EMS Protocols

[arajca]

In general, all the Good Sam statutes do is give you some cover from incidental damages PROVIDED you were not negligent in your care, i.e. you gave someone CPR and broke their ribs.

They also do not provide cover from other actions. There are cases where EMTs rendered aid outside their system, were commended for it, then had their certifications pulled becuase they were practicing outside their system. the Good Sam laws didn't apply because the EMT violated the statutes regarding praticing in a system. They did not have a legal duty to act, so they are no longer EMTs.

[Krapenhoeffer]

And they can get sued for breaking out ALS protocols outside of their home counties.

However, WI has the broadest scopes of practice for all levels. And I get my idea from an EMT-IVT I know, who is a volunteer EMT in Iowa Co., but works at a school in Dane Co. After some legal wizardry and help from the Madison Fire Dept., he was able to get protocols for the school that allowed him to use his ALS protocols that IVTs are allowed in Dane Co. I think that everyone can agree that a school is not an EMS agency, but clearly they can have their own protocols.

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care. And so, the Paramedics made it very forcefully clear that they want us to have our jump packs with us at all times. So I just modified mine to accept ALICE clips, and it goes with me on missions. I don't carry an AED or O2, because those things are either a) expensive or b) heavy or some combination of the two. They live on the ambulance. When I'm on a CAP mission, or if I'm driving or anything, my first priority is to get the patient to an ambulance. Now, if the ambulance gets there, and they're undermanned, I'll go on, and then I'm on the state's dime.

[Eclipse]

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care.

Do you seriously believe that?

[a2capt]

Probably, if what you do falls within the vail of the good samaritan laws.

[darn]ed if you do, [darn]ed if you don't some ambulance chaser will figure out you knew how to do more and didn't, in their opinion... and sue you for that too. The whole thing just sucks.

[PA Guy]

The Good Sam laws do not prevent you from getting sued. They provide you with a defense of your actions. You will still be out the time and money going to court to prove that your actions fell within the scope of the Good Sam law. 

[sarmed1]

I wouldnt count on good sam laws to protect your butt.  I personally think it would be difficult to prove in a civil court that CAP time is covered under the good samaritan laws.  The belief or reasonable expectation; I have a badge that identifies me as _________ (EMT, Paramedic, Nurse, Doctor)  & CAP has provided me with an "official" duty status as the same.  Medical care is expected (and identified as a skill..ie First Aid) for members engaged in search and rescue.  (Just because CAP says that WE dont provide "paramedic care" doesnt mean that's the industry satandard, which I imagine is what the "public expectation" is based off of.... ie FEMA resource typing document, NFPA 1670, NASAR etc) That sounds dangerously close to a duty to act, so if something goes wrong in your emergency stabilization and care up to your level of training ( ie the expectations of someone of the same level of certification) and injury results I am guessing there is a good potential for a negligence suit. (especialy if someone finds one of those sue happy TV injury lawyers)

mk

[Eclipse]

^ Yep...

...and...

The final verdict from a civil perspective would be determined by a jury, one likely not to draw the line as close as someone doing mental
yoga to internally justify an action which is clearly against the published regs in both spirit and function.

The mere fact that you are disavowed by the very agency you are working "for" will probably get you half way to cooked.

[SARDOC]

And we had it hammered into our brains from Day 1 that an EMT can only be sued if they are on the state's dime. When I'm off duty (CAP missions are considered off duty, I checked), I can't be sued for providing care.

Do you seriously believe that?

I know in Virginia Malpractice three things must be proved for Malpractice.

1) The Provider Must have the "Duty to Respond" (on duty for Volunteers and Being paid a wage for Career members)
2) The Action Taken by the Provider Was GROSSLY Negligent. (Another Similarly trained Provider finds completely unreasonable)
3) The Action Taken by the Provider actually was the Direct Cause for Substantial Harm to the Patient.

If I am Off Duty I am covered by the Good Samaritan Act which has an exemption specifically for Off Duty EMS providers to provide care.  If I'm off duty I can't be sued for malpractice...it's in the code.  That being said I can still be sanctioned by my agency or the Board of EMS rules and regulatory committee.

[PA Guy]

Good Sam laws vary from state to state as well as EMS rules and regulations.

