When to use your EMT training?

[Rafa]

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A hypothetical situation:

You're walking through the mall/Walmart/some public place, and someone collapses/starts showing signs of extreme physical distress. A crowd starts to gather (bystander syndrome). People call 911, etc. You're an EMT. Do you get involved? Are there legal ramifications of doing so?

 

[DropkickMurphy]

You're not legally obligated to do anything (in most states), but I would hope that you would feel some moral obligation to render assistance. This is of course assuming that you became an EMT for some purpose other than a paltry attempt to make yourself look "better" on your med school app.

And yes, there could be legal ramifications to helping out, but if they concern you so much as to prevent you from doing what you are trained to do, then perhaps medicine isn't the career for you.

 

[Doctor~Detroit]

i think many states have "good samaritan" laws that protect bystander intervention as long as you had good intentions (and acted within your training boundaries).

 

[Flopotomist]

i think many states have "good samaritan" laws that protect bystander intervention as long as you had good intentions (and acted within your training boundaries).

Good samaritan laws generally do not protect professionally trained health care workers (such as EMTs). However, if you provide a standard of care that a person with similar training would provide, you are generally safe. You are NOT legally obligated to do ANYTHING, although morally, I would hope that you would do something.

I have been an EMT for nearly 10 years, worked full time as an EMT for 3 years (didn't know I wanted to go to medical school, just wanted a fun job), been involved in probably 10 or so off-duty situations similar to the one you describe (I am a walking black cloud apparently) and never had any legal problems. Although several of those people died, I ALWAYS received thanks from the family for at least trying.

 

[BuckerPark]

Good Sam laws only help the Joe Schmo who decided to stop and help. People with medical training are expected to perform up to their level of expertise and within their scope of practice. They aren't covered by these laws.

i think many states have "good samaritan" laws that protect bystander intervention as long as you had good intentions (and acted within your training boundaries).

 

[Flopotomist]

Good Sam laws only help the Joe Schmo who decided to stop and help. People with medical training are expected to perform up to their level of expertise and within their scope of practice. They aren't covered by these laws.

I believe the general standard is did you act the same way that a person with a similar level of training would have acted in the same situation. For example, it would be UNreasonable for you to perform a crich with a steak knife, as another EMT would not perform this out-of-scope procedure in a given situation, but it WOULD be reasonable for you to perform CPR. It would be reasonable for you to refrain from performing mouth-to-mouth on a patient with Hep B if you had no barrier protections as another EMT in the same situation would have reasonably acted the same.

Generally, in most settings as an off-duty EMT, your potential actions are fairly limited, and include:

1. Crowd control and scene safety. For example if there is a suspected chemical exposure, it would be reasonable for you to evacuate the area.

2. Activation of EMS. It would be reasonable to call 911, or instruct a bystander to do so.

3. C-spine protection. It would be reasonable to stabilize a trauma patient in some form of C-spine protection while awaiting EMS to arrive with formal C-spine protections. It would NOT be reasonable to attempt to clear C-spine that some other EMT had already intiated while off duty unless you plan on accepting the responsibility for the care of the patient all the way to the hospital AND your protocols allow for pre-hospital c-spine clearance.

4. Airway protection. For example if a patient is seizing, it is reasonable to move the person to the ground and keep them on their side to prevent aspiration of any vomit or blood. It would NOT be reasonable to attempt to intubate the patient with an old piece of garden hose you found in the back of your truck.

5. Breathing. For example, it would be reasonable to ventilate a patient with a barrier device if the patient was not breathing. It would NOT be reasonable to pull a MacGyver and put in a chest tube in the middle of the mall.

6. Circulation. If would be reasonable to initiate CPR on a patient with no pulse. It would also be reasonable to follow standard procedures for stopping any active bleeding. It would NOT be reasonable to crack a chest as an EMT in the middle of Denny's

7. It would also be reasonable to assist a patient with the self-administration of appropriately prescribed medications (eg nitro that is for the patient, is not expired). It would NOT be reasonable to shout out "does anybody have any nitro?" and then hand the patient this medication.

8. It would be reasonable to provide basic first aid, such as bandaging a wound, or burn. It would NOT be reasonable to debride burned tissue in the middle of the mall.

