Why can't Paramedics act off duty?

[RedAirplane]

As an EMT, off duty, if I needed to, I could perform BLS assessments and interventions as a Good Samaritan.

Paramedics are restricted to BLS if confronted with a situation. I know of a Paramedic who works as an EMT and only uses BLS stuff.

I understand the liability issue, but suppose an ALS intervention would save someone's life. Aside from the legal, needing a medical director argument, why aren't you guys allowed to do more even when not employed as an ALS provider?

If I misunderstood something please correct me.

 

[PotatoMedic]

Because we are a delegated practice. We can only operate under a physician. And if we do anything while not under a physician we are practicing medicine without a license. Which is illegal.

 

[RedAirplane]

Because we are a delegated practice. We can only operate under a physician. And if we do anything while not under a physician we are practicing medicine without a license. Which is illegal.

I guess my question is... Why is it illegal?

Should allowing laypeople to do open heart surgery be illegal? Yes. They wouldn't know what they're doing.

It isn't like Johnny & Roy where you need to call the MD for every little thing. So the paramedics know what to do (I presume) in the situations that present.

Why not protect paramedics acting in good faith, within the scope of their training, in an emergency situation, even if not under an MD?

 

[chaz90]

Since the scope of our training is attached to a medical director's medical license, they don't want the added liability of freelancing paramedics still trying to operate under their medical director when they're not even on duty.

I understand it completely. ALS skills need ALS equipment and medication, and there's simply no sense in having or desiring that ability to provide ALS care when you're off duty. Not to mention, I really can't think of too many situations where am ALS intervention that someone off duty is going to stumble into is so time sensitive it can't wait for the on duty responding paramedic. Just like BLS, time sensitive hemorrhage control, CPR, and AED usage is all covered under Good Samaritan and perfectly acceptable. I just don't think I'd want to do any more off duty anyway.

 

[Akulahawk]

Paramedics aren't always restricted to BLS when off duty. In Sacramento county, a properly accredited medic that is employed by an ALS service is able to do the full ALS scope when of duty. That's the catch: you have to be accredited and locally employed to enjoy that ability. Even though I'm a paramedic, I can't provide full scope. The EMS medical director has decided to expressly allow his off duty medics to have their full scope. Most medical directors don't want to do that.

 

[Tigger]

Most "ALS intervetions" would require medications and devices that require a prescription, so acquiring that could be a bear. Not to mention that most of these interventions are likely to have immediate impact.

 

[Akulahawk]

Most "ALS intervetions" would require medications and devices that require a prescription, so acquiring that could be a bear. Not to mention that most of these interventions are likely to have immediate impact.

This also is true. The second part of Sacramento County Paramedics being allowed full scope is that most of them aren't authorized to have a "take home" ALS kit. That kit, if authorized, can have all medications and devices except for narcotics. That being said, if the equipment and medications were to become available somehow, then a properly accredited and employed (but off duty) Sacramento County paramedic could utilize their entire scope of practice.

 

[chaz90]

Come to think of it, our admin staff can become "on duty" while off duty and practice with their full paramedic scope. They all have take-home vehicles, radios, and full sets of ALS gear with all medications. As senior staff though, they only occasionally end up backing up one of our on duty field medics or adding themselves to larger incidents. Every once in a while one of them will take a call to help the system out when it's incredibly busy and they're in the right place and feeling ambitious.

 

[DrParasite]

Come to think of it, our admin staff can become "on duty" while off duty and practice with their full paramedic scope. They all have take-home vehicles, radios, and full sets of ALS gear with all medications. As senior staff though, they only occasionally end up backing up one of our on duty field medics or adding themselves to larger incidents. Every once in a while one of them will take a call to help the system out when it's incredibly busy and they're in the right place and feeling ambitious.

If you are in a marked take home vehicle (or an unmarked company owned vehicle, with emergency lights), using department provided ALS equipment, you to assist or respond to a call in your system, you aren't off duty anymore once you start using the company issued equipment (as you mentioned).

Now if they were out of their primary area, and using said equipment, it could be considered working while off duty....

 

[chaz90]

Agreed, which is why I mentioned they put themselves in an on duty status. Every paramedic in Delaware can be "activated" by an on duty paramedic anywhere in the state and immediately begin getting paid and providing ALS care, but our senior staff can do this independently just by marking up as in service on the radio.

 

[triemal04]

ALS skills need ALS equipment and medication, and there's simply no sense in having or desiring that ability to provide ALS care when you're off duty.

Wait...you mean you don't carry a laryngoscope in a quick-draw holster 24/7? I mean...when the big one happens how will you be able to leap to the rescue and save the day!?

 

[ThadeusJ]

I believe the Good Samaritan Act (if it exists in your jurisdiction) allows you to use your knowledge, skills and abilities to the best of your abilities, if required. However you also have to know when to step aside. At the end of the day, you can get sued for anything and the "winner" of these lawsuits tend to be the ones with the deepest pockets. I was once visiting my old clinical site while a family member was in the hospital and the staff asked me, "Hey we're having a mock emergency drill at the moment...could we "activate" you during this drill?". An odd question considering I wasn't an official employee but I told them to add me to the list.

But anyway, let's consider you at a BBQ having a few pops and someone goes down...will you be acting while under the influence in that scenario?

 

[RedAirplane]

But anyway, let's consider you at a BBQ having a few pops and someone goes down...will you be acting while under the influence in that scenario?

Good question, one that I've had but never heard a good answer.

 

[NomadicMedic]

The Good Samaritan act is in place only to encourage bystanders to act without fear of liability, not to allow the practice of medicine without a license. I can say with relative certainty that you'd be okay with some basic BLS, but any off duty ALS, unless specifically sanctioned by your department/medical director, would most likely present with some legal difficulties. Not worth it to me or my family. I get enough ALS when I'm at work. If I can do CPR or stop a massive hemorrhage, I will. Otherwise, I'm calling 911.

 

[johnrsemt]

Bad thing in the Western US I can see it being beneficial to the patient to be able to do so. I was first EMS provider on a scene (that I drove up on); someone had already came and left to call 911 (20 minute drive to cell service, 30 minute response for ambulance). I would have been great to be able to start an IV and give fluids to patient in Neuro shock; (paralyzed from Abd down due to UTV rollover {no seatbelt worn or helmet}). Pt LOC was down and continued to drop during almost 55 minutes I was on the scene (only provider, but lots of potential help).

could the patient have continued to crash even if I could have started a line? yes: would it have been useful to do more than talk to her, and try to keep her warm, and get the UTV off of her? Yes.

Would being able to work as a medic in this situation been helpful? Probably

 

[rmena]

I work in northern CA and have a clause in my employment that states that as soon as the ambulance shows up or responds I turn into a fully active ALS provider. Again, the problem is that I don't carry any meds, IV supplies, etc. to do anything anyway without the ambulance being there but its mighty handy if the medic that shows up is up to his eyeballs in extra work (i.e., multiple pts)

 

[medic907]

The Good Samaritan act is in place only to encourage bystanders to act without fear of liability, not to allow the practice of medicine without a license. I can say with relative certainty that you'd be okay with some basic BLS, but any off duty ALS, unless specifically sanctioned by your department/medical director, would most likely present with some legal difficulties. Not worth it to me or my family. I get enough ALS when I'm at work. If I can do CPR or stop a massive hemorrhage, I will. Otherwise, I'm calling 911.

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?

 

[CCCSD]

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?

Any actions above First Aid/BLS are NOT covered under Good Sam. You go ahead and do that needle decompression or start that line and push meds while not specifically covered under guidelines and come back and let us know.

Nice necropost.

 

[FiremanMike]

I've been in this career a long time. I can't think of a single time off duty when I thought "damn I wish I could needle decompress this dude".

I've only ever stopped at 1 crash, it was a rollover on the freeway and no one was there.. I was calling 911 while walking over and realized I didn't really know where I was. Dispatcher asked me, I was like "uhhh, I'm on I-75.. I'm honestly not even sure what state I'm in, I'm sure other people have called by now, sorry". Anyhow, I did next to nothing at that time.

 

[E tank]

I've been in this career a long time. I can't think of a single time off duty when I thought "damn I wish I could needle decompress this dude".

I've only ever stopped at 1 crash, it was a rollover on the freeway and no one was there.. I was calling 911 while walking over and realized I didn't really know where I was. Dispatcher asked me, I was like "uhhh, I'm on I-75.. I'm honestly not even sure what state I'm in, I'm sure other people have called by now, sorry". Anyhow, I did next to nothing at that time.

A single time for me in 40 years. Mule deer 4 pt in felt strolled in front of a motorcycle. crepitus up to her ear lobes...but between the CNA with a portable pulse ox monitor and the dialysis RN and everyone else who had first aid training in high school yelling out orders, I couldn't get near enough for long enough to do anything anyway...I just split.