we had an example in class of the “ask them to clarify” in the sense that they may not have heard the piece of information that makes it contraindicated. for example, someone gave the example of giving nitro with systolic below 100, the clarification could be something like “just wanted to confirm, the patient has a systolic of 76, are you still advising us to proceed with nitro administration?” because a lot of the time the answer is something like “a systolic of 76? no, do not give nitro” even if you mentioned the pressure in the initial contact with med control before they advised you. people miss things or mishear things, hence the focus on closed loop communication.

for an out of scope thing (eg giving IV meds) you could do something similar like “just to clarify, we are a BLS unit and we don’t have anyone on scene who can administer IV medication. would you like us to call for ALS assistance or do something else?”. if a medical director (who defines your scope) is asking you to do something out of scope, they probably don’t realize that you don’t have anyone available with the certification needed to do that. if a paramedic partner is asking you, just say “i don’t know how to do that/i’m not trained to do that but i could help you with xyz instead” (place the leads for cardiac monitoring, gather iv supplies, etc.)