There really is not a heck of a lot you can do without equipment, so unless you act recklessly and out of your scope - you are not going to get sued.

 

[Zoom-Zoom]

I concur. I also agree that you have a moral obligation to help the person out. You might get "sued"..ie: have to go to court to clear stuff up... but even in this day and age it would be very difficult to get convicted or penalized for something you do, as Flop said, within your scope of practice.

In some states EMTs are required by law to help (at least this used to be true)...there's even an EMT sticker you have to put on your license plate somewhere...not sure which state.

 

[DropkickMurphy]

Minnesota and Vermont are the only two states I am aware of that mandate EMS providers render assistance while off duty. As for practicing up to your scope of practice, in many states you are only allowed to provide BLS level care while off duty because you are not practicing under your medical director's license while not actively representing your agency. The standard of providing the same quality of care as others given your level of knowledge still applies however.

 

[DropkickMurphy]

I believe the general standard is did you act the same way that a person with a similar level of training would have acted in the same situation. For example, it would be UNreasonable for you to perform a crich with a steak knife, as another EMT would not perform this out-of-scope procedure in a given situation, but it WOULD be reasonable for you to perform CPR. It would be reasonable for you to refrain from performing mouth-to-mouth on a patient with Hep B if you had no barrier protections as another EMT in the same situation would have reasonably acted the same.

Generally, in most settings as an off-duty EMT, your potential actions are fairly limited, and include:

1. Crowd control and scene safety. For example if there is a suspected chemical exposure, it would be reasonable for you to evacuate the area.

2. Activation of EMS. It would be reasonable to call 911, or instruct a bystander to do so.

3. C-spine protection. It would be reasonable to stabilize a trauma patient in some form of C-spine protection while awaiting EMS to arrive with formal C-spine protections. It would NOT be reasonable to attempt to clear C-spine that some other EMT had already intiated while off duty unless you plan on accepting the responsibility for the care of the patient all the way to the hospital AND your protocols allow for pre-hospital c-spine clearance.

4. Airway protection. For example if a patient is seizing, it is reasonable to move the person to the ground and keep them on their side to prevent aspiration of any vomit or blood. It would NOT be reasonable to attempt to intubate the patient with an old piece of garden hose you found in the back of your truck.

5. Breathing. For example, it would be reasonable to ventilate a patient with a barrier device if the patient was not breathing. It would NOT be reasonable to pull a MacGyver and put in a chest tube in the middle of the mall.

6. Circulation. If would be reasonable to initiate CPR on a patient with no pulse. It would also be reasonable to follow standard procedures for stopping any active bleeding. It would NOT be reasonable to crack a chest as an EMT in the middle of Denny's

7. It would also be reasonable to assist a patient with the self-administration of appropriately prescribed medications (eg nitro that is for the patient, is not expired). It would NOT be reasonable to shout out "does anybody have any nitro?" and then hand the patient this medication.

8. It would be reasonable to provide basic first aid, such as bandaging a wound, or burn. It would NOT be reasonable to debride burned tissue in the middle of the mall.

There really is not a heck of a lot you can do without equipment, so unless you act recklessly and out of your scope - you are not going to get sued.

Floppy, this is one of the reasons I hope I wind up working with you someday. You're not only correct, you also have a wonderfully biting sense of humor.

 

[sponge]

I'm a former EMT; I let my license expire last year since I knew I working in any service. So if I see an emergency situation, and I still remember my training (which I do), what laws would apply to me?

 

[OSUdoc08]

A hypothetical situation:

You're walking through the mall/Walmart/some public place, and someone collapses/starts showing signs of extreme physical distress. A crowd starts to gather (bystander syndrome). People call 911, etc. You're an EMT. Do you get involved? Are there legal ramifications of doing so?

In some locations you are LEGALLY REQUIRED to render aid. This is true in Texas.

In addition, it is often true that you are covered by your medical director's license and malpractice insurance if you are in the county or coverage area of the EMS service for which you work.

Check your service protocols and local state laws for details. You are covered under Good Samaritan laws if you remain within your level of training.

 

[DropkickMurphy]

I'm a former EMT; I let my license expire last year since I knew I working in any service. So if I see an emergency situation, and I still remember my training (which I do), what laws would apply to me?

