scope of practice question

[Eydawn]

Again... what is ultimately *right* and what you are ultimately *allowed* to do are two different things. As long as you're comfortable knowing that you can and eventually will lose your license for continually acting outside of scope, then it's your life and I won't argue with you.

There *is* a reason we have protocols. You may not like them, but within your system, it's what you've got to work with. There's a reason doctors are allowed to play around with the rules- they have many years of education and experience with which to base their knowledge. Even as a paramedic with a BACHELOR'S degree, you wouldn't have nearly as solid a foundation to base rogue treatments on.

Are you right? Sure. Is this something we should encourage every medic to do? No. Then you have anarchy and every single person exceeding scope saying "but it was my ethical duty to my patient!" Sure, it might be ethically justified... but it's still outside your scope.

I think you're usually fine as long as it was in the best interest of the patient. But your judgement of best interest and a doc's judgement of the same may vary in retrospect... and that doc is gonna be responsible for your discipline and licensure...

Again... this is something everyone has to do for themselves. We will all face situations someday where we either exceed protocol because it's justified, or we don't, and are legally covered.

Wendy

CO EMT-B

[Mateo_1387]

I do not get this argument

If your son dies because I’ve stayed within my scope of practice it would not phase me, I have done everything I could and done what is expected of me to the best of my [s:8d96d40443]ability[/s:8d96d40443] limitations set forth by the cookbook

:wink:

I seem to be the only one at the moment with this opinion, right?

Nah, you are not alone.

If you want to do more for a pt, then go to med school and learn how!

If you do something minor, that may be a little outside your SOP, then as long as you can back up your decision, go for it!

Which one is it? Can we do something more for our patient's or not?

Wouldn't outside our scope of practice be something that we are NOT trained on?

Things you are not trained on probably are outside of your scope of practice. There are also things you were trained on that are not in your scope of practice, these things are usually limited by state or company protocols.

[fireflymedic]

Dwayne, as I stated it is each individual person's decision and each person has to live with that decision. I can't say what is right for you, nor can you say what is right for me. I think we both have enough class to respectfully disagree here? Opinion respected.

I don't think there is a final answer as to what is right or wrong here and to continue to debate it is simply beating a dead horse, so personally I'm done with it. I will say if I know a procedure is detrimental to my patient, and ordered by med control, and within my scope of practice yes I would question - possibly even refuse that treatment. I consider that my responsibility and advocating good medicine. Docs aren't perfect, they make mistakes too. However, if something is recommended and I refuse to do it, I had better be prepared for the consequences because as an MD or DO he has far more training than I and may be aware of a contributing factor that I am not. I better have a full understanding of why I refused the procedure.

Dwayne and others, I respect your decision whichever way you choose and I'm sure neither decision would be made lightly. I can tell that from the discussion in here. I believe the best response to this question is your personal decision which is what was asked, rather than what is "right" or "wrong". Be safe everyone.

[Richard B the EMT]

Years ago, a TV show plot had a paramedic team that felt a treatment was required for a patient. The OLMC denied them. They then contacted a different OLMC, which authorized the treatment. then advised the second OLMC that due to location they were going to transport to the first OLMC's hospital. They caught flack, but persevered.

Does anyone have knowledge of that type situation actually happening? No locations, please, for obvious reasons.

[akroeze]

Then there is always the "What's that Doc? The cell phone is breaking up, I can't hear you!" And then disconnect

[Richard B the EMT]

If I remember, that is pretty much what Johnny and Roy did.

[akroeze]

Yup, it is.

And then if your protocols state that you can proceed with best judgement if unable to contact a Doc....

[BEorP]

I haven't read all the replies, so I apologize if this has already been addressed. I initially voted "no" and didn't give much consideration to the possibility of going outside my scope.

Thinking about this more though I thought of an extremely unlikely scenario where going outside my scope may be worth at least considering. In one service I work for we perform pediatric defib in manual mode (normally PCPs just use auto). What if there was a situation where the defib malfunctioned and would not go into auto mode while working for the other service? I could always just say the defib failed, do CPR and transport. But wouldn't it be better for the patient (at least if in a shockable rhythm) to go through the protocol in manual mode?

Unlikely scenario, and probably not what the OP was looking for since it is outside the scope technically but something that I am trained in and able to perform (in some instances) at the other service.

[DwayneEMTP]

Dwayne, as I stated it is each individual person's decision and each person has to live with that decision. I can't say what is right for you, nor can you say what is right for me. I think we both have enough class to respectfully disagree here?

Absolutely.

I don't think there is a final answer as to what is right or wrong here and to continue to debate it is simply beating a dead horse...

Completely disagree. Even if we don't resolve the problem, we come to know each other better, getting a better feel for tone, sarcasm, etc.

...I will say if I know a procedure is detrimental to my patient, and ordered by med control, and within my scope of practice yes I would question - possibly even refuse that treatment. I consider that my responsibility and advocating good medicine. Docs aren't perfect, they make mistakes too. However, if something is recommended and I refuse to do it, I had better be prepared for the consequences because as an MD or DO he has far more training than I and may be aware of a contributing factor that I am not. I better have a full understanding of why I refused the procedure.

Exaclty what I was trying to say, only you said it much better. For some reason I still see, "Continually operate outside your scope", and "If you want to operate outside of your scope" etc. I had assumed we were speaking of the incredibly rare instance where this would be beneficial, perhaps I was the only one with that understanding.

Dwayne and others, I respect your decision whichever way you choose and I'm sure neither decision would be made lightly. I can tell that from the discussion in here. I believe the best response to this question is your personal decision which is what was asked, rather than what is "right" or "wrong".

Awsome point. It's just that I often don't know what's right or wrong, or what I may find acceptable in the future until I'm able to bounce it around in here for a bit.

I'm grateful for everyone's opinions and for you taking the time to do these mental gymnastics. I think it's important to explore and make decisions on these principals before the time comes when you need them, but don't have the time to think around all the corners.

One last time...Not an advocate for creating your own scope of practice daily...I believed us to be arguing the rare, once in a career decision to act or not.

Have a great day all!

Dwayne

[Just Plain Ruff]

operating outside of protocols or beyond them?

Yes, one time. had a man trapped in a crevass about 6 miles off the road. His knee was dislocated and no pulses to his feet and he'd been trapped for about 3 hours.

No medical control due to no cell phones or radio contact at that point.

gentle inline traction on his leg, felt pop, got good pulses and all was good.

medical control asked me why I did what I did, I told him I felt it was in the patients best interest and no issues after that.

Is that what this absent original poster is asking? by the way, where is the phantom poster? Maybe in chat?