Still Alarm Outside Your Jutisdiction

[thegreypilgrim]

OK, so this is a hypothetical scenario but is entirely plausible and I'm sure it happens all the time. It poses sort of a legal ambiguity although the ethical side of the issue at least appears clear.

Say you just got finished with a long distance transfer that has taken you a considerable distance away from the jurisdiction you're licensed/accredited/whatever to practice in. Being that it'll be along drive back to your area, you and your partner stop at a fast food joint to get something (terrible) to eat.

As you stand in line for your order a great commotion starts as one of the other customers has decided to go into a tonic-clinic seizure. Everyone's freaking out, its crowded, people are all looking at you, others have got their iPhones out recording the events for posterity, things are awkward. This isn't your area, you have no idea what hospitals are nearby or what their capabilities are, nor do you have any knowledge of the local EMS provider and their nearest resources. All you know, is you're a paramedic and you see someone seizing*. How do you proceed?

* This is just meant as an example. Feel free to imagine any other medical emergency unfolding (eg, chest pain, SOB, syncope, old person falls, etc.)

 

[Lifeguards For Life]

OK, so this is a hypothetical scenario but is entirely plausible and I'm sure it happens all the time. It poses sort of a legal ambiguity although the ethical side of the issue at least appears clear.

Say you just got finished with a long distance transfer that has taken you a considerable distance away from the jurisdiction you're licensed/accredited/whatever to practice in. Being that it'll be along drive back to your area, you and your partner stop at a fast food joint to get something (terrible) to eat.

As you stand in line for your order a great commotion starts as one of the other customers has decided to go into a tonic-clinic seizure. Everyone's freaking out, its crowded, people are all looking at you, others have got their iPhones out recording the events for posterity, things are awkward. This isn't your area, you have no idea what hospitals are nearby or what their capabilities are, nor do you have any knowledge of the local EMS provider and their nearest resources. All you know, is you're a paramedic and you see someone seizing*. How do you proceed?

* This is just meant as an example. Feel free to imagine any other medical emergency unfolding (eg, chest pain, SOB, syncope, old person falls, etc.)

Call 911, treat the patient on scene. Treat the patient as if you were an ALS engine first on scene, until an in-district ALS rescue arrives on scene.

 

[thegreypilgrim]

Call 911, treat the patient on scene. Treat the patient as if you were an ALS engine first on scene, until an in-district ALS rescue arrives on scene.

But you have no legal right to practice ALS in this region.

 

[TransportJockey]

By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such

 

[JPINFV]

I second the "begin treatment, call 911, offer assistance when local crews arrive" argument.

But you have no legal right to practice ALS in this region.

That's nice. They can charge me all they want and I'll bet dollars to donuts that the case will be dropped as soon as the media starts running stories about how the big mean government is putting people's lives at risk. Any bureaucrat worth his post will be able to distinguish between a company trying to run calls without proper licensing and a crew who just happened upon a person in distress outside of their area.

 

[thegreypilgrim]

By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such

Here's an example of "system" type differences among different regions of this country. I'm from California, and as such while we have statewide licensure we have to have local accreditation specific to one (or possibly multiple) county. The result is for CA medics driving from one county to another is a lot like entering a different state.

So, for those of you who have statewide authorization just imagine you've been transplanted across state lines as a result of a long-distance IFT.

 

[JPINFV]

By region do you mean other state? Cause that's the only time I can see an issue coming up. IF its a long distance IFT from one end of the state to the other, you are still a state certified paramedic and should act as such

Depends. In California, for example, service licensing and protocols are done on a regional system (local emergency medical service agency) divided up by either counties or groups of counties. Essentially, if your service isn't licensed to be there, you shouldn't be running calls unless you're on a mutual aid call.

 

[TransportJockey]

Right, sorry. I didn't look at location

 

[thegreypilgrim]

I second the "begin treatment, call 911, offer assistance when local crews arrive" argument.



That's nice. They can charge me all they want and I'll bet dollars to donuts that the case will be dropped as soon as the media starts running stories about how the big mean government is putting people's lives at risk. Any bureaucrat worth his post will be able to distinguish between a company trying to run calls without proper licensing and a crew who just happened upon a person in distress outside of their area.

I agree that this would be the most appropriate course of action to take, but isn't disturbing that the legal issues related to EMS could even give rise to a question like this? I bet a fair amount of providers would be reluctant or uncomfortable about doing anything beyond BLS in a situation like this, and thats a shame.

 

[Shishkabob]

As far as my understanding goes--- As long as you are credentialed/certified/licensed in the state you're based out of, you can still do ALS stuff in other states.


This is why AMR is able to send Paramedics out on FEMA contracts and other gigs and still have them do full ALS, like for hurricanes, or for the gulf coast clean up, in other states without requiring them to get another state cert.