In the eyes of the law, you'd be a lay person probably. You would have to ask a lawyer to be certain.

 

[Wackie]

I know what I'm trained to do and what I'm not trained to do. If you stay within what you have been trained to do (certified, not some procedure someone showed you on a whim), then you should be fine. Of course, without equipment, you're some what limited. Under the Good Samaritan law, you're covered as long as you're within your scope of practice given the situation (ex: an off duty paramedic who happens across a scene is not required to intubate a patient because they lack the equipment).


I'm not going to put my mouth all over someone else who isn't breathing without a barrier. Lucky for me (or perhaps them), I'm a wanker and carry a pocket mask (I have a big purse). I really should keep a pair of gloves too. 😀

I'd absolutly love to help out someone. Then I could write my personal statement:
"Call it intuition, or divine intervention, but I looked to my left and saw the exact moment the toddler, dressed as a sailor, swallowed his Hotwheels corvette as if it were a tasty treat. My heart rate increased, readying every muscle in my body. Through my training as an EMT, I knew the toy car was larger than what the toddler could swallow. His distress was immediate. I stood to render aid, wiping my mouth and throwing down my napkin. The steak dinner recently served to me would ruin in the cool air conditioning. However, my thoughts were purely focused on the call to duty. The toddler made one final attempt for air and collapsed. The mother fell to her knees and through sobs cried, 'Is anyone here a premed! Oh please God let someone here be a premed!' I marched forward, braced my feet apart and set my fists on my hips with authority and confidence. As the mother looked up at me through watery eyes, I said to her, 'I'm a premed, ma'am. Please, step aside'.'"
😀

 

[45408]

I'm a former EMT; I let my license expire last year since I knew I working in any service. So if I see an emergency situation, and I still remember my training (which I do), what laws would apply to me?

Yeah, I'm letting mine expire at the end of June, and I'd imagine that you're no longer an EMT, so you're back to "lay person." I don't see why you couldn't intervene with the same actions as an EMT would though.

 

[leviathan]

You're not legally obligated to do anything (in most states), but I would hope that you would feel some moral obligation to render assistance. This is of course assuming that you became an EMT for some purpose other than a paltry attempt to make yourself look "better" on your med school app.

And yes, there could be legal ramifications to helping out, but if they concern you so much as to prevent you from doing what you are trained to do, then perhaps medicine isn't the career for you.

Hahaha, DropkickMurphy, your impression of EMTs is so bitter and jaded....but I loved your reply, because I feel the SAME way as you.

By the way for all those worried about barrier protection: just purchase a small face shield + glove pack that attach onto your keychain. I have one and the gloves have come in handy while off duty on three occasions. The face shield has yet to be used, thankfully.

I don't think anyone here with a moral conscience would feel so great afterwards if they refrained from giving AR on a person that looked a bit shady, and let them lie there apneic and/or in arrest. It's better to be prepared and never have that situation come up, in my humble opinion.

 

[QuikClot]

Key chain as well.

I'm tired of the argument as to whether good sam laws apply to professionals. Say to with me, boys and girls, IT DEPENDS ON THE LOCAL LAWS. Sometimes they do, sometimes they don't. Some places don't have good sam laws in the first place. So if you're travelling, when you see someone hurt or dying, who you might be able to help, here what you do: consult the Yellow Pages, find a lawyer, call the lawyer, get a summary of the local laws as they apply to your particular situation, and consider whether it is worth the terrible risk to go up and do what you have been trained to do. 'Cause I can't be sued; that's my golf shoe money. Geez.

What do you do, on the other hand, if you had a mother who raised you with some values?

* Call 911. The only piece of equipment I always carry, besides a mask, is my cell phone. If you think you feel helpless without kits, try being on the scene of an emergency and not being able to call for back up.

* CPR if dead.

* Reassurance if alive.

* Get a pulse, RR, and history while you wait for the first responders.

* Give a quick report when they arrive and get out of the way.

I realize you can be sued for anything, but really, in that sequence, how much harm can you do?

