FROM THE EMERGI-PRESS       SUMMER 2000

Rendering Care Off-Duty

 by Luanne Underwood, RN, BSN MICN

 Portions of this article are reprinted, with permission, from the Alameda County EMS newsletter.

The Los Angeles County EMS Agency, as well as other local EMS agencies throughout the State, often receive questions regarding what type of aid pre­hospital care personnel may ren­der when they are off-duty. This includes rendering care off-duty during special events or other gatherings when pre-hospital care personnel are not working for an approved provider. Recently, we came across an article in Alameda County’s newsletter which did an excellent job of covering this topic. The following are excerpts from that article which include the most frequently asked questions and their answers.

Q:  If I pass the scene of an accident, am I obligated to stop and render aid?

A:  No one is obligated to stop and render aid. Likewise, no one is obligated to render aid even if they do stop. Those are decisions that are up to each indi­vidual. However, if you are the kind of person who does choose to stop and render aid, it is good to be prepared to safeguard your well being, as well as to under­stand your responsibilities and protection under the law.

Q:  What level of care can paramedics and EMT-Is legally provide on the scene? 

A:  Paramedics and EMT-l's may only offer basic life support (BLS) level care when they are off-duty. Paramedics may only perform advanced life support (ALS) skills as part of an organ­ized EMS system while working for an approved paramedic service provider. Therefore, para­medics may NOT provide ALS level care off-duty pursuant to the California Code of Regulations, Title 22, Division 9.

Q:   What does California law say about pre hospital care personnel providing care off-duty?

A:    Section 1799.102 of the California Health and Safety Code states:

 “No person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages re­sulting from any act or omission. The scene of an emergency shall not include emergency depart­ments and other places where medical care is usually offered.” 

To encourage pre-hospital care personnel to render care at the scene of an emergency, Section 1799.106 of the Health and Safety Code was included and states the following:

.... In order to encourage the provision of emergency medical services by firefighters, police officers or other law enforcement officers, EMT-l's, EMT-ll's or EMT­P's, . . [these individuals] who render emergency medical services at the scene of an emergency shall only be liable in civil damages for acts or omissions per­formed in a grossly negligent manner or acts or omissions not performed in good faith. A public agency employing such a fire­fighter, police officer or other law enforcement officer, EMT-l, EMT­II, or EMT-P shall not be liable for civil damages if the . . .[individual] is not liable.”

Q:   Does a paramedic, when working for an approved paramedic service provider, have to take orders from a nurse or physician at the scene of an emergency?

 A:  Nurses, either on-duty or off-duty, may only offer assistance and suggestions, they may not assume medical management of the patient. Physicians licensed in the State of California, either on-duty or off-duty may lend assistance to a pre-hospital care team that is in charge of the patient; however, they may not direct paramedics in advanced life support procedures. Medical direction must come from the base hospital. When encountering a physician at scene, paramedics must obtain proper identification, consisting of a California Physicians and Surgeons License and note the physician’s name, license number and license expiration date on the EMS Report form. In the event radio communication cannot be made or main­tained with a base hospital, paramedics may assist the physician at scene and may provide ALS level care under the direction of the physician provided that his/her instructions are consistent with Los Angeles County EMS Agency policies and procedures.

 California law does not preclude a licensed physician from rending patient care at the scene. When a physician at scene chooses to assume or retain responsibility for medical care of a patient, pursuant to Reference No. 816, Physician At Scene, such physician must take total re­sponsibility for the care given. Reference No. 816 further states, “He/she must also accompany the patient until the patient arrives at a hospital and responsibility is as­sumed by the receiving physician, unless relieved of the responsibil­ity by the base hospital.” (For ad­ditional information regarding “Physician At Scene” please refer to Reference No. 816 in the Los Angeles County Pre-hospital Care Policy Manual.)

If you have a question or is­sue that requires immediate re­sponse, please contact Luanne Underwood, Chief, Pre-hospital Care Operations at (323) 890-7576. It is preferred that non-urgent questions be put in writing and faxed to (323) 890-7629 or e-mailed to lunderwood@dhs.co.la.ca.us. We will print as many of the questions, as possible, in this column. If you want to ensure a response, please be sure to in­clude your name and telephone number.