Originally Posted by skier_j
It is my understanding that you should not release a patient to a lower standard of care so that if they did so (provided care or treatment above the level of OEC) and a BLS ambulance ride was eventually deemed necessary, then they would be obligated to go with the patient to hand off to the ER attending physician.
If they stayed within the care confines of an OEC tech, there would not be an issue, of course they would still have the option to go with the patient if they choose to, but they would not be obligated to do so.
I follow what you're saying. You make a good point, which I think is worthy of a little elaboration.
The legal concept you're thinknig of is abandonment. Essentially, once you initiate care at a particualr level, you are obligated to continue providing care at that level unless and until (a) it is no longer possible to do so; (b) the patient no longer requires that level of care, or (c) you transition the patient form your care to someone who can provide an equal or higher level of care.
(a) is straightforward. If you are all alone, and you start CPR on someone in the middle of nowhere, and you become physically exhausted, stopping CPR is not abandonment.
(c) is straightforward. A ski patroller who hands a patient off to an ambulance crew is obviously not abandoning the patient.
(b) is trickier. If a doctor examines a patient and determines that the patient is suffering from an injury that is appropriately treated using standard first aid techniques, he or she can probably pass care off to a ski patroller without committing abandonment
. If, however, the doctor is wrong, and the patient really did need more advanced care that the doctor was capable of providing, he may have committed malpractice
Similarly, suppose a paramedic is working at a ski area that is not a licensed ALS agency. In this cae, the medic still has all of his ALS knowledge and experience, but he can only practice basic first aid because doing more would constitute the unauthorized practice of medicine. This can be a tricky situation. If the medic is first on scene, can he appropriately pass care off to OEC technicians? On the one hand, there is nothing that the paramedic can do that the OEC technician can't (because the medic can't practice ALS). On the other hand, the medic still has the ability to perform a more thorough assessment, and might be able to make more appropriate decisions about the patient's disposition.
And, what happens if the ambulance crew that shows up to take the patient to the hospital is a BLS crew? Does the medic have to go with the patient to the hospital, even though he still won't be able to provide ALS-level care?
These are not easy questions to answer, and the best answer may vary from situation to situation. For this reason, it is usually a good idea to have a protocol in place. Most EMS systems I've worked in have protocols for how to transition care form ALS to BLS where ALS is not indicated. Many EMS systems also have protocols that state that if a doctor wants to assume responsibility for a patient's care, and provide care or treatment that is beyond the scope of the ambulance crew's scope of practice, the doctor must use his own equipment and physically accompany the patient to the hospital.
Of course, each ski area's circumstances and access to advanced care is different, which is why it makes sense for patrol directors and management to think about these issues ahead of time.