As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs, and ACPS?

In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.

The following scenario will attempt to address Professional Boundaries:

2.5  Professional Boundaries

Professional boundaries in patient care include the physical and emotional limits of the patient-provider relationship.

  1. A regulated member must maintain professional boundaries with patients at all times and in any interaction, including but not limited to:
    1. Providing adequate
    2. Allowing privacy while the patient is undressing or
    3. Obtaining informed consent for intimate or sensitive
    4. Using appropriate examination techniques when touching sensitive or personal areas of the body including, but not limited to, breasts, genitalia or anus.
  2. The regulated member must always act in the patient’s best interest and manage the boundaries within the patient-provider relationship.
  3. Regulated members must also respect that each patient’s boundaries may be unique to their experiences including culture, age, values and experiences with trauma.


Todd is an Advanced Care Paramedic working for an industrial oil company. He works as the stand-alone medical provider onsite and must be available for any medical emergencies that may arise. While on shift, Todd is called to attend to a 52-year-old female who is complaining of shortness of breath and chest pain. He arrives to find his patient, Darlene, sitting on a chair in the medical tent looking diaphoretic and pale. Todd proceeds with his assessment and starts to formulate a treatment plan, which includes calling for a transporting unit.

Note: In this scenario, we will assume that Todd is following the appropriate medical control protocols when assessing and treating this patient.

During Todd’s assessment of the patient, he becomes aware of the fact that he will have to obtain an ECG as part of his treatment plan. He recognizes that he will have to perform a physical exam and to do so, will need informed consent from Darlene to agree to the assessment as well as the ECG, which would include the removal of her sweater and brassiere. Todd also realizes that despite being in the medical treatment area (with no other persons around), it would be appropriate to offer Darlene a blanket to be able to cover herself during part of his assessment if she so chooses.

Todd then focuses his attention on Darlene and goes on to explain to her that he would like to obtain an ECG, why he would like to do so and how the procedure will proceed. After Darlene hears about the steps of the procedure, she gives Todd the informed consent needed to continue with the procedure and all that it will entail.

As soon as Todd receives consent, he then lets Darlene know that he will turn his back for a moment while she removes the necessary clothing and drapes herself with the blanket. Darlene is appreciative of Todd respecting her boundaries in this instance.

Once Darlene finishes undressing, she lets Todd know he can resume with the ECG procedure. Todd explains what actions he will be taking as he begins placing the 12 lead cables and electrodes in the appropriate sequence. He goes on to explain that some breast tissue is covering the optimal placement area where he needs to place the electrodes and offers options on how he can place it, while respecting her boundaries.

Todd lets Darlene know the first option is that Darlene can move her own breast while Todd places the electrodes or, alternatively, the second option would be that he can use the back of his hand to displace the breast tissue. Darlene lets Todd know that she would feel more comfortable moving her own breast. Todd acknowledges and respects Darlene’s boundaries and proceeds to place the electrodes and cables once Darlene moves her own breast tissue.

With Darlene’s cooperation and consent, and in addition to Todd being mindful of her boundaries, he is able to successfully place the electrodes and cables, allowing him to obtain the 12 lead ECG.

In this example, Todd demonstrates his knowledge and adherence to the standard 2.5 – Professional Boundaries in which a regulated member must maintain professional boundaries with patients at all times and in any interaction. He also acts in the patient’s best interest and manages the boundaries within the patient-provider relationship. Finally, he respects that each patient’s boundaries may be unique to their experiences including culture, age, values and experiences with trauma.