scope of practice question

[fireflymedic]

People, there is a scope of practice for a reason. If you want to exceed it, go and get the additional training which permits you to do so. Otherwise, if you like your job, and like not being in court, then stick to what you have been trained to do. As one so eloquently stated earlier - how many lives will you save if you lose your license? I think HERO mentality seriously plays a part here.

Also, what many of us simply forget is that many times basic procedures which all of us are trained to do WILL get the job done. Now that's not saying there's not a time and place for ALS. There certainly is, or we wouldn't have it. However, when all your ALS toys fail, you better have darn good BLS skills to back 'em up. It's amazing how many medics I've seen that simply seem to forget their BLS if they can't do their IV or get that tube. Their world falls apart. Oh the things we forget.

Personally, no I wouldn't exceed my scope of practice. And yes, while it would be hard to sit back and only be able to perform up to what I was trained to do, I understand that training and oversight is there for a reason. How many basics run on an ALS stocked truck? Lots in our area but it functions as a BLS truck unless they intercept. If the rules and oversight weren't there, we may have basics doing all sorts of things that aren't within their scope. Ideally you shouldn't be doing anything until you know the reasoning behind WHY you are doing it. We SHOULDN'T (note I said shouldn't ) be training basics, intermediates, or even medics just procedures. They should understand the reasoning behind why they are doing it. If you don't, I think you are doing your patient a disservice.

All that can be summed up in what I've told people many times, "I've worked way too hard to get and keep this license to lose it to stupidity". Exceeding your scope of practice is just that - stupidity. Period, end of story.

[letmesleep]

People, there is a scope of practice for a reason. If you want to exceed it, go and get the additional training which permits you to do so. Otherwise, if you like your job, and like not being in court, then stick to what you have been trained to do. As one so eloquently stated earlier - how many lives will you save if you lose your license? I think HERO mentality seriously plays a part here.

Also, what many of us simply forget is that many times basic procedures which all of us are trained to do WILL get the job done. Now that's not saying there's not a time and place for ALS. There certainly is, or we wouldn't have it. However, when all your ALS toys fail, you better have darn good BLS skills to back 'em up. It's amazing how many medics I've seen that simply seem to forget their BLS if they can't do their IV or get that tube. Their world falls apart. Oh the things we forget.

Personally, no I wouldn't exceed my scope of practice. And yes, while it would be hard to sit back and only be able to perform up to what I was trained to do, I understand that training and oversight is there for a reason. How many basics run on an ALS stocked truck? Lots in our area but it functions as a BLS truck unless they intercept. If the rules and oversight weren't there, we may have basics doing all sorts of things that aren't within their scope. Ideally you shouldn't be doing anything until you know the reasoning behind WHY you are doing it. We SHOULDN'T (note I said shouldn't ) be training basics, intermediates, or even medics just procedures. They should understand the reasoning behind why they are doing it. If you don't, I think you are doing your patient a disservice.

All that can be summed up in what I've told people many times, "I've worked way too hard to get and keep this license to lose it to stupidity". Exceeding your scope of practice is just that - stupidity. Period, end of story.

ut'oh.....sounds like another one advocating the whole continuing education thing..............I couldn't agree more, GREAT POST AND POINT!

[reaper]

noo wa man thaat egucasion thing is four losers :roll:

[spenac]

The problem of exceeding scope of practice is a fine line. For me at my old job I did things as an EMT-I that even the Paramedics are not allowed at my current full time job.

[DwayneEMTP]

People, there is a scope of practice for a reason. If you want to exceed it...,

I think you and I interpreted this question differently. I didn't read it to say "Are you looking for a reason to exceed your scope of practice?" But "If a life was salvageable if you would step outside your scope of practice, would you do so?"

I have no desire to step outside my scope of practice, but will do so if a life is at stake.

I think HERO mentality seriously plays a part here...