 

[JPINFV]

This is one of those scenarios where EMS is funny We're stuck between the the technician and professional designation. We want the respect of being a profession, the pay of being a profession, and latitude of being a professional health care provider right up until the water (either clinically or legally) gets the slightest bit murky or more education is required. Then people cry out about how they're 'not paid, educated, or empowered to make anything resembling an independent decision that might carry any liability.' Professional ethics, morals, and critical thinking says to treat and no one should require a written policy saying otherwise.

 

[JPINFV]

As far as my understanding goes--- As long as you are credentialed/certified/licensed in the state you're based out of, you can still do ALS stuff in other states.


This is why AMR is able to send Paramedics out on FEMA contracts and other gigs and still have them do full ALS, like for hurricanes, or for the gulf coast clean up, in other states without requiring them to get another state cert.

In general disaster relief work is going to be treated differently from day to day operations. I wouldn't take a paramedic licensed only in California, for example, and start having them run day to day dispatched calls in Nevada. Similar, regardless of how the law is technically written (which I'm willing to bet that there are exemptions for disasters), I highly doubt that the intent was or application of said laws to prevent providers from responding to still alarms. Even if a government official wanted to enforce the law, the "Home town hero in trouble for saving a life" story is going to be the local print and news media's proverbial wet dream.

 

[firetender]

Maybe I missed it somewhere in the post but because standing orders are region by region, even hospital by hospital in some cases, ALS is not really an option without communication with a receiving hospital.

Until such a time as you can communicate and receive permission to treat (which would very much depend on your accurate assessment of it being a true emergency necessitating your immediate intervention -- in which case I'd do what needed to be done and ask for permission later) you're limited to basic stabilization. You can always ask 9-1-1 for an accurate ETA of local support.

 

[TransportJockey]

In some states, standing orders and scope of practice is essentially universal state wide...

 

[jjesusfreak01]

Let me ask this. Why would your ability to practice medicine under your MDs license end at the county line, since their license doesn't end there? If you are on duty, out of zone, and witness an incident needing your assistance, surely your medical director wouldn't have a problem with you helping out here, but doesn't it just become the MDs call in the end?

You are state certified, your MD is state licensed. County borders are used as jurisdictional borders simply so that you can have unified systems within that area.

Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat. If you are done with your shift, you might as well be off duty. Probably a good idea to just call the medical director and ask permission if you need to do ALS interventions (code call).

 

[TransportJockey]

Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat.

As someone who has done long IFTs (anywhere from 4-12 hour trip one way) not eating till you get back in district doesn't always work very well.

 

[Veneficus]

Around this area you must be credentialed in the state you are tranporting from and the state you are transporting to.

In this state there is a standard scope of practice and all credentialed EMTs are authorized to perform the treatments of such in an emergency situation.

If you perform any paramedic level treatments you must give your cert number to the arriving EMS system and you are held to the level of care you provided. You are required to carry proof of your cert level here by law.

If you don't have it on you anyway, your SSN will work as we have a statewide searchable database by either cert number or SSN that will list any cert you ever held here including expired ones.

If you are from out of state you must furnish a copy of your credentials prior to any care. (aka have a copy of your state card on you with a number)

 

[WolfmanHarris]

Until such a time as you can communicate and receive permission to treat

Not everywhere operates in this old way. Here only a couple very specific procedures require contact with a Physician. Most of those (save our current thrombolytics trial) can still go forward if contact fails.

For us the provincial system is seamless coverage. As I move from one dispatch area to another I have to book on with that dispatch centre, my truck than shows on their AVL system and I'm in service in their area as I move through. Usually this just happens as we transport to hospitals outside our usual area, but if we do a transfer far outside our area, but still within the province we can be utilized, to full scope of practice for any calls that occur. My home is over an hour from Toronto, but I once saw a TEMS truck responding to a call in downtown Peterborough, because they got stuck as the closest available unit when they cleared off a transfer.

This doesn't apply if I do a transfer outside the Province. At that point we would treat to full scope, call 911 and await local transport. Though this is more practical than regulation as we likely don't know the area. I know Ottawa Paramedic Service which does border Quebec, can and will do calls over the border if they're desperate. Which can be funny at the hospital since that part of Quebec has no ALS and the receiving staff get confused.

Over the US border though all I am allowed to do is first aid and await local resources. (We do the rare trip to NY or MI)

 

[MrBrown]

I don't have a "jurisdiction" outside which I cannot treat, we are not in the sue happy USA.

 

[JPINFV]

Let me ask this. Why would your ability to practice medicine under your MDs license end at the county line, since their license doesn't end there?

Because, speaking of California at least, medical licensing and EMS licensing are not comparable. There are no local licensing issues with physicians like there are with EMS providers in states with a strong regional system.

You are state certified, your MD is state licensed. County borders are used as jurisdictional borders simply so that you can have unified systems within that area.

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

Another question entirely is what are you doing on duty in another county and eating? In my area, you have to return to your county and clear as fast as you can, and then you can stop to eat.

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