EMT-B and an EMT-P on a BLS call, who is more liable?

[defib_wizard]

How can you be a paramedic without a drug box and monitor? That in itself should be more of a liability than level of care.

I'll give you an example of what I have seen with the state where I work. An emt / medic crew were investigated by the state, both were held to their scope of practice. The medic had additional issues to answer for due to their higher level. In the end the complaint was found to be unwarranted.

The lesson I learned from this was ( no it wasn't me ) everyone associated with the call will be held to their scope of practice and standard of care. If the medic feels a bls skill was not needed and the standard of care shows that it is, then the basic emt is just as liable. I was following orders doesn't work.

If you are not the one that is doing the paperwork and there are potential issues. You need to review it and correct the problem. You will be asked what happened and if your story doesn't match the documentation then you have a problem.

[ccmedoc]

The highest licensed person on car always has the greatest liability. Period. Even if only BLS supplies are available the higher licensed individual is able to do a more thorough assessment and come up with a more in depth treatment plan. If you increase your ability you increase your liability.

Agreed...

The most important tools or skills you take to the field are you education and assessment skill. As a paramedic, you should have increased both. You would be hard pressed to find anyone that would say your legal duty or liability was equal to an EMT, simply because of the truck you are riding in. The drug box and the toys do not make a paramedic a paramedic. It should be the education, and the ability to use this education to analyze a medical situation to a higher extent than the basic EMT.

I think to even ask the question is ludicrous and a means to a cop out. Do you lose a few IQ points or have a bout of amnesia when you board a BLS ambulance...I suspect some do :shock:

-Just my opinion 8)

[Christopher.Collins]

In my neck of the woods, alot of people on the job are also volunteers elsewhere... Medics, EMTs, Firefighters... etc.

One BLS, volunteer ambulance company I was with has quite a few paramedics within the ranks as well as a couple nurses and a PA also. Since it is a BLS company only they could only work at the BLS level.

While I do agree that there may be more liability on the person with higher certification... I disagree that they are technically "in charge" from a care standpoint. While yes they are higher certified and have more formal training they are only able to act as an EMT-Basic. Again it is a BLS only company, they do not have medical control to act otherwise (the medic or the company). Therfore they cant diagnose or perform any ALS skills... of course some medics utilize them more than they would the basic if it is an ALS call. Ethically of course, I would still expect them to perform better and perhaps give a more thourough work up... but legally they are still just a basic while working with their BLS company.

~~~~~~

In terms of how I deal with anyone not a part of a responding company but still higher certified... I ask them for ID including their certification card. If they cant prove they are a healthcare provider or the good Doc has a PHD instead of an MD, they're off the scene. If they dont have PPE and the situation calls for it, they're out also. Then of course if they are a medic and want to help they are told they by law have to go to the hospital with me, unless a dispatched medic shows up. Same for the Doc, only they have to go, medic or not if they choose to help.

Be very carefull if you have someone outside your agency trying to help though. I had a minor MVA once (hardly a scratch on either car). First person there was an EMT from god knows where... but not near or in my PSA. We take over patient care, shooing off the outsider, and the young lady decides she dosnt want to go to the hospital. I gave her the rundown on refusals... if things should change or you change your mind, and asking 3 times if shes sure... etc. And just after she signs the paperwork that freaking EMT comes running up to MY patient and harrasses her. Before I could even get the damn cops attention I hear crying and, "allright I'll fu*%ing go, just leave me alone."

I documented the hell out of that situation, unfortunatley and regretably I didnt get that EMTs certification number.

But regardless the damage was done...

This young woman who didnt want any assistance was badgered into it. Therfore an emergency ambulance and hospital bed (and whatever other recourses) were put out of service to help someone who never even wanted it. All that aside I was more upset for my patient who was lying on a backboard in a cold ED for whatever length of time before she was finally seen (it was busy that day). I mean how embarassing can that be, just because some dumb schmuck was on a power trip and wanted to play para-god.

This should also go as a reminder if you help out in someone else's jurisdiction... be smart, as you would in your own area. Of course... if your not smart on the job with your own people, your better off to keep driving past whatever you come across :twisted: lol

[ERDoc]

Ultimately the ones to decide who has the highest medical authority is the jury. In NYS, on a BLS call, everyone is considered an EMT. It is only when the call becomes an ALS call that people then become EMT-Ps or EMT-CCs. So, in theory, if you have a medic and a basic working/volunteering for a BLS service they are both only seen as a basic in the eyes of the law (which does not mean the same as the eyes of the jury). However, if there is an ALS service and the call should be ALS, but the medic decides to BLS it, that medic will be responsible for whatever happens. Again, this is based on the law in NYS and not on what a jury will decide.

[fiznat]

Heh so they are both EMTs until someone decides that something went wrong. Then - surprise! - you're a medic again!

In my opinion, a paramedic with any sense in him simply doesn't put himself in this situation at all.

[crotchitymedic1986]

If it comes to a lawsuit, everyone on the scene will be named in the suit, regardless of rank/certification. Then you will have to defend your actions/inactions through your documentation of the call and your company's policies and procedures manual. Two ways to handle this are:

1. As mentioned above, your department can create a POLICY that states, once someone of higher training arrives on the scene, and they want to provide patient care, they will have to ride to the hospital with the patient, and assume responsibility for their actions.

2. Have a written policy that states that whenever there is a conflict on the scene, medical control will be contacted for advice (medical control could be the closest ER or a specific ER for your service).

Just as you could have a podiatrist show up, who thinks he needs to crack a chest. You could have a Paramedic on the scene who doesnt have a clue or EMTs that dont have a clue. Get a supervisor or medical control involved, and document what happened and at who's direction.

[firedoc5]

Been there, done that. On my days off I'd go to my folks where my father was the coordinator of the BLS vollie service. Every now and then I'd go on the calls basically for kicks & giggle. But every now and then they definitely needed ALS treatment. Remember, this is only a BLS unit. no monitor, no drug box, no ET equipment (this was in the early '90's.) The most advanced equipment was IV's and those were only for nurses to use if they were on a long transfer and one of the IV's ran out or went bad.

We checked in with the "legal eagle" doc's. and came to this conclusion. Yes, I was a Paramedic, but was outside the ALS EMS system (North Egyptian Advanced Life Support System). Legally I could not do any ALS skills. Now, I could talk someone through it or make suggestions, even give orders. I just could not physically do any ALS skills. Now as far as BLS skills, I could do all that I wanted to.

So, I found my usefulness when operating with my dad's BLS service was just to drive. Any suggestions or corrections on doing BLS skills were OK and welcomed, but I could not do any ALS skills myself.

I hope this answers some questions. And I really hope things have changed.