Question about scope of practice for more experienced people

[hrising]

I have a question for you more experienced people: Does exceeding your scope of practice include collecting diagnostic information or only interventions? That is, if I know more questions and tests I can use to try to figure out what is going on with a patient, can I ask them and use them, as long as I don't intervene or make a judgement that is outside of my level?

The question is specifically related to neurological examination, and part of my intent was that I wanted the person to treat the whole thing more seriously and get checked out at the hospital.

[AZCEP]

To the best of my knowledge, there is no scope of practice involved with a patient assessment.

You may be limited in the use of some tools in gathering your information, but the assessment itself isn't typically restricted. Things like ECG, BGL, SpO2, and EtCO2 will be included, or excluded from a given level's scope. You would just have to figure a way to obtain the informational equivalent some other way.

You would be in more danger of violating your scope by giving a medical opinion, or advice.

[pyroknight]

Even ECG, SpO2, and ETCO2 would be difficult to include in a scope of practice because they are non-invasive, diagnostic tools. As a state administrator, I only include invasive skills (or manipulative skills like fracture/dislocation reduction) and medications as part of a scope of practice.

Anything you can do diagnostically that does not delay delivery of the patient to definitive medical care may be beneficial and can not cause harm. Just make sure that you are not spending half-an-hour on scene checking all the cranial nerves and doing a full neurological examination when you should be moving toward the hospital.

[BushyFromOz]

i wonder if they are talking about physical tests such as hepato jugular reflux or babinski's sign?

[Ridryder 911]

Not to be knit picky, but truthfully EMT's do not have a "scope of practice", with that saying there are general guidelines for each level of practice.

No, I doubt there should be any limitations on assessment and knowledge, but there is practicality and appropriateness. The same as a ER physician can order and perform several tests to rule out and diagnose long term illnesses that would not be appropriate to start long term treatment. Rather the physician can make an initial assessment and diagnosis to refer.

I probably assess more in detail than others. Yet, I know when it is appropriate and warranted. Checking the cranial nerves on a CVA and not knowing or being able to report and understand and then possibly treat those findings worthwhile?

Again, my suggestion is to keep it practical and use good common sense that it is applicable to that situation, not causing delay and attempting to go past your level of license or certification.

R/r 911

[hrising]

Thank you all for responding.

The situation was an event station and the patient was an alert oriented walk-in complaining of dizziness as the result of a fall days earlier. If I had gone beyond what was specifically in the protocol to test, the extra time might have convinced the person that it was worth going to the hospital to get checked instead of waiting until the morning or not going to the doctor (I really felt getting checked out by a doctor should really happen soon). The extra information might also have helped define the problem better, I thought.

It sounds like what everyone is saying is that I should pay utmost attention to not wasting time getting the person to treatment, but that beyond that, if I don't give advice I'm unqualified to give, I can collect whatever non-invasive assessment information I feel I need, given the situation.

[Rescue0ne]

To the best of my knowledge, there is no scope of practice involved with a patient assessment.

Agreed.

EDIT: Didn't see Rid's response til after I posted this.

Again, my suggestion is to keep it practical and use good common sense that it is applicable to that situation, not causing delay and attempting to go past your level of license or certification.

END EDIT

In accordance with your level of certification/licensure.

EXAMPLE: if you're an EMT-Basic...and you want to check a patients blood sugar levels...I don't recommend pricking the patient & using a glucometer, unless you're cleared to do so by your OMD & department. Even though it IS diagnostic...it would be out of your scope of practice unless you're cleared for it. Same thing with 12-lead. Unless you're trained & cleared for it...doing so may see you with a reprimand by the end of shift.

I think I interpreted the question correctly. If I didn't, I apologize.

[rayemtjax77]

As an EMT-B working in a Stroke center in North-East Florida, I work as a triage tech and I do neuro assessments on patients all the time. I am the only one that is allowed to do so due to my training as an EMT.

[spenac]

If in route no problem asking more questions. During long transports to our nearest hospital many times I have plenty of time to ask lots of extra questions. We used to have a person that was legally a doctor enough said. This person would call us to the office with all kinds of wild ideas. In transport just talking with patients, no testing above my level, by the time I got to the hospital I had saved the persons life w/o doing any interventions. I.E. Tropical disease turned out in talking person had been over doing a med, Abdominal aortic aneurysm turned out person had ulcer and had eaten spicy food for breakfast. Just 2 of many, I actually never transported a real patient from that office. I gathered valid info. I passed info to the ER doc and almost immediately miracles occurred, they found out not dying just needed some simple treatment if anything. By talking and getting full story I saved many a person from tests and treatments not needed. In fact usually when I would call hospital with patients from that office I would get asked what was really happening. So the point is ask questions if it doesn't interfere with patient care, just avoid doing treatments you are not educated and protocoled to do.

[AZCEP]

As an EMT-B working in a Stroke center in North-East Florida, I work as a triage tech and I do neuro assessments on patients all the time. I am the only one that is allowed to do so due to my training as an EMT.

There is no one with a higher licensure, or more education at this "Stroke center" than a basic EMT? Your training as an EMT is not sufficient to be able to assess anyone with a reason for going to a "Stroke center". To say you are the only one allowed to assess patients is a bit obtuse.