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

[mycrofft]

Apologies abot my "no poll replies" comment

My browser keeps using cached pages so I have to hit "reload" to see updates. Lots of responses, thanks again.

 

[AnthonyM83]

Sorry, back to te original topic, no was never told I could nor heard of someone telling someone else they could legally exceed scope in an emergency. All discussions on the topic among coworkers have been in the context of what circumstance would make you exceed scope or violate protocol in order to save a life with the clear understanding you would probably lose your license and or job and possibley be sued or do jail time.

 

[Melclin]

Sure. Best to consult with a more experienced ambo first, but if its reasonable and you can justify it, why not. Reasonable is the key word there. I wouldn't do clamshell thoracotomy, it would be absurd. I don't know the first thing about how to do it. A needle cric on the other hand, out rurally, well that's a different issue. I know the theory behind it, the gear is there, hop on the radio for a more experienced ambo's advice on its appropriateness and maybe they walk me through it. I don't see to much of a problem with that.

I heard a story about a basic who kept putting in EJ lines in perfectly healthy patients, at first he was simply asked to stop, but kept doing it and without a good reason, despite being repeatedly told to stop, so he was shown the door. That's pretty much the way of things here.

I think the difference is that our scope of practice isn't dictated by law. The service decides what we can and can't do, not some legislative committee buried deep in the bowels of parliament.

 

[Aidey]

Yes, but not by a 911 agency. When I worked wildland fires our MD basically told us that extreme situations were possible, and that he was prepared to talk us through whatever was necessary. Given the situation though, this was very likely to be wound care stuff and not an emergent c-section.

 

[lightsandsirens5]

Yes, but not by a 911 agency. When I worked wildland fires our MD basically told us that extreme situations were possible, and that he was prepared to talk us through whatever was necessary. Given the situation though, this was very likely to be wound care stuff and not an emergent c-section.

Work with a guy who is an ex Air Force PJ. He has all kinds of stories from his first involvement in EMS in the 70s or so, through his job as a PJ and eventual transfer back to civilian EMS.

He told me last night about getting flown out two hours to a civvie ship with a sailor having probable appendix issues. He said there was an Air Force doc in the plane circling above who was going to talk him through an appendectomy step by step. Wouldn't that be amazingly fun???

 

[BEorP]

I dont see why its even out of the scope but I didnt make the rules. :unsure:

Much of the rest of the world would wonder why an EMT-B can even work on an ambulance when the training and education is compared to their providers. I do not mean this as a personal attack against any EMT-Bs, but let's keep all of this in perspective. Yes, it is a simple skill, but EMS should be about so much more than skills. Granted, you don't need to fully understand hypoglycaemia and diabetes to perform the skill for an EMT-P, but if there is any chance you'll be doing it on your own, shouldn't you have a full understanding of what the condition and what this assessment is telling you? I meant for that to be rhetorical, but in the American system I guess the answer would be that no, the skill is more important.

 

[mycrofft]

What the poll says and what the comments say seem to cross.

People say "No, never", but comment that their medical control or co-workers are contemplating the circumstances and procedures they would follow in abeyance of training and law.

Interesting to hear about places that the decision of scope lies with the medical controller and not by law! In USA, I would suspect that is not truly the case, but elsewhere, how does that turn out generally? Does it happen frequently? What are the repercussions if any?

 

[Smoke14]

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

Yes I can and I have several times during my career. Each time it has happened I have been on the radio or phone with our ER physician and each time it was the physician that suggested what to do.

 

[Veneficus]

People say "No, never", but comment that their medical control or co-workers are contemplating the circumstances and procedures they would follow in abeyance of training and law.

I answered "no, never."

Because nobody I know was ever told it was ok to do.

In my comments I pointed out I have witnessed providers exceed their scope of practice under different circumstances and they did not find themselves answering for it.

So like many things in life, it is not whether or not you do somethin; it is whether or not you get caught that determines if you get in trouble.

Like many other aspects of life as well, not putting yourself in the situation is the best way to avoid having to face the consequences of the action.

