly, that's probably the best thing a knowledgeable provider can do: make sure the appropriate resources are on the way. This can be the helicopter, ALS, rescue company, or maybe even hazmat. The sooner they are requested, the sooner they can arrive.

I've stopped at more crashes than I care to admit (much more when I was younger and dumber), and I've dealt with more than my share of helpful laypeople when on the ambulance. My rule has always been the same: if i stop in my POV, do what I can, and when the AHJ show up, give them whatever information I have and let them do their job. When I am the responder, I want them to tell me whatever they have to tell me and then go away (politely, of course), so I can do my job. It would be a very rare situation where I would want to keep the layperson there.

Nowadays, the most I would do is apply a TQ and call 911.

If I showed up at a gnarly crash, and saw a random guy (who I didn't know) was putting a chest tube into someone, I would have many many many concerns...
 

CCCSD

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Good Sam laws do vary from state to state. The basic idea is to encourage people to voluntarily help someone else who is in an emergency situation by removing any fear of legal or civil liability for acts performed in good faith. It doesn’t give one carte Blanche to do whatever is desired… but rather to give emergency aid. Sticking to BLS level care is pretty much universal in terms of what you’d be covered for, but in some locales that protection could extend to you providing care up to the limit of your training and available supplies as long as what you do isn’t done in a grossly negligent manner. Case in point: Sacramento County (CA) accredited paramedics are expressly authorized their full scope while off-duty. Most aren’t allowed to have fully stocked ALS kits, but should one become (somehow) available at the scene of an emergency, they may do literally anything their protocols authorize. And they’re covered by Good Sam. Where things get interesting is when it comes to persons like me: I’m an ED RN. The county only authorizes BLS level care by me off-duty but theoretically I could do ALS up to my limits and be covered by Good Sam… so I’d be fine on the criminal / civil liability stuff but I’d get into trouble with the BRN and the EMS system for going above BLS. So it’s safest for me to stick with BLS. That being said, should I renew my paramedic accreditation with this county, that opens up the ALS world again. Which I wouldn’t do anyway… too expensive for me to maintain my own full-up ALS kit.

While I’m on-duty, Good Sam doesn’t apply and what I can do is even weirder. BLS at times, above ALS at times and yet never part of the 911 system.
What happens when BLS rig shows up and you’ve started ALS, and you are off duty?
 

NomadicMedic

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Now I drive a marked take-home vehicle and have ALS gear with me. It's a bit of a conundrum. Do I stop or pretend I didn't see it?
 

Akulahawk

EMT-P/ED RN
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What happens when BLS rig shows up and you’ve started ALS, and you are off duty?
Sacramento County, not that big of an issue. 911 is basically exclusively ALS. If a BLS IFT rig shows up...
You have some splainin’ to do…
As long as you're authorized to have an ALS take-home kit, you ride in if you can't downgrade the patient to BLS, you sign their report as the tech, and you notify EMSA that you witnessed something off-duty, you're authorized to have a take-home kit (EMSA already knows who is), and that you rode in with the patient while off-duty. The splainin' isn't an issue. If you're not authorized to have whatever stuff you have with you... and there was no magical source for the stuff to be there... Yep. Lots of splainin' to do!
 

CCCSD

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Sacramento County, not that big of an issue. 911 is basically exclusively ALS. If a BLS IFT rig shows up...

As long as you're authorized to have an ALS take-home kit, you ride in if you can't downgrade the patient to BLS, you sign their report as the tech, and you notify EMSA that you witnessed something off-duty, you're authorized to have a take-home kit (EMSA already knows who is), and that you rode in with the patient while off-duty. The splainin' isn't an issue. If you're not authorized to have whatever stuff you have with you... and there was no magical source for the stuff to be there... Yep. Lots of splainin' to do!
What if you can’t just “ride in”? Does “riding in” put you on the clock? What if you’re injured “riding in”?
 

ffemt8978

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Now I drive a marked take-home vehicle and have ALS gear with me. It's a bit of a conundrum. Do I stop or pretend I didn't see it?
The marked take home vehicle might trigger a duty to act, depending on local laws. Might want to check into that.
 

NomadicMedic

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The marked take home vehicle might trigger a duty to act, depending on local laws. Might want to check into that.
PA does not have a specific duty to act for “off duty” providers anywhere I can find when perusing the EMS act or any others related to first responders… but not stopping in a marked vehicle would make for some pretty poor optics.

