As you may know, the Code of Ethics sets out the basic ethical commitments that guide all regulated members of the paramedic profession in Alberta. Each regulated member is required to understand and comply with this Code, but how does this translate in the day-to-day work of EMRs, PCPs and ACPs?
The following scenario addresses responsibility to oneself – recognizing professional limitations and practising within one’s education, training, knowledge, skills and judgement.
3.1 Recognize professional limitations
Recognize professional limitations by understanding their capabilities and limitations, and performing only the functions that fall within their scope of practice for which they have been educated and trained and in which they possess the required knowledge, skills and judgement.
Scenario:
A Primary Care Paramedic (PCP), Maya, has worked on a rural ambulance for two years. During an evening shift, Maya and her partner, Daniel, respond to a community recreation centre for a middle-aged patient with severe shortness of breath, low blood pressure and signs of worsening respiratory failure. Freezing rain has delayed the responding Advanced Care Paramedic (ACP) unit, and transport to the nearest emergency department will take approximately 35 minutes.
The patient’s condition continues to decline despite the care Maya is authorized and prepared to provide. A recreation-centre employee identifies a bag of advanced airway equipment kept onsite for special events. Daniel suggests that Maya use an endotracheal tube, noting that he has seen ACPs perform the procedure many times and that doing something may be better than waiting.
Maya recognizes the equipment from training demonstrations and has assisted an ACP with similar procedures. However, she has not been educated, assessed or authorized to independently perform this intervention. She also knows that observation and informal exposure do not establish the knowledge, technical skill or clinical judgement required to use it safely.
Maya feels pressure to act. The patient’s family is asking why more is not being done, Daniel appears increasingly concerned and the ACP unit remains delayed. Even so, Maya pauses and clearly identifies her limitation: the procedure falls outside the functions she is currently authorized and competent to perform independently.
Rather than attempting the advanced intervention endotracheal intubation, Maya continues the assessments and treatments that are within her scope, optimizes oxygenation and ventilation using the equipment she is trained to use, requests updated medical direction, asks dispatch to explore an alternate intercept point and prepares for rapid transport. She delegates appropriate tasks to Daniel and communicates the patient’s changing condition using clear, closed-loop updates.
The crews meet enroute. Maya gives the ACP a concise handover, including the patient’s response to treatment and the limits of the interventions available before intercept. The ACP assumes care and performs an advanced airway intervention. The patient is transported to hospital with improved ventilation.
After the call, Maya and Daniel debrief with their supervisor. Maya explains why she did not use the advanced device and reviews the clinical decisions she made within her authorized scope. Daniel acknowledges that urgency and familiarity with a procedure had influenced his suggestion, but neither replaced the education, training, assessment and judgement required to perform it safely.
By recognizing her professional limitations, declining to perform a function outside her competence and actively pursuing safe alternatives, Maya demonstrates accountability to the patient, her partner and the profession. Her response shows that remaining within scope is not inaction; it is the disciplined use of available knowledge, skills, judgement, consultation and resources to provide the safest possible care.
Recognizing professional limitations means:
- Knowing the functions permitted within your current scope of practice and any conditions or restrictions that apply.
- Honestly assessing whether you have the education, training, current knowledge, technical skill and clinical judgement required for a specific function.
- Understanding that having observed, assisted with or previously learned about a procedure does not automatically establish current competence to perform it independently.
- Not allowing urgency, peer pressure, patient or family expectations, or the absence of a higher-level practitioner to push you beyond your capabilities.
- Continuing to provide all appropriate care within your scope rather than treating a limitation as a reason to disengage.
- Seeking consultation, medical direction, additional resources, an intercept or transfer of care when the patient requires functions beyond your competence.
- Communicating limitations and escalating concerns clearly so that the team can make a safe and timely plan.
- Pursuing additional education and supervised practice when a recurring limitation identifies a learning need.
This scenario demonstrates that professional responsibility includes knowing when not to perform a function. A regulated member must consider both formal scope and personal competence in the circumstances. By naming her limitation, using the full range of care available to her, seeking support and transferring care appropriately, Maya protects the patient while maintaining professional accountability.