Today’s correspondent is
… currently looking into joining an App called ‘Good Sam’. It’s designed to alert people within a small geographical area to a patient in Cardiac arrest. This allows rapid hands on CPR possibly prior to Ambulance response.
my question today is; What equipment is allowed to be carried by someone in a non-work capacity. Can they carry an AED (Defibrillator), Glucometer for testing sugar levels, advanced airways such as Igels, blood pressure cuffs?
I fully understand that any and all drugs are not allowed.
I am currently employed by an Ambulance service.
I have previously written about the Good Sam app- see Crowd sourcing first aid (August 12, 2014). Given my correspondent is ‘currently employed by an Ambulance service’ I will assume that they are a registered paramedic.
The law does not define the scope of practice of health practitioners. As professionals it is up to health practitioners to only practice within their areas of competence. When a paramedic is at work their employer verifies that they are competent to complete the work that the service defines as their scope of practice. When on their own time it’s up to them to determine their scope of practice.
There is no regulation of the items listed, ie Defibrillators, Glucometers, advanced airways such as Igels (see Use of artificial airway by a sports volunteer (March 14, 2016)) blood pressure monitors etc. Anyone can buy them, and anyone can use them if they know how. The restriction, as my correspondent has noted, is on scheduled drugs. You cannot buy, possess or supply scheduled drugs without an appropriate authority that is unlikely to exist with an off-duty paramedic.
I have previously argued that for the purposes of health professional registration and compulsory insurance, a paramedic who renders first aid should not be considered to be practicing his or her profession if he or she does not then have professional indemnity insurance. I did argue that the more equipment associated with paramedic practice that he or she has, then the more likely it is that they would be considered to be practising their profession (see Michael Eburn, ‘Registered paramedics, insurance and first aid – looking for coherence in law’ (2019) 16 Australasian Journal of Paramedicine https://doi.org/10.33151/ajp.16.663). If one is going to carry airways, glucometers etc one would also want to carry professional indemnity insurance as required by the Paramedic registration standard – not because of a high risk of liability but because that is required by law for registered paramedics.
Carry whatever you want to invest in, other than scheduled drugs, if you believe you are competent and capable of using that equipment when clinically indicated.
Surely the real question here is whether the individual registered paramedic can ever not be what they are (a registered paramedic) working in the course of their employment given that the only way they have been alerted to the incident is by virtue of applying for approval to join the Goodsam app using their work provided credentials, and being approved to join the app by their employer. In some states staff are advised that should they attend an incident as a result of a Goodsam activation they are eligible to be paid a ‘call-out’. On that basis would it be reasonable to operate on the basis that one’s employer has approved membership of the app, that they have taken specific action to review currency, certification and willingness to respond, and that in relation to each incident notified, the individual paramedic is only made aware of the incident by virtue of their employer making them an active member of the system, and therefore they could be considered acting in the course of their duties as reasonably requested by their employer and therefore their employer may be held vicariously liable for their actions. Would it be reasonable to assume that for all intents and purposes the individual practitioner is ‘on-duty’ once these things have occurred.
That’s a different understanding of the app. My understanding was that anyone with a first aid certificate could sign up to be a responder. It’s my understanding that you don’t need to be approved by your employer to sign up. Certainly if employer jurisdictional ambulance services are specifically encouraging staff to sign up and offering to pay them if they respond that could have the implications your suggesting. But it doesn’t change the answer and I think the real question is still – what equipment can I carry? Unless the employer is going to provide an ‘off duty’ kit for its paramedics they’re still going to have to decide whether they want to put together a response kit or not. Liability is really not an issue remember no-one has been sued for doing first aid.
The app will allow you to sign up, however you will not be notified of any incidents unless the administrator for your geographic area has ‘approved’ your credentials and allowed you onto the system – here in Victoria we only allow credentialed, operational members on the system and i understand it is the same elsewhere around Australia. If you just sign up as a ‘general’ member you will not receive any alerts. The guidance for our approved members is to identify yourself as a member of the Ambulance Service despite not necessarily wearing a uniform, that way other bystanders/family members will understand that you are not just a random member of the public turning up at their house in the middle of the night.
Notwithstanding the change and complexity of a new system like this, given that the alternative is for a Statutory Ambulance Service to consciously choose to leave Cardiac Arrest patients on their own in the community for longer than could otherwise be the case, do you think that a clearly articulated fear of prosecution and regulatory action pertaining privacy is fundamentally at odds with our professional obligation to do all that we can to assist these patients.
Sorry, what do you mean by ‘a clearly articulated fear of prosecution and regulatory action pertaining privacy’?
I note that AV is now inviting anyone with first aid qualifications to join up to GoodSam – see https://www.ambulance.vic.gov.au/goodsam/become-goodsam-responder/
Key individuals who have actively obstructed the trial and implementation of Goodsam and other similar systems have based their obstruction on the basis that they are concerned that their organisation will be exposed to additional liability (that they are never able to be specific about), stating variously that: “what happens if resuscitation is not successful” and also that the organisation would attract the attention of the state privacy watchdog for sending any response other than the current response of an on-duty ambulance crew in an ambulance. Such is the unprofessional and bureaucratic mindset of many key decision makers still limiting our ability to the best for our patients within the respective health services.
Without knowing the details I would agree that both of those claims are ridiculous. If resuscitation is not successful the patient dies, the goodsam app doesn’t change that and no-one promises that resuscitation will always work. As for privacy you have to use information for the purpose it was collected and it’s collected to obtain an emergency response. We know in Vic that can come from Ambulance Victoria or the MFB or CFA but if you’re always authorising good sam responders and they’re Ambulance Victoria paramedics that’s still a response by ambulance Victoria. And if it’s any trained first aider the triple zero caller was after an emergency response and that’s what they’re getting. Of course I haven’t see the details of any objections but based on what you say I would suggest they are ill founded.
If one of the questions being asked is related to, what constitutes an ‘off-duty’ Registered Health Professional ….
I can tell you with absolute clarity …. you are always considered ‘on-duty’ the moment you expose yourself to ANY situation that relates in any manner to your employment situation.
As an off-duty Registered Nurse, I engaged with a ‘former’ patient in a public place ( completely outside any hospital grounds ) ….
Not my ‘patient’ …. not on duty / shift …. wearing plain street clothes …. out on a public street / public place ….
I was considered as just as ‘responsible’ for the person’s welfare as if I were interacting with them on duty, in a hospital ward.
This was merely a ‘social’ encounter. There was no physical harm done to the person, but ‘the authorities’ pushed for a case of ‘professional boundaries’, and made an exaggerated claim of ‘psychological harm’ to the person concerned ( which I refute ).
In summary, you are never considered ‘off-duty’ or as an ‘ordinary citizen’ if you are AHPRA registered …..
If you’re a paramedic and step up to help you are of course a ‘paramedic’ and in that sense ‘on duty’ but you are not there as your employer’s representative. Whether a registered paramedic who works for Ambulance Victoria is ‘on duty’ for Ambulance Victoria if he or she steps up to help is a matter for AV but they may well have policies to ‘sign’ the member on. Perhaps a better turn of phrase would have been ‘at work’. Fundamentally I’m drawing a distinction between when you are on the employers time or not, you are indeed always a registered health professional.
Meh. I personally just carry my wallet, keys and phone; and a pocket face mask on my key-chain. If someone needs help as I’m passing-by, I’ll help to the best of my ability as a Good Samaritan, and call for an Ambulance which carries all the necessary equipment in it.
In my opinion, if you’re “off-duty” take the time to enjoy your day off; our jobs in healthcare are busy as they are.