 

[naru]

i know when i was a emt, good samaritan laws applied when i was off-duty. you still have to dial 911 and get assistance, but were not legally required to give cpr. and even if you did, good samaritan laws applied.

different story if you are on duty.

i worked in california btw.

also, i would imagine that if you were in one of those states where aid was required if you are an emt off-duty, if you still didn't help, you really wouldn't get caught. and even if you did, you can always claim that you didn't have proper protection (ie gloves). i could be wrong.

 

[leviathan]

Listen to QuikClot.

1. Local laws vary.

2. Nevertheless, forget what the laws are and just do what you feel is morally right.
2a. No, it isn't morally right for an EMT-B to try cracking a chest in the food court of a suburban mall or doing anything beyond his scope of training.

3. It is morally right to refrain from doing AR/CPR on a person you don't know if you suspect they may have a communicable disease, BUT you will still feel awful for not helping the patient. Avoid that situation from ever happening by simply buying a keychain faceshield + gloves.

 

[jojocola]

Interesting!!!

Becoming an EMT sounds awesome! How long does it take? How many hours per week of school? Could I be an EMT while taking difficult courses such as orgo and physics?

 

[Captain Fantastic]

Minnesota and Vermont are the only two states I am aware of that mandate EMS providers render assistance while off duty. As for practicing up to your scope of practice, in many states you are only allowed to provide BLS level care while off duty because you are not practicing under your medical director's license while not actively representing your agency. The standard of providing the same quality of care as others given your level of knowledge still applies however.

That's the way it works in Missouri. You have no "duty to act" when you're not on shift. We have Good Sam laws on the books that protect you if you decide to act, but you have to stay within your scope.

If off-duty Medics perform advanced interventions they can be slapped with practicing medicine without a license -- like you say they're not working under a medical director at the time -- so it's best to stick with BLS care. 😉

Put me in the "would respond off duty" category. Last year on Halloween I witnessed a three car accident on I-70. I pulled over and did the Ricky Rescue thing until EMS arrived. It's a whole new ballgame when you're on scene with out an ambulance, a jump kit, and a partner.

 

[45408]

Interesting!!!

Becoming an EMT sounds awesome! How long does it take? How many hours per week of school? Could I be an EMT while taking difficult courses such as orgo and physics?

a semester of 8 hours of class per week.

orgo and physics aren't difficult.

j/k. I took my EMT-B the same time as 17 other credits, including organic and physics.

 

[notdeadyet]

Becoming an EMT sounds awesome! How long does it take? How many hours per week of school? Could I be an EMT while taking difficult courses such as orgo and physics?

You can take an EMT class with a full load. EMT classes take up a lot of time, but it's all taught at a high school level. Just lots of memorization.

Before you do, keep in mind that EMT training is basically advanced first aid. Reading forums like these and whatnot, it's easy to confuse EMT with Paramedic. EMTs do not give drugs (oxygen excepted). It's largely based on what you can do with your hands and some basic equipment to keep the patient alive until you can hit better care.

I was an EMT and am not dissing the field. It's just that I know lots of folks hear EMTs telling war stories and get the impression that the training is some silver bullet that it's not. It's great training for advanced first aid and life support, but don't view it as a prep for med school or whatnot. Lotta fun, though.

 

[FenderHM]

Interesting!!!

Becoming an EMT sounds awesome! How long does it take? How many hours per week of school? Could I be an EMT while taking difficult courses such as orgo and physics?

i did a class at a cc that was 4 hours per week for 2 semesters... totally awesome, took gen chem and other sciences (psych, nutrition) concurrent. once i was certified i volunteered about the same amount of time (4/week)

 

[naru]

i've heard interesting stories from emts and medics who say that once they started to carry some gear around , a lot more medical emergencies start to "happen" around them off-duty.

once they got rid of the gloves, cpr mask, shears, etc, they haven't run across a medical emergency off-duty.

 

[willow18]

i've heard interesting stories from emts and medics who say that once they started to carry some gear around , a lot more medical emergencies start to "happen" around them off-duty.

once they got rid of the gloves, cpr mask, shears, etc, they haven't run across a medical emergency off-duty.