Perhaps that would play a role for you, but I believe that those that know me here will tell you that it is not a part of who I am. Perhaps you see anything that causes one pain while doing the right thing as heroic. I don't. I will try to do what I feel is morally and ethically right because that's what being a paramedic means to me. I was taught by those better than me that I am obligated to protect my pts from all comers. Police, nurses, Dr.s and yes, even my medical director. I must have been asleep the day they taught "Protect your pt unless it's likely to get you jammed up, then allowing them to die needlessly is acceptable."

I'm not selling this to you. This is how I choose to live my life. I've attempted to help people when doing so put my life at risk. Do you think I can somehow choose not to do so simply because my medic ticket is at risk? Not likely.

Also, what many of us simply forget is that many times basic procedures which all of us are trained to do WILL get the job done. Now that's not saying there's not a time and place for ALS. There certainly is, or we wouldn't have it. However, when all your ALS toys fail, you better have darn good BLS skills to back 'em up. It's amazing how many medics I've seen that simply seem to forget their BLS if they can't do their IV or get that tube. Their world falls apart. Oh the things we forget.

It's unfortunate you spend your time around such weak medics. But again, the age old bullshit of BLS before ALS isn't really what this thread it about unless I've misunderstood something.

Personally, no I wouldn't exceed my scope of practice. And yes, while it would be hard to sit back and only be able to perform up to what I was trained to do,...

I was trained to do monkey skills. I was educated to know how the body works, what it needs to survive, how my actions and medications affect those needs, and to use that education to create possibly life saving interventions on the spot. If after bringing my training and education to bear I find that my pt needs don't fit into the protocol, or their chances for survival will be lessened by strict adherence to the protocols than I will do what I think it right and take my beating afterwards.

All that can be summed up in what I've told people many times, "I've worked way too hard to get and keep this license to lose it to stupidity". .

If you can only see stupidity here then you very much should stick to your protocols. It's not time, nor may it ever be, for you to think on this level that demands you may make a sacrifice for your art. For me, the very soul of paramedic medicine is pt advocacy. If I remember that, that I must defend them from sickness, from trauma, from insufficient care, and yes, also from possibly poorly written protocols, then I stay on track.

I think the view you have is a smart one. I think it will guarantee you a career much longer than mine, but when you choose to forfeit a life to follow a rule then you are no longer fulfilling your obligation as a paramedic. You may do complex medicine, but it is soulless, and I'm willing to bet your practice suffers for it.

Thanks for sharing your thoughts....

Dwayne

[letmesleep]

If you can only see stupidity here then you very much should stick to your protocols. It's not time, nor may it ever be, for you to think on this level that demands you may make a sacrifice for your art. For me, the very soul of paramedic medicine is pt advocacy. If I remember that, that I must defend them from sickness, from trauma, from insufficient care, and yes, also from possibly poorly written protocols, then I stay on track.

I think the view you have is a smart one. I think it will guarantee you a career much longer than mine, but when you choose to forfeit a life to follow a rule then you are no longer fulfilling your obligation as a paramedic. You may do complex medicine, but it is soulless, and I'm willing to bet your practice suffers for it.

Thanks for sharing your thoughts....

Dwayne

I think your being a bit harsh here Dwayne. Being a Pt advocate is the goal, right? That is what we are supposed to do and be, but how is stepping out of your scope of practice being a Pt advocate? Sticking to your scope of practice is your job, anything beyond that requires a higher level of care. If a Pt is so trapped in a vehicle that amputation is the only way to save their life, are you going to do it, or get a surgeon to respond to handle cutting the legs of your Pt off? Amputation is outside your scope of practice, but not the surgeon's. I totally agree with being a Pt advocate, however their is a limit in your skills that can be preformed in the street. Your not doing your Pt any favors by stepping outside that scope of practice when your not trained in a particular procedure that maybe life-saving. Who is going to protect your Pt's from you in this case?

[reaper]

I will do everything in my power to save my Pt's life, to a point!