…and really, I’d say that having a marked take home vehicle would mean you’re always on duty. So, unless my stopping causes more confusion at an incident or someone is already there, I’ll stop and at least let the PSAP know what’s going on.
 

DrParasite

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PA does not have a specific duty to act for “off duty” providers anywhere I can find when perusing the EMS act or any others related to first responders… but not stopping in a marked vehicle would make for some pretty poor optics.
I would argue that being off duty while driving in a marked vehicle with proper equipment would be extremely poor optics, esp when the news says "@NomadicMedic keeps on driving while baby dies" or some other sensational headline
…and really, I’d say that having a marked take home vehicle would mean you’re always on duty. So, unless my stopping causes more confusion at an incident or someone is already there, I’ll stop and at least let the PSAP know what’s going on.
Clarification: always on duty when you are in the car. That's why many places say you can only drive the take home to and from work, or when you are on company business. If the car is parked outside of your house, or you are in your POV with the family, it's hard to say you are still on duty, even if you are issued a take home vehicle and it's home.
 

NomadicMedic

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I would argue that being off duty while driving in a marked vehicle with proper equipment would be extremely poor optics, esp when the news says "@NomadicMedic keeps on driving while baby dies" or some other sensational headline

Clarification: always on duty when you are in the car. That's why many places say you can only drive the take home to and from work, or when you are on company business. If the car is parked outside of your house, or you are in your POV with the family, it's hard to say you are still on duty, even if you are issued a take home vehicle and it's home.
This is true. This is why when I’m in that vehicle I have a set of gear.
I know other places use an ”out of service” sign when the vehicle is getting serviced or driven by someone who shouldn’t be driving it.
 

FiremanMike

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I used to think it'd be super cool to have a take-home car. Now I see the ugly side of that where I'm driving a billboard and would feel compelled to stop for every little thing.

If I end up in an admin position with a take-home, I'm going to try to get one that is unmarked with hidden lights.
 

Mark911

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If you read the history of Good Samaritan law it was originally to encourage Physicians and other healthcare professionals to help in an emergency, then was later adapted to provide coverage to the lay bystander. So with that statement being made, wouldn’t you want to be able to help within your scope? Obviously you’re not going to have a full medication bag or anything, but if you had a decompression needle (easily purchased on line) and had all the indications to do so (with the patient rapidly declining) and the ambulance is 20 or 30+ mins out, should you be able to act then, or is it still too much? If you really wanted to CYA call the local medical control, provide your credentials to them and ask for order to do so. Many people in my area carry at least a full BLS bag if not an ALS bag they use on duty then take home. Some with meds and some without. Could they get local medical control for authority to administer if they aren’t under their usual medical director?
I think you have to look really carefully at your local legislation. Remember that those physicians that you are referring to are practising under their own licenses and insurance. In some places paramedics also practice under their own license and insurance and are part of self-regulating colleges but this isn't the case everywhere. However, I also think that if anyone wants to provide whatever help a typical lay-person could reasonably provide (stop bleeding, do CPR, one an airway etc) there probably isn't a jurisdiction in the world that would prosecute for something like that as long as there is neither negligence nor malfeasance.
 

FiremanMike

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However, I also think that if anyone wants to provide whatever help a typical lay-person could reasonably provide (stop bleeding, do CPR, one an airway etc) there probably isn't a jurisdiction in the world that would prosecute for something like that as long as there is neither negligence nor malfeasance.
I’m not trying to be rude, but what you said is literally the meat of the Good Samaritan law..
 

Mark911

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In the US, without physician oversight? Where?
Yeah, I don't know much about the US situation but there are jurisdictions in Canada, UK, Aus, NZ etc where the profession os self-regulated, degree based, self-insured and or some combination thereof. In my primary jurisdiction, I work under my own license and insurance - the service has a medical director but there is nothing in the law that says that the medical director can't be a paramedic rather than the standard physician. I think its still not common to see anything other than the physician in these roles but really, who knows our job better than us and as long as we can back it up with a science-based higher education... I think its a goal to shoot for as a profession.
 

Phillyrube

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I was a medic when I was hired as a cop. Same jurisdiction. I had permission to carry my gear, just ALS airway stuff. We had AEDs so PD got punched on those calls. Dispatchers also let me know if something hot was going on near me. Got a bunch of tubes that way plus other skills once fire or rescue arrived. Was able to turn patients over since everyone knew me or had precepted under me. It was a good time and we got good saves.
I'm retired now
I have tunnel vision while driving since I hate civil court.
 
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