[ol'fido]

Way back in the late '80's, it was required for a GTL to be Advanced First Aid qualified. This meant generally through ARC. At the time, I was going to school at SIUC and the health ed department was offering Basic FA and Advanced FA courses for credit. The course not only qualified you but also gave you instructor certification which was handy in training the other members of the GT. However, as I understand it the Adv. FA course went away and was not really replaced with anything else. Also, CAP regs have never really caught up with this change either.

At SARCOMP '88 in Alpena, MI, I got the high score on the FA written test even though other teams had EMTs and Paramedics on them. This is because the USAF Flight Surgeon that put together and graded the test had done it from a Basic FA perspective. The EMTs and paramedics went through their protocols instead of giving the ABC type answers that the test called for.

Our GT philosophy was the FA training was mainly for internal team use. A team member gets hurt or has a sudden illness/environmental injury, we could take care of it. We felt that more than likely our team would be used to lead or guide in regular EMS units, not provide it ourselves. Also, there was the consideration of exposing team members to BBPs.  While I do not think that we would ever do anything that was not covered by the Good Sam law, I wouldn't want to try it either.

This is one of the many elephants in the living room that NHQ refuses to deal with.

[Ned]

This is one of the many elephants in the living room that NHQ refuses to deal with.

I'm sorry, but are you referring to here?

Our regulations are pretty unambiguous when it comes to medical care provided by CAP members to other members or the public.  We don't do it in anything other than a genuine bona-fide emergency.

And then we do it withing the limits of our skills, abilities, and resources.

I'm not sure what the 52 different Good Samaritan Laws that CAP operates under has to do with the subject at hand.

[ol'fido]

Referring to the FA requirement for GT. The ARC dropped the Advanced FA course long ago but CAP apparently didn't realize this for some time. I don't expect perfection from NHQ but at least can we agree that there are many areas where the regs and manuals have not kept up with developments? This is especially confusing since we went to the online regs and manuals which was supposed to better facilitate this. This may not be your experience in working with HQ but from my perspective out in the field it is. Perception is reality.

[Eclipse]

What is confusing here?  CAP only requires basic First Aid.  Defined by our wing as the "Community Level".

[ol'fido]

Read what I said. What is confusing is that regs have not kept up with other developments even though the online paperless regs were supposed to be more easily edited and changed. We go on about it constantly with 39-1.

[commando1]

Disagree with me if you wish, but the way I view a bona fide emergency that requires medical attention is that unless they are going to die right in front of me I don't need to mess with it. Granted, I am not an EMT but I am working on my First Responder cert. If they are in the plane, don't touch them. If they are alive, talk to them. If the plane is on fire, then and only then, remove them. I am one of those guys who is completely obsessed with SAR. But if CAP prohibits me from doing something there is probably a reason. Not that I agree with all the reg's, but I try to respect them. If CAP reg's prohibit me from giving someone basic care and they will likely die as a result then I will tear off my CAP nametape and continue. I don't suggest that a 15 year old with basic first aid attempt to splint someones leg. But if they go into cardiac arrest right there I do suggest he begin CPR.

[IceNine]

Layman and professionals alike are trained to do everything we (CAP) should be doing.


 
CALL 911




Then while you're waiting....  ABC's

Body Substance Isolation- If it's not yours and it's wet, don't touch it (without gloves)
Scene Safety- Am I safe here now? Soon?  Is my crew safe here now?  Soon?  Is the victim safe here now? Soon?
# of pt's/victims - How many ambulances do we need?

Airway - If they cannot talk to you head tilt/chin lift OR modified jaw thrust.  EMS 101 while you're there ask politely that they not move their head, put your hands on either side of their head to remind them.

Breathing - Are they breathing? Check respirations for no more than 15 seconds, if nothing perform CPR

Circulation - Do they have a pulse?  If not perform CPR.  Are they bleeding LOTS?  If so, put pressure on it with a clean dressing, t-shirt, towel, etc.

If they were ok when you got there, start over and check ABC, ABC, .......  Until help get's there.


We will all choose to do those things differently depending on training.  We shouldn't be using anything we can't get at walmart to heal people.  The singular exception I can think of is if a BVM is available I will use that every time for CPR.  But you also don't have to be licensed to take CPR/PR.

[Eclipse]

CALL 911

http://www.youtube.com/watch?v=YkyhvCdJ_vM