Works differently with me. I always carry gloves in my backpack. I was picknicking in the park the other day and left to another area of the park for a minute. True to form, I came across a bike vs. runner accident with the runner bleeding heavily, both having had LOC. As an EMT, in my case anyway, your first instinct is to help and I could never have just walked by. It was amazing how 20 people standing around couldn't even complete a 911 call. Anyway, I had to talk to the dispatcher, provide C-spine stabilization, stop the bleeding (after sheepishly asking patient #1 if she had AIDS or any STD's. My EMT instructors would kill me for it, but I believed her) and give plenty of psych support to two patients...one of whom didn't understand a word of English! Yea, good times.

 

[DropkickMurphy]

It is morally right to refrain from doing AR/CPR on a person you don't know if you suspect they may have a communicable disease, BUT you will still feel awful for not helping the patient.

Uh, maybe, maybe not. I have this expression that goes: "Me, my girlfriend, my daughter, my partner, anyone else on the scene, then the patient." This is in reference to the ranking in terms of their priority to me. I will do nothing for someone further down the line that is likely to harm (or prevent me from helping) someone closer to the beginning of the list.

 

[DropkickMurphy]

Hahaha, DropkickMurphy, your impression of EMTs is so bitter and jaded....but I loved your reply, because I feel the SAME way as you.

My opinion of EMT's is not bitter and jaded, my opinion of people in general is- especially premeds.

 

[DropkickMurphy]

I'm a wanker and carry a pocket mask (I have a big purse). I really should keep a pair of gloves too.

That makes you a whacker, not a wanker.....slight difference there really....

 

[DropkickMurphy]

I don't think anyone here with a moral conscience would feel so great afterwards if they refrained from giving AR on a person that looked a bit shady, and let them lie there apneic and/or in arrest.

Been there, done that, went home and slept very soundly thank you. As I said, my ass before the patient's.

Repeat after me: "Me, my girlfriend, my daughter, my partner, anyone else on the scene, then the patient." 👍 😀

 

[AmoryBlaine]

Works differently with me. I always carry gloves in my backpack. I was picknicking in the park the other day and left to another area of the park for a minute. True to form, I came across a bike vs. runner accident with the runner bleeding heavily, both having had LOC. As an EMT, in my case anyway, your first instinct is to help and I could never have just walked by. It was amazing how 20 people standing around couldn't even complete a 911 call. Anyway, I had to talk to the dispatcher, provide C-spine stabilization, stop the bleeding (after sheepishly asking patient #1 if she had AIDS or any STD's. My EMT instructors would kill me for it, but I believed her) and give plenty of psych support to two patients...one of whom didn't understand a word of English! Yea, good times.

👍
1. Well done.
2. Congrats on having a pair of gloves in your bag, fantastic idea. I'm not even trained in EMS and I keep a box of latex gloves in my car.
3. Agreed on how a crowd of 20 people can be useless, if you even know CPR I think you should always stop by and make sure SOMETHING is getting done.

 

[willow18]

👍
1. Well done.
2. Congrats on having a pair of gloves in your bag, fantastic idea. I'm not even trained in EMS and I keep a box of latex gloves in my car.
3. Agreed on how a crowd of 20 people can be useless, if you even know CPR I think you should always stop by and make sure SOMETHING is getting done.

I wasn't clear. My point was that just as I departed my backpack and gloves for a moment, I came across the bloody scene gloveless...hence the asking about AIDS of the patient.

It really was funny, I ran over, started treating the patients, and someone thrusts a cell phone in my hands to talk to the dispatcher.

Re the keeping a mask in the car, I don't see the point. The face masks are not really that protective of all communicables. Besides, the Red Cross has revised their guidelines and no longer recommends giving breaths during CPR. You just need to keep the airway open.

 

[jbar]

n't see the point. The face masks are not really that protective of all communicables. Besides, the Red Cross has revised their guidelines and no longer recommends giving breaths during CPR. You just need to keep the airway open.

My understanding is they (AHA) stopped recomending giving breaths when dispatching CPR over the phone, and for some lay rescuers. They did this since they found that so many people we hesitant to do mouth to mouth, and therefore didn't do compressions, that it was better to at least give them compressions. While compressions are still the most important thing to do, my understanding is that if you are a trained rescuer (ie have learned to do rescue breathing, are an EMT, RN etc) you will still do ventilations.

