Regarding The Duty To Act

A while back, when I wrote about the duty to act, I emphasized the idea that the duty to act only extends to “on-duty” medical personnel. In fact, my exact words were,

“If you are a trained medical professional and you are acting with an expectation of compensation you have a duty to act appropriately and within the scope of your training when called to assist with an emergency situation.”

I figured I should emphasize the idea that trained EMTs don’t have a duty to act when they aren’t being compensated for their services. This seemed to be the point of greatest confusion. I never thought much about making it clear that while you are on duty, working as an EMT, you are required to act.

I know … it seems painfully obvious. I thought so too. But over the past few weeks, there have just been a slew of stories that seem to fly in the face of the obvious.

First, there was the strange story of the UK paramedic who watched his EMT partner deliver a non-breathing child, didn’t call for any assistance, then watched her try to resuscitate the child. To his credit, he did drive her to the hospital while she continued the resuscitation attempt in the back.

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What Makes A Good EMT?

I get a bunch of E-mails from people just starting their EMT education who want advice on how to excel in their programs. “How should I prepare? What books do you recommend?” The questions vary but their is always the familiar flavor of enthusiasm and the same basic question, “How do I do this well?”

Success in this field is fairly predictable. Use the right recipe and you’ll get there. I think the hierarchy of EMS success looks like this:

1.) Attitude

2.) Motivation

3.) Tolerance for repetition

4.) Goal orientation

5.) Strategy and tactics

6.) Performance

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Understanding OPQRST

After my post/rant about the overuse and misuse of the DCAP BTLS TIC acronym in EMS education, I was asked the question, ” Well, are there any acronyms that you do find useful?” And the answer is an emphatic yes. Some acronyms make for useful mnemonic devices to help us recall needed information in stressful situations. Despite my strongly worded warning about the use of acronyms, I think there are several good ones that have valid clinical uses.

For sure one of the more useful acronyms I’ve learned is OPQRST. I learned it back in EMT school in 1989 and I’ve been using it ever since. I can’t imagine how many times I’ve gone through these letters in my mind while meandering through a subjective assessment with a patient.

This is an acronym that has stood the test of time, which is saying a lot in the word of emergency medicine. Considering everything that has come and gone in the last three decades of EMS evolution, the most remarkable thing we can say about OPQRST is that it has endured.

Today lets dive a little deeper into the nature of OPQRST questioning. What does OPQRST mean? When should we use it? What kinds of questions should you be asking to get the information we’re looking for and where does the OPQRST standard fall short of providing us with a complete picture of a patients pain.

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The EMT Code of Ethics

Did you know you had a code of ethics? You do.

It was writen by Dr. Charles Gillespie and adopted by the National Association of EMT’s in 1978. It probably appeared somewhere near the front of your EMT textbook. It may have been touched upon by your instructor during your medical / legal lecture. It’s less likely that you were ever ask to raise your hand and recite its words (or accompanying oath.)

Consider what it means to be ethical. Ideas regarding what it means to act ethically in the practice of medicine have been handed down from hard won lessons of human history. From the sacred pledge of the Hippocratic Oath to the tenants of the Declaration of Helsinki and the Nuremberg Code,  medical ethics has evolved to deepen our understanding of what it means to be a moral provider of medical care.

Your patients place great trust in you because your authority rests on the honor and tradition of a code of medical ethics. In case you haven’t read it in a while, here is the EMT Code of Ethics.

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