Treating Patients While Off-duty

[Richard B the EMT]

_{My boss made sure I had a full ALS jump bag and monitor and I would respond POV, stabilize the patient if necessary and ride in with the ambo. jump bag for anything off duty. I'm not sure how it works back east or in the midwest, but where I am licensed/certified (Arizona, California, Nevada), Paramedics cannot freelance (meaning cannot operate at an ALS level if not on duty) unless specifically directed to in advance by the medical director for that region/area. That being said, I would stop at serious MVA's to make sure everyone was ok and offer BLS care only if necessary.}

Would I be correct that the area(s) in question might have several OLMC centers, and if you called, on your cell phone, the "wrong one" for a specific location, you'd be stepping on someone's toes, even if the offended OLMC would probably have given you the same authorizations and permissions?

[azemt2007]

Would I be correct that the area(s) in question might have several OLMC centers, and if you called, on your cell phone, the "wrong one" for a specific location, you'd be stepping on someone's toes, even if the offended OLMC would probably have given you the same authorizations and permissions?

Here in the west, we have very few if any volly services. As such, the state has divided into areas of response and awarded them to private or municipal ems agencies. Those specific agencies each have their own medical director that oversees the area. State law does not protect nor grant a paramedic that does not work under that medical director to provide ALS care off duty unless there is already a prior arrangement with that particular medical director. Each base station has a base medical physician, then there is a medical director above them. So there wouldn't be any stepping on toes per sei as there is one director for each response area.

[Richard B the EMT]

State law does not protect nor grant a paramedic that does not work under that medical director to provide ALS care off duty unless there is already a prior arrangement with that particular medical director. Each base station has a base medical physician, then there is a medical director above them. So there wouldn't be any stepping on toes per se as there is one director for each response area.

So if a Paramedic from service "A" responds while off duty to a call in service "B"s area, unless service "A" has a reciprocal (spelling?) agreement with service "B", said Paramedic cannot use the OLMC of service "B", and utilize their Paramedic skills? What if the Service "A" Paramedic, while attempting to operate off duty in service "B"s area, attempts calling the service "A" OLMC? Are you saying the rules forbid such action mearly due to geographic location within the same state? If such is the case, I once again invoke Dickens' "Mr. Cacawber": "The law is a ass!"

[Just Plain Ruff]

Unfortunately it's probably true Richard.

I was driving home from louisiana a number of years ago, had an interview with Acadian ambulance. I had my Louisiana medic license as well as Missouri license.

Came upon a MVA with a seriously injured patient. First ambulance arrived and was an ALS ambulance but only had two emt's in it. They said that's all that they could get to respond.

We worked on getting the patient packaged and ready for transport. Patient needed an IV as well as pain management but when I made contact with the receiving hospital and explained who I was the hospital said just transport. I asked why he wouldn't give me orders for ALS and he said that even since I'm licensed in Louisiana I need to be employed by a ems company to perform skills. Not sure if that was right but that was his stance.

So I put the patient in the ambulance and they left. I was willing to go to the hospital with the patient but was precluded from doing so. Did I like it , nope, did I understand the doctor's stance Yep!!!!

If a medic called my hospital and asked for orders and they were off duty and not employed by the ambulance service that covers our area, then they would not get orders either.

The law is a fickle thing. It is what it is.

Is your medical director or medical control willing to give medical orders to a off duty medic who is not employed in your jurisdiction?

[Siffaliss]

Guess I'm a little late reading this one, it's been interesting. There is a duty to act while in the ambulance out and about, even if there's a patient in the back. Several times if I'm driving as opposed to attending I've come across an accident, so I will most certainly stop and ask if anyone is hurt or needs anything. I update dispatch saying either yay or nay for an ambulance or, fluids down send fire, or the po-po's, etc etc.

Everyone has their off duty stories, so here's one. A couple of years ago while driving to my grama's for dinner (because I hate cooking and she does it so incredibly well), right in front of me I see a car/ped. The ped was an 11 year old girl, but regardless it was right in front of me. Couple cars from opposingly directional traffic stopped and were trying to pick this kid up as I was walking over. Her left foot was pointing over to the right, swelling to the left upper leg (oh, and pain++++) and they figured if they picked her up and put her in their car they could take her to hospital because "they would be there before the ambulance got here". So I'm shouting to leave her where she is, I had two level headed bystanders keep the rubber-neckers moving along while I waited for the incoming unit. I knew the crew, stayed holding c-spine until she was boarded, then went and had a wonderful German dinner.

After texting the one crew member later on that night, it turned out the kid also a spinal fx although I cannot remember where, and she did end up making a full recovery several months later. Had those idiot bystanders picked her up and drove her, she could have been paralyzed.

So in situations like that, sure I'll stop. There is no duty to act while off duty here as far as I know, and I don't even think there is a "Good Samaritan" law anymore. I have a box of gloves in my trunk, nothing more. If there is no crew yet on scene, no potential harm to me and it looks as though someone actually needs help, I can't really see myself not stopping for a few minutes. As soon as I'm not required anymore, I'm out.

Edited November 4, 2011 by Siffaliss

[Bernhard]

I asked why he wouldn't give me orders for ALS and he said that even since I'm licensed in Louisiana I need to be employed by a ems company to perform skills. Not sure if that was right but that was his stance. [...] If a medic called my hospital and asked for orders and they were off duty and not employed by the ambulance service that covers our area, then they would not get orders either. [...] Is your medical director or medical control willing to give medical orders to a off duty medic who is not employed in your jurisdiction?

Here, I'm a Rettungsassistent from the moment I get my certficate. 24/7, life long. If out of duty it's my decision what I do - but if I want, I can do all what I'm able to and have the equipment for (even, if this is given to me from a BLS ambulance). If I introduce me as medic, I would be accountable in a certain way for all things, but I have not exactly the same liability as on duty, circumstances would be taken into account. I'm publically insured as any other civilian if I get hurt during aid and can get replacement/money for damaged own posessions (i.e. bloody clothes). No med control here (not even on-duty), who could deny me something.

[Richard B the EMT]

Is your medical director or medical control willing to give medical orders to a off duty medic who is not employed in your jurisdiction?

I am unsure. I have called them up to get further information re some EMT City requests for information postings I have done, after advising them I was going to post their response.

[WhiskeyTangoFoxtrot]

Paramedics make terrible first aiders, just sayin...

I have stopped but most often I pass by. I do not have a star of life sticker in my window though I do have one tattoed on my body. I still get a woody when I drive by a good MVA and if it looks like I can help and it is prudent for that time certainly I will, but most situations just don't warrant it. It has been said a few times in this thread. We assess each situation and choose appropriately. I respect the people that stop for everything, but I do not lose sleep when I choose not to.

As for the initial question to this thread, I would have done the same thing. I would sit back and watch for a few moments a decided if I really needed to jump in to help rather than run in to be the hero. With that being said, the decison to help is based not only on my assesment or physical skills but my emotional skils as well because we as proffessionals all (I use all loosely because I have worked with some serious idiots)have a unique ability to bring a calm over the caos and sometimes that is all that is needed, and can be of far greater value than whether I had a full set of equipment in my trunk or not. (Which I don't)

[Happiness]

I still get a woody when I drive by a good MVA

Ok is it just me or does this appear to have the influance or both Squint and Dwayne Hummmmmmmmmmmmmmm

Edited November 8, 2011 by Happiness

[WhiskeyTangoFoxtrot]

OK you figured it out, they had a one night stand and I am their bastard child.