If you go outside your SOP, you are practicing medicine without a license. That can get you arrested and lose your license for life.

I am here to help, but I will not put my family at risk for "Stupidity". If you have something off the wall, call MC. If they say no, then that is that. Yes, you would be stupid to do it after MC has refused it. You would have no defense in that case.

[fireflymedic]

Dwayne - in no way, shape or form did I say don't advocate for your patient. I am all for medics and basics and anything in between advocating to give their patients the best care humanly possible. That was actually the key point of my post which sadly you missed. It is our responsibility to ensure they get the care they need and the best possible care that it can be.

Now, as far as your insult as to the medics I spend my time around I beg to differ. I was speaking among services I have observed. The service I operate within has well trained, experienced medics that I wouldn't think twice about trusting mine or my family's life too. They are actively involved in research for improving patient care and always looking for ways to better their skills. I truly believe they are among some of the best in the business and most compassionate about their care. Please do not show your ignorance by speaking of what you do not know.

Exceeding your scope of practice is practicing medicine without a license. If I can get someone more qualified to be responsible, by all means I will. That is not to say that I won't go toe to toe with a doc (and have before) questioning how a patient was treated because I wanted to know his reasoning behind it when I thought there might have been a better idea. I don't know it all and I'm all for the opportunity to learn. That is what being a medic is about is educating yourself and your patients and promoting the best care possible for them. It's not about being the person that exceeded his scope of practice 'cause he "thought" it was right and end up possibly causing more harm than good.

If you had the situation that you performed an action and didn't know all the contraindications and indications for it and ended up causing harm potentially killing your patient then was exceeding your scope of practice worth it? In this thread we've only discussed positive results from people exceeding their scope of practice, but there's enough things that go wrong when you are properly trained that can cause negative results, if you weren't within your scope of practice, that's career suicide. We all sit back and say we couldn't live with ourselves if we watched a patient die because we thought we could do something, but what if the patient was bad and your actions made them worse or killed them - could you live with yourself then?

This comes down to each person's individual thoughts and convictions, but personally we should all remember the biggest rule - first do no harm, and if your actions should on the off chance not help but hurt the patient you have done just that. Caused harm. How would you answer those questions when faced with them? Would you still feel justified and how would you justify it to that patient or their family. Think long and hard about what you do. The results will last a lifetime.

Always be safe and smart out there.

[DwayneEMTP]

I will do everything in my power to save my Pt's life, to a point!

That is an oxymoron. If you will do everything in your power, then the only 'point' is when it becomes beyond your power, right? Not when someone you disagree with tell you to stop.

I am here to help, but I will not put my family at risk for "Stupidity".

Nor would I. There are places that insist that you call before initiating an IV. If my pt needs and IV yet medical control refuses, then I will start the IV. I have gone against medical orders in Afg, and will do so again when someone not on scene refuses to give me permission to do what my eyes, and education, show to be necessary.

If you have something off the wall, call MC. If they say no, then that is that. Yes, you would be stupid to do it after MC has refused it. You would have no defense in that case.

I have known several good medics that refused orders from medical control, or provided interventions that they were specifically ordered not to. Each is still practicing medicine, happily providing for their family. Their defense was that medical control was wrong. They made decisions from afar that were incorrect for the situation on the ground. When the medics explained their reasoning all went away happy.

I promise you this. If you work in CO Springs and follow medical control to the detriment of your pt, medical control will pull your right to work under his lisence the moment you step through the hospital doors. He expects you to know how to do medicine, and to do medicine even if it means going against orders. I am tasked to protect my pts, not cover my ass by claiming, "But MC told me too!!!"

If you are not confident in your medicine then covering your ass is an outstanding career move. If you have confidence in your medicine, and have committed yourself to advocating for your pts. then you don't assume that MC is the final word.

Dwayne

[jmp6753]

Working as a Medic in my county, with our protocols there is hardly anything I cant do.