Today’s correspondent is ‘… a paramedic with Ambulance Victoria’ who says:

… as I’m sure you are aware the hospital ramping issue is a hot topic within the industry at present.

There is currently a lot of discussion regarding the paramedic scope of practice while ramping for hours, in particular paramedics taking blood tests from their patients once a doctor has seen the patient on the stretcher and ordered the blood tests. I’m just wondering if there are any legalities around paramedics taking blood tests, in particular a paramedic who is also trained and currently practises as a Registered Nurse on their days off from Ambulance Victoria.

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The issue will always be what is ‘reasonable’ and that requires consideration of all the circumstances including the patient’s needs and the paramedic’s skill set. 

There is more to a blood test than simply taking blood.  A phlebotomist has to know how much blood to take for particular tests and which tube to put the blood in given that some carry additives for the various tests (see https://phlebotomygeeks.yolasite.com/resources/TUBEZ%20AND%20USES.pdf).  There must also be a process to get the blood to relevant laboratory for the necessary tests to be done. And it has to be recorded that the sample has been taken and the necessary paperwork completed to ensure that the sample is correctly identified, tested and the results accurately reported in the correct patient record.  I imagine that paramedics treating a patient whilst ‘ramped’ cannot access the hospital’s record keeping system nor the various pathology requests.  And if the patient is not yet admitted, how does the sample get linked to the particular patient?  If on the other hand, it’s a simple test like blood sugar levels then presumably paramedics can test that and record the result on their own patient record form.

If you take blood and it turns out it cannot be tested or used there is little damage done other than the patient has a needle inserted in their arm that they did not need and even if that were negligent, or a battery, it is not going to sound in significant damages.  But it is unprofessional to expose a patient to a procedure that is not in their best interests or that has no therapeutic benefit.

Conclusion

In simple terms if a paramedic is asked to do something that is clinically indicated in the patient’s best interests and is within the paramedic’s skill including their skill set because they are also a registered RN, then I cannot see any legal issues in performing that task. It is consistent with both the paramedic’s and the hospital’s duty to act in the patient’s best interests.  But one should always stop and consider whether the task really is within their skill set taking into account not just the procedure but the context in which it is to be performed. 

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.