Lifeguard interfering with MY PT CARE!?!

[geezlaweezy]

I've encountered situations when I was lifeguarding and tending to a situation when a doctor or someone with more quals than I arrived on the scene. In those cases it can be very sticky because the situation is under my 'jurisdiction' and it's my duty to perform to the best of my ability for the pt. While on the job, we are legally responsible for those people, and if we let people who are off duty medics or doctors over rule us and things take a turn for the worse, it can end up being our butts on the line... union, management, company, etc get on our case. It could be a case of policy (usually is) and since upper management doesn't really understand what really goes on, the legal crap will hit us in the face after the fact.

In your case, sounds like your friend was a bit panicky and probably wasn't able to think properly... there are LOADS of lifeguards who just can't handle REAL situations (but can perform well on simulations) which is unfortunate. In terms of off duty medic/nurse/doc arrival, I get to choose whether I want their help or not because again, my ass is on the line too. Usually I accept the help, and as long as after the fact they're willing to sign off that the pt is ok or I document their ID#, and get their contact info, it's smooth sailing.

[ERDoc]

The important thing is that the person who identifies themself as a medic/EMT/MD/RN/etc be able to provide proof. You would be justified in turning someone away if they were unable to produce ID. We used to have a guy who would run around in one of those generic EMS jackets you can get from Galls and tell everyone he was an EMT. Happened one too many times and he got himself in over his head with a sick pt. Ended up getting a pair of shiny silver bracelettes courtesy of county PD.

[whit72]

ERdoc wrote:

Whit's comment about not identifying yourself, this too could lead to legal problems should someone recognize you and things go bad, not to mention that ethically you should not be lying to your patients.

Why should he identify himself as an EMT? Should you identify yourself as a doctor? He doesn't have an ambulance, and you don't have an ER. I just cant see how you can be held responsible whether EMT, MEDIC, RN, MD if you don't have the tools to do your job.

When we are sitting around at shift change and two calls come in and both trucks go out. If another call comes in we have to call for mutual aid we don't go out in our personal vehicles because we don't have the proper equipment to do are jobs effectively.

I believe its a lose lose situation, I myself have been torn between acting and not acting. I mean where do you draw the line should you act absolutely. Do we most of the time? No. I don't believe you should be held to your standard of being a EMT or MEDIC when you do not have equipment needed to do your job effectively. So how can you be judged as an EMT or MEDIC in a court of law? I never understood that.

[JCicco345]

To jail with her, and have her brought up on charges.... DONE......

OK, FINE... She was negligent...and he's a wacker..BOTH PROCEED DIRECTLY TO JAIL..DO NOT PASS GO..DO NOT COLLECT $200..... 8) :shock:

ACE

So that would make you what ??? Ignorant Right ?

[ncmedic309]

This one can be debated all day long and from a ton of different angles. I understand that in some states you have a duty to act as soon as you identify an incident, regardless if your on or off duty. In the long run, I think there is a major exception to all these incidents regardless of your state laws, if you don't have the proper equipment to provide care, then you can't be held to providing care. Just an example, you are driving in your POV and come across an accident, you don't have any equipment on you, what's next? I have to act even though I don't have the proper equipment? I'm supposed to ignore the core principles of scene safety and put my bare hands on a patient and expose myself to blood and other bodily fluids? What do I do with the unresponsive patient w/ copious amounts of blood in the airway, I have no gloves, no suction, no BVM or airway adjuncts, or anything that's going to help me care for this person. Why should I have to put myself in that situation, just because I have the training? What about safety? Maybe I didn't feel safe on the side of the highway with no warning devices or vehicles blocking oncoming traffic from running me and the patient down, am I still supposed to stop and act, just because I have training? I can't see how any of these incidents would hold up in a court of law, if you don't have the proper equipment to render aid, then you shouldn't be held to doing so, when technically, there is no duty to act. I apologize for getting off topic, as I'm sure this has been discussed 1,000 times in 100 different topics on this forum alone. Did I get my point across?

[vs-eh?]

What exactly is the debate here?

If you are NOT working, you only provide BLS care as can be deemed reasonable by the situation at hand. If you come across a scene first, you use your education and wicked BLS skills to help his person.

If you are not first on scene and NOT working you can identify yourself if you want and offer help within a basic ABC/first aid BLS scope of practice. If the people who ARE working say "No thanks." You leave.

The vast vast majority of cases will NOT allow you to do anything more than that, and even this basic "helping" is at the discretion of those working.

You CANNOT do anything more.

An off-duty Paramedic witnesses an arrest. Does his amazing pre-cordial thump (because he is amazing) and starts CPR. 911 is activated. He gets a history for the BLS crew who arrives 3 mins later. This BLS crew does not know this person who identifies themselves as a paramedic. But seeing his skills allows him to assist. The crew does there thing and gets on to transport. The crew is in a generic vehicle that has a stock of ACLS supplies. It's not like this off-duty paramedic can intubate or start an IV or something. And if at the start the crew says "We don't need any help thanks", after arriving...YOU MUST LEAVE.

