Today we revisit the question of practice what you know or practice what the organisation you’re working for says.  In context let me be clear I’m talking about treatment that is required to save a patient’s life or to save them from permanent disability.  Not treatment that might be convenient or ideal but is not time critical.

Today’s correspondent is a paramedic who sees that

There is a varying scope of practice currently between the different sectors of Paramedicine in Australia. After recent legal cases involving the deaths of patients at festivals, it would be good to get some clarification on where paramedics stand in regards of whether they practice to their trained scope or whether they provide the standard of care that the private company scope allows even in situation where the required equipment is available. The answer to this question may be a little obvious though in the eyes of the law and recent AHPRA registration I’d like your take on where paramedics stand legally.

Let’s give this some context.  Let us assume that my correspondent is trained in, and competent to perform, intubation and does so as part of his or her duties when working with the jurisdictional ambulance service.  Today he or she is working for a private provider at an event and intubation is not within the scope of practice defined by that private provider, but, for whatever reason, an intubation kit is available.  A patient comes in with a compromised airway, intubation is indicated and will improve their chance of survival.  What do you do?

If you don’t intubate the patient dies but you can say you ‘stuck to the company’s procedures’.   Remember the story of the death of Allison Hume ([2011] FAI 51; see Legal confusion leads to unnecessary death (December 8, 2011)):

[The Incident Controller] in particular, considered that the rescue operation was “a success”. In his view he had adhered to the policies and procedures set out by Strathclyde Fire and Rescue Service. He had obtempered to the letter the instruction contained within the Memoranda from Strathclyde Fire and Rescue Service of the 14 and 27 March 2008. There had been no casualties other than the one to whom the Service was called upon to rescue.

Unfortunately this was not a successful operation: a woman died who had … survivable though life threatening injuries…

You can ‘obtemper’ (‘obey, comply with’) the company’s ‘scope of practice’ but no-one is going to think that the outcome was a success if the patient dies when they could have been saved.

If you’re afraid of liability who’s going to sue?  The family of the patient who life you save? Or the family of the patient you let die even though you had the skills, knowledge and equipment but you wanted to make sure you in no way ventured outside the protection of vicarious liability.

As for professional standards, it is ‘unprofessional conduct’ to engage in ‘conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers…’ (Health Practitioner Regulation National Law s 5).  How would peers see conduct by a paramedic who is at work, caring for a patient, who has the skills and equipment necessary to save a life and fails to do so?

If you can save the patient’s life, do so.  If you’re afraid to do so for fear or repercussions from your employer or because you’re afraid you may step out of the shield of vicarious liability it’s time to stop and rethink whether you believe you are competent and to ask why are you working for this company?  If you aren’t willing to back yourself, then maybe it’s time for a new profession.


Don’t let the patient die if you can avoid it.

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