Hartmanns solution and canulars

[Wayne]

Charliefox.

Interesting view point. I agree with you that most of us are often in locations where response times are less than ideal.

The woods i teach in are a min of 30-40 mins response for an paramedic to arrive. Hence I have sought training beyond FAW and am looking to increase my skills.

I would however still be in a difficult situation if i chose to perform an invasive procedure without your qualifications to back me up. Also without regular practice my chances of success would be much less than yours.

 

[charliefox]

I would however still be in a difficult situation if i chose to perform an invasive procedure without your qualifications to back me up. Also without regular practice my chances of success would be much less than yours.

True. I think it's fair to say that most, if not all, posts on this thread are by sensible people with a love of the outdoors who have a genuine desire to help people, particularly if those people's lives are at risk.

As Martyn's already outlined, it's a legal minefield. I'm blessed at work with "guidelines" not "protocols", the practical implication being that I choose, to a point, where to draw the line. I have to work with words like "consider" or "if deemed appropriate". The ramifications being that if I'm an ultra cautious paramedic who's skills probably aren't where they should be, every job becomes an exercise in covering my backside. Every victim of an RTC get's fully immobilised and blue lighted into A&E, taking up lots of valuable resources - I digress.

If life's at risk and you are doing your best for that person, whithin your training, you should have nothing to worry about. If I decide to step outside my guidelines AND it's clinically defensible AND the patient's outcome is positive - no problem. However, if I've just watched ER and decide that a thoracotomy might be appropriate, good bye job

Bottom line - I can't be prescriptive over what skills and what level of training are appropriate to what environment because I can't see all ends. Get a good FAAW course under your belt, carry some sensible kit and use your head - hopefully we'll not be an hour away

 

[Martyn]

charliefox, just wondering of the legal aspects of administering medications while off duty. I know paramedics practice under the county coroners licence while on duty and it's under his licence that you give medications, but are you covered by the coroner's licence when off duty?

 

[charliefox]

charliefox, just wondering of the legal aspects of administering medications while off duty. I know paramedics practice under the county coroners licence while on duty and it's under his licence that you give medications, but are you covered by the coroner's licence when off duty?

Had a long chat with work about this years ago. Provided I'm within JRCALC guidelines I'm covered, whether we're talking clinical interventions or POMs. The problem comes if I decide to do anything and take payment for it, then it's seperate insurance etc.

Most of the paras I know who are fairly switched on carry kit with them. We leave the cardiac stuff well alone (I've not managed to acquire a 12 lead defib yet ), however the Hartmanns, adren 1:1000 and glucose is usually available.

I only administer if there's a crew on the way, I always inform the local control that I'm on scene and what I've given, then hand over to the crew.

Avoids any embarassment

 

[JohnC]

I'm back from a cubscout weekend, very hot, very tired cubs.
We had to apply sunscreen, give out calpol, plasters galore, anisthane (?sp) cream for someone who rolled through a patch of nettles, nosebleeds and 2 asthma attacks. Everyone had signed sheets to allow immediate first aid and it went very well all things considered.
My job is giving chemotherapy, and I cannulate, give IV fluids, take bloods all week. I'd be caustious about cannulating outside the hospital, because the diagnosis element is missing from my training. As part of that team I have limited diagnosis responsibility, and I'm aware that giving IV fluids can sometimes be as dangerous as IV withholding fluids.
However, when someones collapsed, getting IV access can be very important, and the earlier the better before peripheral circulation shuts down etc.

 

[charliefox]

However, when someones collapsed, getting IV access can be very important, and the earlier the better before peripheral circulation shuts down etc.

A good point well made John. Just because you cannulate doesn't mean you then have to administer anything.

 

[stovie]

..... Under such circumstances, preofessionals with a duty of care are legally obliged to do everything and anything within their "scope of professional practice" . .....

This legal and professional obligation to stop and help, has been written into law by parliament and a professional could face prosecution and loss of licence for ignoring it.

Martyn, are you sure about this. If it is right, then it's new to me. I have always been under the impression that there was NO legal obligation to do anything (we are talking outside of work here, right?) but as you do correctly state, if you were seen to pass by and it was reported to the NMB, then they could take a very dim view on the matter; professional accountability and all that.

 

[Martyn]

Martyn, are you sure about this. If it is right, then it's new to me. I have always been under the impression that there was NO legal obligation to do anything (we are talking outside of work here, right?) but as you do correctly state, if you were seen to pass by and it was reported to the NMB, then they could take a very dim view on the matter; professional accountability and all that.

Certain mate.

Section 8.5 of the NMC code of conduct...

8.5 In an emergency, in or outside the work setting, you have a
professional duty to provide care. The care provided would be judged
against what could reasonably be expected from someone with your
knowledge, skills and abilities when placed in those particular
circumstances.

...In an emergency, in or outside the work setting, you have a professional duty to provide care.

The code of conduct is ratified by parliament and is a legal document.

 

[Wayne]

Martyn is talking about medical professionals as opposed to First Aiders.

I had a friend who owned an ambulance bought off ebay. he used to love driving it around until i informed him he was legally obliged to stop at a RTC. He was planning to convert it to a camper. He isn't a nutter in case he reads this.

 

[stovie]

Certain mate.

Section 8.5 of the NMC code of conduct...



...In an emergency, in or outside the work setting, you have a professional duty to provide care.

The code of conduct is ratified by parliament and is a legal document.

Yes. But that doesn't mean you can be prosecuted for not intervening. You may lose your job/licence to practice because of your code of conduct, but legally there is no obligation. Or am I misinterpreting it???

 

[Martyn]

Yes. But that doesn't mean you can be prosecuted for not intervening. You may lose your job/licence to practice because of your code of conduct, but legally there is no obligation. Or am I misinterpreting it???

Yes mate. Your duty of care set out in the NMC code of conduct, is a legal requirement as well as a professional one. You can be prosecuted for neglecting it as well as suffer professional disciplinary action.

 

[Wayne]

Yes. But that doesn't mean you can be prosecuted for not intervening. You may lose your job/licence to practice because of your code of conduct, but legally there is no obligation. Or am I misinterpreting it???

I see your point. I am unsure. I always interpreted it to mean liable to prosecution.

I will endeavour to find out.

 

[charliefox]

I see your point. I am unsure. I always interpreted it to mean liable to prosecution.

I will endeavour to find out.

I'm afraid I'm with you on this one Wayne. I spoke to a QC regarding this only a few weeks ago. I asked him where I stood as a paramedic. As he pointed out, I can't be compelled to do something higher than the law of the land, which places no duty of care on me.

I would respectfully suggest that if all health professionals were expected to attend everything that they came across, we'd all be armed to the teeth with defibs and response bags. The simple fact is I'm not obliged to respond legally or as part of my professional registration. The fact that I do is a moral undertaking on my part.

 

[Martyn]

I'm afraid I'm with you on this one Wayne. I spoke to a QC regarding this only a few weeks ago. I asked him where I stood as a paramedic. As he pointed out, I can't be compelled to do something higher than the law of the land, which places no duty of care on me.

But if your profession places a duty of care on you, you can be prosecuted for neglegting that.

I would respectfully suggest that if all health professionals were expected to attend everything that they came across, we'd all be armed to the teeth with defibs and response bags. The simple fact is I'm not obliged to respond legally or as part of my professional registration. The fact that I do is a moral undertaking on my part.

Well nurses and doctors do have a professional duty of care at all times of the day and night, which is quite clearly set out in the guidelines quoted above (for nurses). Though the important phrase "The care provided would be judged against what could reasonably be expected from someone with your knowledge, skills and abilities when placed in those particular circumstances." is key. If a nurse worked in a nursing home, she would not be expected to deliver care beyond her scope of normal practice.

 

[Martyn]

Had a long chat with work about this years ago. Provided I'm within JRCALC guidelines I'm covered, whether we're talking clinical interventions or POMs.

I think you are on very thin ice with this. You are not a prescriber and you cant prescribe medications outside of your sphere of work. The JRCALC guidelines (which are thin at best), say...

Drugs administered by ambulance staff fall into two categories, non- prescription drugs such as aspirin and those that are controlled under the Medicines Act 1968 and are designated prescription only medicines (POMs). Under normal circumstances, POMs can only be prescribed by a qualified doctor (or dentist), but exemptions exist which allow suitably trained ambulance paramedics to administer these drugs in specified circumstances.

I'm not sure those specified circumstances extend to off-duty. I would think not. Can you provide some clarity or cite some legal document or context which says it's appropriate for you to do this?

 

[stovie]

We are talking "off duty" here, and 'legally' there is no obligation for me to become involved. Morally is a different story...as is professional accountability.

Nowhere is it written that i 'have' to get involved outside of work as a legal obligation.

 

[Martyn]

We are talking "off duty" here, and 'legally' there is no obligation for me to become involved. Morally is a different story...as is professional accountability.

Nowhere is it written that i 'have' to get involved outside of work as a legal obligation.

I'll give the NMC a ring and check.

You are legally obliged to follow the code of conduct, I'm sure. But I will check.

 

[stovie]

I'll give the NMC a ring and check.

You are legally obliged to follow the code of conduct, I'm sure. But I will check.

You cannot be prosecuted for not following the code of conduct. You could be sued by a third party for causing harm as a result of neglecting the code of conduct, and lose your job as a result of neglecting your code of conduct by being hauled infront of the NMC, but to drive passed an RTA in which someone was obviously in need of help, though morally and professionally abhorant, is not in itself a crime, regardless of your occupation....

...though you may prove me wrong. In which case we had better tell the European Resusitation council, as I have been misinforming people for several years when teaching ALS

 

[Martyn]

We are talking "off duty" here, and 'legally' there is no obligation for me to become involved. Morally is a different story...as is professional accountability.

Nowhere is it written that i 'have' to get involved outside of work as a legal obligation.

My apologies, I stand corrected.

I couldnt get through the the NMC, so phoned the RCN and asked. They told me thier is no legal obligation to follow the code of conduct.


I should spend less time looking at knife law and more time looking at professional law.

 

[Martyn]

You cannot be prosecuted for not following the code of conduct. You could be sued by a third party for causing harm as a result of neglecting the code of conduct, and lose your job as a result of neglecting your code of conduct by being hauled infront of the NMC, but to drive passed an RTA in which someone was obviously in need of help, though morally and professionally abhorant, is not in itself a crime, regardless of your occupation....

...though you may prove me wrong. In which case we had better tell the European Resusitation council, as I have been misinforming people for several years when teaching ALS

Yes, apparently, you are quite right.