Too many scenarios for impersonation, malpractice, errors, etc...I don't know of ANYONE who would do anything more for any patient other than very very basic assistance if requested while off duty. If you see a person "pulling rank" with you off duty, I would be even more inclined not to believe them.

[Nate]

I have been in this situation, and I usually thank the person kindly and let them know they are no longer needed. The only person in Texas who can remain in control of a patient once I'm there as a paramedic is a doctor (and he must show proof). Truth is, there are very few doctors who are going to assume treatment of a patient and risk their butts outside of their clinics, office, hospital, or ER.

I think the author of the first post was 100% wrong. Just because you have a badge or t-shirt doesn't mean you are entitled to anything. I don't care if you were an EMT, there isn't anything more you could do for that patient off duty then what a decent lifeguard can do. I worked as a lifeguard back in high school and wouldn't you imagine it, but basic lifeguard skills and the EMT-Basic course are very similar. Both are thaught basic first aid, CPR, rescue breathing, how to use an AED, c-spine, splinting, oxygen, etc. The only thing a lifeguard can't do is give Nitro, ASA, breathing treatments, and help a patient with an Epi pen.

So tell me how you being an EMT or a Firefighter is going to make any difference?

[fiznat]

I worked as a lifeguard back in high school and wouldn't you imagine it, but basic lifeguard skills and the EMT-Basic course are very similar. Both are thaught basic first aid, CPR, rescue breathing, how to use an AED, c-spine, splinting, oxygen, etc. The only thing a lifeguard can't do is give Nitro, ASA, breathing treatments, and help a patient with an Epi pen.

So tell me how you being an EMT or a Firefighter is going to make any difference?

Correct me if I'm wrong here as I was never a lifeguard, but while the technical skills are similar between the two classifications, I beleive that the EMT level gets a little farther into A+P and the pathophysiology of disease. This comes along with the ability to take vital signs and understand (at least on a basic level) their meaning. The difference may seem small, but I think it would come a little more in handy given the seemingly medical nature of the "call" in this case.

As many others said, the laws controlling this kind of scenario do vary from state to state. Working on an ambulance here in CT, we certanly have the right to turn away bystander care- even if it is at a higher level. That said, given this kind of situation it seemed prudent that the lifeguard should try to take advantage of the EMT on scene for the well-bieng of the patient. To deny this, though, was the lifeguard's right and choice.

[Richard B the EMT]

1) Once again, we seem to have run into the "Legal Duty to Act"/"Moral Duty to Act" situation. This will be addressed under local protocols, and if no legal duty to act exists under those protocols, it is up to the morals, or lack of the same, of the individual as to doing anything.

2) Just wearing a T-shirt with the local department logo on it doesn't qualify an individual as an actual, trained, off duty member of that department. If the wearing of an FDNY or NYPD logo hat or T-shirt was an indication, fully a quarter of the #2 Train passengers are members of these departments. We know otherwise. If you come on an individual who seems to be affecting some kind of rescue and wearing logo-ware, under local protocols here in NYC/NYS, they are required, BY LAW, to produce Identification on request. If they refuse, or are unable to produce any ID, when the uniformed on duty LEOs get there, they can be enlisted to remove said individual from the scene.

3) If the "on duty uniformed" person, in this case, the lifeguard/"friend" ordered you away from a patient, apparently not recognizing you, perhaps this individual was so hyped up with the call, that they didn't realize it was you. I can not say for certain, I was not on the scene. If you can, approach that individual, when both of you are off duty and removed by both time and distance from the scene of the call, and ask what happened that the person ordered you away, when per what I think I'm reading here, you are higher medical authority, and, judging by MY protocols here in NYC/NYS, could have run the scene.

4) Check with local protocols, also, on the possibility that by following the lower trained person's order for you to leave, if you might be in violation of "Patient Abandonment" policies and protocols. Of course, this would be done on a quiet, low level, as you don't want trouble for yourself.

[FireGuard69]

WOW....thats a lot of replies...

1) I WAS worried about the Legal Issues, as I was trained in NJ, and was told you legally HAVE to act upon an emergency

2) I KNOW she is a spaz, and does not operate well under pressure.

3) Her partner, knew I was a Firefighter, and asked me to assist the pt, so my assistance was requested.

4) My "Friend" has been to my firehouse, and we have swapped lifeguarding stories, from when I was a Lifeguard/EMT, so there is no question that she knows, and she said to me, "you are not a f*cking Firefighter, go away"

5) I only showed ID/Shirt after she made a big stink on the radio to her supervisor, and when the family looked concerned. I was in a pair of boardshorts at the time. I am NOT a wacker/ricky rescue, or whatever you wanna think.It was a girl in her teens who was suffering form heat exaustion from what I could gather from my 5 second pt. assessment

6) For a kicker, she left before Fire/EMS got on scene.......abandonment anyone??? :roll: