scope of practice question

[akflightmedic]

Your point has validity provided that I am guaranteed a new career and no loss in income, benefits or reputation for choosing to do so; for to harm myself and my family for years to come, over one immediate decision to step outside established boundaries not within my scope, me thinks I will play it safely.

Within a typical EMS organization, I can not be faulted for following the rules. Personally, I am ok with that, even if it means the expense of one's life. I will not ruin my life for your illness or injury, as it is not my emergency. (Heard that one before?)

The caveat to the above being immediate family, as I would lay my life down for them. Outside my circle of family, you are on your own provided that the actions I were taking were within a career organization. The legality of my actions can be justified if I were in a different or unique situation, but on the everyday run of the mill EMS job, no...stay within your scope.

I like playing devil's advocate, not all of the above is true

[Michael]

Your point has validity provided that I am guaranteed a new career and no loss in income, benefits or reputation for choosing to do so; for to harm myself and my family for years to come, over one immediate decision to step outside established boundaries not within my scope, me thinks I will play it safely.

I don't recall suggesting you or anyone not play it safely. (If I were Dust, I'd have said, "Where did I say you shouldn't play it safely ?" And maybe a few other things. :wink:)

In fact, my first response was to agree, and back you up with a quote from Shakespeare. (And if I were Wendy debating with Dust, I might scrutinize placing reputation above human life. But I'm just Michael, so I'll reiterate my modest purpose, which was to identify the terms of the situation described.) These terms seemed to be withholding vs. supplying care-outside-your-scope-of-practice, when that withholding appears as though it will be fatal to the patient, and when that supplying may jeopardize and compromise your and your dependents' future comfort and convenience.

No one can be obliged to act heroically; that's what your "It's not my emergency" means. To me the question seems to be whether choosing to offer such a sacrifice is, or can be, in fact, heroic.

Within a typical EMS organization, I can not be faulted for following the rules. Personally, I am ok with that, even if it means the expense of one's life. I will not ruin my life for your illness or injury, as it is not my emergency. (Heard that one before?)

The caveat to the above being immediate family, as I would lay my life down for them. Outside my circle of family, you are on your own provided that the actions I were taking were within a career organization. The legality of my actions can be justified if I were in a different or unique situation, but on the everyday run of the mill EMS job, no...stay within your scope.

It sounds like you're saying not just that you're not obligated to perform such a sacrifice, but that someone else is obligated not to. That's where I started scratching my head. Or maybe heart.

I like playing devil's advocate, not all of the above is true

Then I hope your immediate family have a Plan B!

[Dustdevil]

I just get the sickening feeling that the OP did something really stupid, way outside of their SOP, and is now looking for us to tell him/her that it was okay.

[Eydawn]

Is the action one you are very unfamiliar with and does it have complexities that are beyond your medical understanding? Will it save the patient but debilitate them? How far outside of your scope is the activity? Is there a way you can get a physician on-line to authorize your actions and take the responsibility for it?

To step outside of your protocols safely, you must have some sort of education or understanding with which to back up your actions in front of all those nasty lawyers... if you don't have that base, and you know your actions would be indefensible, or defensible yet so far outside your scope that any defense wouldn't matter, you might wish to reconsider stepping over that line.

Any of us might be faced with a situation in which the only way to give the patient a chance at survival is exceeding protocols. I think the word *survival* is key, and the odds of that survival should certainly play into one's decision. Is it worth it to risk losing your license or certification and all of the time and effort you have put into becoming the medical provider that you are? If the odds are somewhere around 10% that the action will result in definite survival, I don't think it would be an acceptable risk.

While you have a duty to advocate for your patient and do the best possible thing you can for them, you also have a duty to yourself and those who may be depending on you. Balancing those duties can be difficult, especially in areas where providers are in short supply and you find yourself sacrificing family time in order to provide coverage... sound familiar to anyone? So... if you sacrifice your license to save a patient, and remove yourself from your primary field of income, how is that any better for your family?

However, there may be instances in which you *know* the action is the right thing to do, regardless of consequences. In that case, God be with you and make sure you can defend it. Kind of reminds me of the paramedics who worked a pregnant code and performed an emergency C-section with online medical direction, but had their licenses revoked or suspended... the kid's alive, and I don't think either of those fellows would regret the decision they made.

I would tend to err on the side of human life... but then again, I am also a wicked public speaker and manage to convey myself honestly (at least, that's what my coach used to tell me) so I feel like I would be moderately comfortable defending actions I took in the best interest of the patient. If it's just something glitzy that doesn't impact survival, then you're an idiot. If it is something that will truly make the difference... the judgment and responsibility are yours. Think hard when you act.

Side note: Does it bother anyone else that the word "judgment" is spelled without that extra "e" from "judge"? I type "judgement" all the time and my computer yells at me. /side note

Wendy

CO EMT-B

[Richard B the EMT]

I have never operated outside my scope.

If the situation came up, either the Paramedics, or the OLMC Doctor better be giving me instructions, because I cannot "freelance" in any state of good will.

If, in those circumstances, I did do the deed, and get hit with the "outside of scope" charges, I'm taking either the Paramedics, or the OLMC Doctor down with me.

[Michael]

Wendy, Dust will tell you to use a British spellcheque.

[Dustdevil]

Yep, judgement passes my spellchecker. Although, "spellchecker" doesn't.

[MrBird]

I just get the sickening feeling that the OP did something really stupid, way outside of their SOP, and is now looking for us to tell him/her that it was okay.

Agreed.

So, what's the scoop? Did you do something and are now taking heat for it?

Spill it! We'd love a good story.

[CBEMT]

Not me personally, but I do know somebody who, back in "the old days," saved a child's life while off-duty, operating out of scope but within training provided him by the military during his service there.

The state yanked his license for a year. I don't believe EMS was his primary occupation at the time, if it ever was. But the kid lived, the mother was grateful, and he didn't lose his livelihood, so I think he considers it a good trade.

[defib_wizard]

I can not for some reason think of a situation that would make me want to exceed my scope of practice. The idea of what if it was someone in my own family doesn't wash with me. Because if I am helping them I am not a medic I am a family member. And what I do (within reason ) is covered under the good samaritan law. Besides if I'm on duty I have my als equipment and pretty liberal treatment guidelines. If not I have no equipment and we are back to the good samaritan law again.