Practicing medicine vs. advanced first aid

Prompted by tonight’s episode of NCIS, which is now on. A former corpsman with field experience renders more-than-first-aid at the scene of a car crash. She is taken into custody because she practiced medicine without a license.

How much ‘first aid’ can a non-licensed person render in an emergency? Suppose someone will definitely die if he doesn’t have an immediate tracheotomy, and it just so happens that I stayed at a Holiday Inn Express last night? Now, that’s an absurd scenario. Anyone that badly off is going to croak before you finish calling 9-1-1. But I do the trach, and the guy lives. Then I’m charged with practicing medicine without a license. Even though the operation was a success and the patient lived, I still broke the law.

I’m pretty sure an untrained person (read: someone who cares enough to get some training at some point, but ‘never’ uses the training) can paint a cut with Betadine and cover it with a sterile pad without running afoul of the PMWOAL rules. The first-aid kit in my car has a wire splint in it, so I’m pretty sure I can safely use it to immobilise a broken bone. That’s a little more advanced than treating a cut. Nobody carries a cervical collar with them, but if someone is in an accident some rolled-up clothing can keep the head straight until paramedics arrive. Stitching someone up? If there’s a severed vein, closing the skin isn’t going to help. But a giant laceration might need to be secured, especially if you don’t have enough gauze to wrap it. I can’t see the need for sewing in an urban or rural setting, but it might be life-saving if you’re out in the backcountry. ITSM that that is ‘practicing medicine’.

So how far can an unlicensed person go to save a life without being prosecuted?

From all my first aid courses, the answer is that you can render aid up to what you have been trained and certified to do. I can splint, bandage, warm, cool, and administer an epi-pen, as well as do CPR. If I try to perform surgery, administer drugs, or diagnose an illness I’m going beyond my level of training and am subject to liability and possibly charges.

I haven’t had a CPR card since 1994. Does that mean I cannot administer CPR without being charged with PMWOAL?

It varies by state in the US (Along with care that’s authorized at different levels of certification for actual professionals.) For your local it’s good to check in to the good Samaritan laws. If it’s reasonable care given the situation you might be completely protected legally. Going “I saw a tracheotomy on a rerun of MASH once” and jamming a pen in their neck might not be reasonable. :wink:

Once upon a time the US Army had CPR in it’s common task manual. Many places in the US if I observed someone in cardiac starting CPR would have been perfectly reasonable even though I’d never been certified by the Red Cross.

I’d be willing to call the episode BS since I doubt the writers checked the jurisdiction in question’s laws.

Maybe this is why the Lone Ranger never sticks around…

I remember the trach question going around before - the answer was “no way in Hell could you do that legally (in the US), no matter the circumstances”.
Either let the slob die or:
remove license plates, put on gloves and mask
perform surgery
run like Hell and hope you didn’t do anything to leave a traceable clue.

My pen in the throat might not be legal, and it may well cause a really nasty infection.
As long as the slob doesn’t die, he’s way ahead:
Nasty infections can be cured
Death can’t be cured

CA California Health and Safety Code Section 1799.102

An untrained bystander is covered as long as “reasonable and ordinary” steps are taken.
It then specifically says "Not so fast there, Ms. “I saw it on MASH”:
Except any “act or omission constituting gross negligence or willful or wanton misconduct.”

So, if you want to sue the guy who tried to stop your wife’s arterial bleeding without having a clue:
Sue the bastard and let the Court decide if his actions were “reasonable and ordinary” or “gross negligence or willful or wanton misconduct”.

IOW - keep walking, let her bleed out. If you have a cell, call 911 - who knows, somebody MIGHT just get there in the next 20 seconds…

A wild guess says whether you get charged or not depends to some extent on whether your intervention turns out to be beneficial. If your MASH-style tracheotomy opens the jugular instead of the windpipe, I think you have a problem.

Whatever the law may be, I find it hard to imagine that a jury would convict if the action could be demonstrated to have saved the person’s life, or even (if they were not going to die) substantially improved their medical outcome in some way.

Obviously this is going to depend on the specifics of the law in the jurisdiction concerned, but most jurisdictions recognise some kind of “necessity” defence. If you need to do something to save a life, that’s a good defence.

This is something that has come up in the UK. The simple answer is that no one cane ever come up with a cite for a case where someone was even prosecuted, let alone convicted, in these circumstances.

That could be the same here in the US. Since the NCIS episode was based on Virginia law maybe Bricker can come in and give us the facts. Is there actually a criminal charge involved in these cases? I understood Good Samaritan laws were to protect medical practitioners from civil suits.

On a camping trip over a Memorial Day weekend, a friend cut himself with his axe (alcohol was involved). I carry a pretty decent first aid kit, so I cleaned and bandaged the wound in preparation for a long drive to the hospital. My buddy saw the suture kit in my first aid box and asked if I could just stitch him up. Against my better judgement, we iced his wound and I sutured it.

Idiot friend went to his PCP to have the stitches removed the following week. Everything healed perfectly. In conversation my buddy mentioned that his friend had sutured him in the woods. The doctor was all pissy and wanted my name, which my friend refused to provide. The doctor apparently wanted to “report” me.

IIRC Franco wasn’t charged. :slight_smile:

My guess is as wild as yours, but to my mind, the difference between first aid and practicing medicine is that first aid is what you do to keep things from getting any worse (e.g. keep a person from dying, keep a wound from getting infected) until competent medical personnel can take over if necessary. Practicing medicine involves actually curing/fixing what’s wrong.

I work in a 9-1-1 center and have occasion to tell people what to do in medical situations before an ambulance arrives. I presume anything we tell a caller from our doctor-approved instructions would not put a caller at risk of any practicing with a license offense.

Most of those instructions are based upon stabilizing things until help arrives but a few do cross into actual treatment/cure. (e.g. Give juice to diabetic with suspected low blood sugar. Place patient on oxygen if decompression sickness is suspected.)

First aid can include reducing a dislocation. If you’re not trained to do so properly you can do some serious damage. In a wilderness scenario you often can be called upon to do something that otherwise you’d just wait for the EMTs to arrive. Knowing what you can and should do versus when you need to hunker down and wait for help is a big part of the process.

Again, the “reasonable and ordinary” phrase is the guideline. Anyone can stop bleeding by applying pressure. Not everyone should be applying a tourniquet. Suturing wounds is beyond my level of expertise and is not something I would every attempt. In fact, we’re instructed to leave the wound open to avoid infection. Closing a wound like that in the field without proper cleaning is a recipe for disaster. That’s why people shouldn’t perform procedures they are not trained for. :slight_smile:

When I backpack I carry a wilderness 1st aid book which goes into setting broken bones and quite a few other things I am grateful I never have had occasion to do. I have a lot of trouble imagining that practically any effort made in good faith in the total absence of access to medical personnel would be illegal.

Really folks - it is NOT what you could or could not believe - it is a matter of what a Court believes.

“Callous refusal to lend assistance is not actionable” is an expression I remember from 40 years ago.

When the CA law says: go ahead and be a nice guy, but remember: your actions are subject to legal review (which is what it says), one might want to consider the “reasonableness” of various Court decisions.

If you go beyond your level of training and expertise, regardless of the dire circumstances, you are unprotected. If someone his having an allergic reaction and I decide to perform an emergency tracheotomy rather than just sit and wait it out, and the person dies, there are going to be consequences. There are cases where extreme measures by untrained people are reckless and may be subject to criminal and certainly civil actions.

Good faith and appropriate training is a reasonable level of protection. Good faith and lack of training is not.