 

[MrBrown]

Brown can do whatever the heck Brown likes, for Brown is a force untoBrownsself and not governed by any law of physics, thermodynamics, religion, humanity or civility ... except Mrs Brown

Locally we can give a drug or treatment not described in our delegated scope of practice when asked to do so by a Physician and can give a drug within our scope of practice for something other than described (e.g. salbutamol for hyperkalemia) when in consultation with an Ambulance Service Medical Advisor.

Such circumstances are rare, Brown has never heard of it ever taking place but there is the possibility one day Brown supposes.

 

[DesertMedic66]

I answered "no, never."

Because nobody I know was ever told it was ok to do.

In my comments I pointed out I have witnessed providers exceed their scope of practice under different circumstances and they did not find themselves answering for it.

So like many things in life, it is not whether or not you do somethin; it is whether or not you get caught that determines if you get in trouble.

Like many other aspects of life as well, not putting yourself in the situation is the best way to avoid having to face the consequences of the action.

Agreed. I've seen it a few times. Normally if it helped the patient and the patient lived then they don't have to answer all the questions. If the patient dies then that's where they normally get the questions.

I answered no, never. I have never heard anyone say it's ok to go outside your scope. It's not worth it to me to possibly lose your license and possibly face criminal charges.

 

[usalsfyre]

I didn't answer the poll as there isn't one that fits my situation. Our medical director has stated our scope is flexible.

 

[mycrofft]

usalsfyre, that falls under "boss" in my thin little book

Brown, then you cutomaril;y stock out of scope items to anticipate these orders, or are you improvising, or pulling over to a drugstore enroute and buying stuff?

 

[Shishkabob]

Honestly, it depends on what you mean by "exceed your scope".

Intra-nasal meds are technically in my scope, but IN Fent is not in my protocols, though I have done it. Etc etc etc.




But in all technicality, there is no legal scope of practice in Texas as far as EMS is concerned.

 

[mycrofft]

Sidebar about protocols in Calif

I was surprised by the degree of stuff employers could include into LVN (licensed vocational nurse) standardized procedures IF they met some professional training standard, but only up to the point where critical professional decisions needed to be made (whereas RN's can make such decisions, it is a licensure watershed).

 

[MrBrown]

Brown, then you cutomaril;y stock out of scope items to anticipate these orders, or are you improvising, or pulling over to a drugstore enroute and buying stuff?

Um, no, and the idea of doing such is very disturbing.

Brown is referring to using medicines other or outside of their delegated use, for example, salbutamol is for bronchoconstriction but can be used in hyperkalemia. Such is not part of our delegated scope of practice, an Ambulance Service Medical Advisor must be consulted. Like Brown says, it has never happened to Brown or anybody Brown knows.

 

[Veneficus]

But in all technicality, there is no legal scope of practice in Texas as far as EMS is concerned.

I am sure there must be something that restricts your medical director from basically authorizing an unlimited scope of medical practice.

Even with training (if you could possibly get it) I am sure there would be major issues if you were authorized, even in a unique situation to attempt something like an emergent open thorocotomy.

Or even a vaginal exam for that matter.

 

[usalsfyre]

I am sure there must be something that restricts your medical director from basically authorizing an unlimited scope of medical practice.

Even with training (if you could possibly get it) I am sure there would be major issues if you were authorized, even in a unique situation to attempt something like an emergent open thorocotomy.

Or even a vaginal exam for that matter.

Nope, actually, not that I'm aware of. That said, I believe the standard used is "provides a reasonable degree of training" (I'll look the statute up tonight) which rules out things like open thoarcotomy based on the amount of time it would take to reasonablly train someone...

 

[mycrofft]

Brown I'd trust you to treat me "off label".

I just had this vision of your ambulance pulling into a drive through pharmacy pickup, handing the radio to the tech through their window, and getting supplies, lights spinning all the while.

OK, for the readers at large, what would be worse to you: when definitive care is hours away, to either watch a patient die , or to hasten his death by attempting something out of scope (with or without medical control or other guidance by radio)?

 

[silver]

This is interesting. I think it shouldn't ever be taught to go outside the scope, but if it is ethically appropriate then I think it can be done (if you possess the skills).

The downside of doing something outside of the scope is that you have to be prepared to accept any consequences. The ethically right decision is not always the legally right decision. One needs to a risk/reward analysis before doing something foolish.