 

[jbar]

Uh, maybe, maybe not. I have this expression that goes: "Me, my girlfriend, my daughter, my partner, anyone else on the scene, then the patient." This is in reference to the ranking in terms of their priority to me. I will do nothing for someone further down the line that is likely to harm (or prevent me from helping) someone closer to the beginning of the list.

I think the answer is if you are the kind of person who will feel bad for not doing CPR, then you should carry gloves and a mask. Problem solved. Especally as an EMT (since in most situations you are the highest trained person on scene which often makes me feel compelled to help, even if I know there isn't much I can do until the ambulance arrives)

 

[jbar]

My understanding is they (AHA)

Revised AHA guidelines for the gunners:

http://circ.ahajournals.org/content...SUSCITATION_AND_EMERGENCY_CARDIOVASCULAR_CARE

bar

 

[NontradICUdoc]

Unless you CLEARLY identify yourself as an EMT, you are under no legal obligation to do anything.

If you are wearing any sort of identification that CLEARLY marks you such as a patch, a uniform, or even your car and you are told then you are obligated to render aid. The minute you yell "I am an EMT" you are legally obligated to render aid until the rig arrives or you are liable for Negligence and abandonment.

 

[Flopotomist]

Unless you CLEARLY identify yourself as an EMT, you are under no legal obligation to do anything.

If you are wearing any sort of identification that CLEARLY marks you such as a patch, a uniform, or even your car and you are told then you are obligated to render aid. The minute you yell "I am an EMT" you are legally obligated to render aid until the rig arrives or you are liable for Negligence and abandonment.

This actually varies by state.

One other point - everybody on here keeps talking about their fear of contracting AIDS, or a fear of assisting a "shady" looking person. Man, some of you guys were REALLY not paying attention in class, a few reminders:

1. You will not contract AIDS by having your intact skin coming into contact with the patients blood or other infectious fluids. Putting on gloves to do CPR is a bit silly.

2. You can not assess somebody's HIV status by seeing if they "look" shady.

3. There are other diseases I would be much more afraid of than HIV (eg TB, Hep B)

 

[Rafa]

2. You can not assess somebody's HIV status by seeing if they "look" shady.

You obviously haven't read the literature! Word on the street is that you can estimate someone's T-cell count by how unnattractive a victim looks.... 😱

 

[jbar]

This actually varies by state.

One other point - everybody on here keeps talking about their fear of contracting AIDS, or a fear of assisting a "shady" looking person. Man, some of you guys were REALLY not paying attention in class, a few reminders:

1. You will not contract AIDS by having your intact skin coming into contact with the patients blood or other infectious fluids. Putting on gloves to do CPR is a bit silly.

I carry gloves with my CPR mask not so much for CPR but so I'll have them for "bleeders." Though with CPR I'd rather be wearing gloves if I need to reach in an remove a forign body from the airway, or for when (not so much if) the patient starts puking fromt the CPR and puke gets everywhere.

 

[willow18]

1. You will not contract AIDS by having your intact skin coming into contact with the patients blood or other infectious fluids. Putting on gloves to do CPR is a bit silly.

3. There are other diseases I would be much more afraid of than HIV (eg TB, Hep B)

Right, so carry around a magnifying glass and before patient contact check for any micro-cuts/scratches that will have you in blood contact.

True about TB, Hep etc.

I also carried around the 'shady' stereotype until I had a nice, middle-aged, white MVA patient with bloody cuts.

Me: So do you have any medical history?
Patient: No
Me: Any diabetes, heart problems, asthma?
Patient: No
Me: Anything else medically related I should know about?
Patient: ummm, I'm HIV positive.
Me: (winking to partner: glove up smartass).

 

[jbar]

we show up on a indiv. in custody, just had been tazed by the cops. He's thrashing around, still fighting with them. As we are getting ready to start a line, the cop says "oh, and by the way, we think he might be code orange." Code orange? What? Like a terror alert? Turns out it means they think he might have something contagious, like HIV or Hep. I think the cops forget we don't use the same codes as they do. I've responded a couple of times for a "code six party who is code five," not really being sure what we are going to.

no glove, no love.