scope of practice question

[chbare]

Cannot believe I have been asleep so long as to miss this one. I have to go with the general direction on this one. Some of the situations I have seen so far include; IV therapy, epinephrine for anaphylaxis, and treatment of pre-eclampsia. Look, if you as a paramedic work for a service where you have to obtain permission to place an IV or give epinephrine, one of two concepts exist. 1) Your medical director does not understand EMS. 2) Your medical director does understand but is fearful of letting a paramedic perform an intervention under the physicians license. (Not difficult to understand with some of the educational standards.) Either way, this means your service sucks and you should not even be working for such a place. Problem solved.

Take care,

chbare.

[KWILES9]

[/font:33834cbfaf] I'm a LPN and hopefully will soon be an EMT. If I knew something from my nursing experience that might not fall into my EMT scope of practice, then I proberly would. But only if I felt it was life or death, at that point I feel doing something would be better then doing nothing...If I was the patient and their was someone around that might know something that would help me.....and no one else with more experience was their.....then I hope they would at least try to save my life, even if it was out of their scope of practice....But only if that was the only option.

[akroeze]

I honestly can't think of a single thing an LPN could do within their scope that an EMT couldn't that would be life or death.

[defib_wizard]

dwayne why are you so insistent on this? I am missing something here. I have sat in the medical directors office before for doing a skill that is in my scope of practice in a situation that is bizarre. The pt did have a good outcome from it and 2 weeks later the MD was in the same situation. I was the one that notified the director of the situation and requested input.

What sort of situations are you talking about that you would consider going out of your scope.

[Timmy]

It’s pointless comparing nursing and EMS, they focus on different areas.

[Doczilla]

Dwayne- My reply was not a specific rebuttal to your arguments, just a general statement on deviation from scope of practice. I think you and I are talking about two different concepts.

We have to make sure to distinguish 2 things: deviation from scope of practice, and deviation from protocol. A procedure that is permitted by protocol (even if it requires MD authorization in real time) is still within the medic's scope of practice. Protocols are determined by the medical director, whereas scope of practice is usually outlined by the state. I was speaking of deviating from scope of practice, performing a procedure which is not routinely permitted to be done by providers at that level in that particular state. The examples I provided are all scope of practice issues, not just stepping outside of protocols.

'zilla

[akroeze]

Dwayne- My reply was not a specific rebuttal to your arguments, just a general statement on deviation from scope of practice. I think you and I are talking about two different concepts.

We have to make sure to distinguish 2 things: deviation from scope of practice, and deviation from protocol. A procedure that is permitted by protocol (even if it requires MD authorization in real time) is still within the medic's scope of practice. Protocols are determined by the medical director, whereas scope of practice is usually outlined by the state. I was speaking of deviating from scope of practice, performing a procedure which is not routinely permitted to be done by providers at that level in that particular state. The examples I provided are all scope of practice issues, not just stepping outside of protocols.

'zilla

What would your thoughts be Doc if a medic started a Versed drip on a status seizure patient when they don't have it in their protocol.

[DwayneEMTP]

dwayne why are you so insistent on this?

For a couple of reasons. I was taught, and very much believe that the heart of paramedic medicine is pt advocacy. I am morally and ethically tasked with knowing as much medicine as possible, being physically fit, etc to protect my pts from illness and injury. I am also tasked with being mentally fit to protect them from poor advice that may be given by other medics, nurses, or even the medical director. That if, after bringing my education, training and experience to bear on a problem, I'm asked to provide or withhold an intervention that I believe to be in error, I'm morally and ethically obligated to refuse to follow through with it.

So far the only arguments that I've seen against my doing so go back to "You shouldn't because you don't understand it." Not the case, the argument assumes I understand the indications, contraindications and believe a life to be in the balance.

"If you need to do so then get a job where that skill is allowed." This is silly, as the entire thread assumes we are in this position now, not at some later date. I'm obligated to this pt, not to some future hypothetical pt.

"If you don't like your system, change it." Again, has no place in this conversation as we're talking about an emergent, unforseen occurance. I'm not sure how to predict the unpredictable to make those changes.

"Work somewhere else." Not even slightly interested in responding to this foolishness.

"Your intervention may cause more harm than good." Once again, it's been assumed in the argument that I have a fair understanding of the cost/benefit. Could I be wrong? Sure. But to do nothing, when I believe I can help increase the odds of a positive outcome, has a 100% chance of failure.

Vs-eh?, as you've shown time and again that you simply wanted your little moment to take a shot at U.S. EMS education I won't waste time on you. But I'm curious, if your education is so superior why is it that you're unable to hold your own in debate even with American basics?

What sort of situations are you talking about that you would consider going out of your scope.

Shoot...I'll have to think about it. The silly ones for sure. Pt trapped in a burning car by his mostly amputated leg. Amputate or let him burn? I'll try to come up with some decent examples, though as I've stated about a gazillion times, I'm not looking to work outside of my scope of practice, nor even outside of my protocols, so if I could predict them then they would likely be a non issue.

Dwayne

[Timmy]

How long have you been a paramedic for Dwayne?

[DwayneEMTP]

Dwayne- My reply was not a specific rebuttal to your arguments, just a general statement on deviation from scope of practice. I think you and I are talking about two different concepts.

We have to make sure to distinguish 2 things: deviation from scope of practice, and deviation from protocol. A procedure that is permitted by protocol (even if it requires MD authorization in real time) is still within the medic's scope of practice. Protocols are determined by the medical director, whereas scope of practice is usually outlined by the state. I was speaking of deviating from scope of practice, performing a procedure which is not routinely permitted to be done by providers at that level in that particular state. The examples I provided are all scope of practice issues, not just stepping outside of protocols.

'zilla

Gotcha Doc. I didn't make the distinction, though I understand it, because it didn't seem to matter. It seems to me from this discussion that a person's life should be forefieit if there is any possibility that a rule exists prohibiting your action. In fact, the best I can see here, if a medical director that failed to make a rule concerning a particular issue then you should no longer be responsible for that procedure either.

I'm off in the ditch on this one I guess...But I'm used to it... :-)

Dwayne