Legal Liability

[PFDRes47cue 653]

Hey everyone,

I received a reply from the author of the JEMS article....it is as follows:

Interesting questions. I always think we should try to do the most good for the most people.

Thus, you have to take into account all that is going on and the resources that you have available. In your first scenario, is there another unit that could get to the cardiac arrest? What's the cardiac arrest resuscitation rate in your community? How many people are on your unit - can you drop one at the accident to triage and open airways while the other one/two can continue to the arrest while calling out other resources? When I was full time FD we were three paramedics to a truck and it wasn't unusual to drop one of us with a jump kit at one scene while the truck continued to the next; we knew there were transport units enroute and sometimes there were also volunteers.

Your next question involves more of a "dispatch triage" and I will assume that you have some form of priority dispatch system in which calls are triaged and prioritized. I would think it's ok to divert to the higher priority call but BLS or even first responder units - mutual aid if you have to call it - should be summoned to the lower priority call.

Hope that helps!

Well done Rengaw87.

[Dinosaur 844]

Those agencies are long gone. They merged and became F U Ambulance Service and exist everywhere. Nothing like the medic running for his flycar before we even got inside the ER so he could jump on the hot call coming in.

Yeah, they consolidated in the movie but here in New York they're still fighting consolidation so it's still F&B and Unity around here. Pathetic.

[velcroMedic1987 330]

Hey everyone,

I received a reply from the author of the JEMS article....it is as follows:

When I was full time FD we were three paramedics to a truck and it wasn't unusual to drop one of us with a jump kit at one scene while the truck continued to the next; we knew there were transport units enroute and sometimes there were also volunteers.

Imagine that! Knowing you have transport units coming and having three paramedics on an ALS unit. Sounds like a real system.

[INIT915 1,119]

Hey everyone,

I received a reply from the author of the JEMS article....it is as follows:

Interesting questions. I always think we should try to do the most good for the most people.

Thus, you have to take into account all that is going on and the resources that you have available. In your first scenario, is there another unit that could get to the cardiac arrest? What's the cardiac arrest resuscitation rate in your community? How many people are on your unit - can you drop one at the accident to triage and open airways while the other one/two can continue to the arrest while calling out other resources? When I was full time FD we were three paramedics to a truck and it wasn't unusual to drop one of us with a jump kit at one scene while the truck continued to the next; we knew there were transport units enroute and sometimes there were also volunteers.

Your next question involves more of a "dispatch triage" and I will assume that you have some form of priority dispatch system in which calls are triaged and prioritized. I would think it's ok to divert to the higher priority call but BLS or even first responder units - mutual aid if you have to call it - should be summoned to the lower priority call.

Hope that helps!

See how gray this topic is? Even the attorney specializing in this type of law says "I would think". Not black and white, despite the posters here indicating it is. And remember, citing laws and case law from other states is somewhat useless if you are working here in New York. The intricacies of civil (and criminal) law vary greatly from state to state. That even holds true in Federal Court. Caselaw varies greatly between Circuits. So a federal negligence claims in the 9th Circuit (West Coast) may need to meet different standards then say in the 2nd Circuit (NY, Conn., Vt.).

[Guest alsfirefighter]

I'm not really understanding why some of you still after very good input in posts from respected members in the profession on the street, are making this out to be so much more then it needs to be. Every type of situation can and will fall in a gray area. As I said in my initial post...if you are flagged down and stop...rapidly triage the situation and act accordingly. Notify your dispatching center of the situation and what you need in order to handle the situation overall...whether it be you control the situation you came across and have them send a unit and you explain the situation to the parties...or you stay at the one you are at and have another unit dispatched to your initial call and document a PCR for both incidents. There is no one exact answer here...attorney or not. Use your brains and stop the chicken little sky is falling with worries of litigation. Use your best judgement and document accordingly...unless you are extremely negligent you will have no worries lawsuit or not. And here is other food for thought...if you have multiple patients...do you not triage? And if you are the lone unit or even person on scene...do you not often have to leave patients to go to another and may not get any further if you have a critical injury that you can intervene and save or stabilize them? Similar instance...and again document document document. I can tell you there are times where enroute to one call, that another call will drop and be along my response route and have people waiving thinking I'm coming to them...sometimes I can stop quickly to tell them...other times I've seen them too late to safely stop and keep going. It happens. Relax...do your job the rest will come along.

[ny10570 745]

I'm not really understanding why some of you still after very good input in posts from respected members in the profession on the street, are making this out to be so much more then it needs to be. Every type of situation can and will fall in a gray area. As I said in my initial post...if you are flagged down and stop...rapidly triage the situation and act accordingly. Notify your dispatching center of the situation and what you need in order to handle the situation overall...whether it be you control the situation you came across and have them send a unit and you explain the situation to the parties...or you stay at the one you are at and have another unit dispatched to your initial call and document a PCR for both incidents. There is no one exact answer here...attorney or not. Use your brains and stop the chicken little sky is falling with worries of litigation. Use your best judgement and document accordingly...unless you are extremely negligent you will have no worries lawsuit or not. And here is other food for thought...if you have multiple patients...do you not triage? And if you are the lone unit or even person on scene...do you not often have to leave patients to go to another and may not get any further if you have a critical injury that you can intervene and save or stabilize them? Similar instance...and again document document document. I can tell you there are times where enroute to one call, that another call will drop and be along my response route and have people waiving thinking I'm coming to them...sometimes I can stop quickly to tell them...other times I've seen them too late to safely stop and keep going. It happens. Relax...do your job the rest will come along.

What he said...

[Guest rengaw87]

A second email from the author of the JEMS article:

This question is impossible to answer because there are too many variables. For example, if the scene you come across looks major, that's very different from coming across a fender bender where the occupants are all out of the car. Another variable is what your resources are - and where they are - at that moment in time. I've had instances where a crew was getting lunch and happened to be in the right place at the right time. A good framework for making these decisions is to get as much information as you can about each of the calls via dispatch, hopefully priority dispatch that can give you the information you need, and make a decision based on the information you have. There are no easy or blanket answers.

Additionally, there is a call into the NYS DOH through my supervisor...waiting on a response.

I understand there is no black and white, just a perplexing topic for many EMS providers, and a complex one that I thought warranted a discussion. No need to be harsh in your responses about it. I've heard many convincing arguments regarding the topic.

[Guest alsfirefighter]

Not sure what makes you feel anyone is being harsh in their responses, I've found them all to be to the point and informative and many to be in line with that the author had emailed you back on. I applaud you on the diligence of your quest for information, more who ask questions on here should do the same. Very commendable and professional.

[ckroll 101]

This is a fine topic, that as far as I have read has not yet been answered. There are separate issues. What does the thoughtful provider do to provide the most help to the most people? And...all else being equal, does the call at hand take precedence over the call pending? It's not being chicken to want to know that.

Months ago, I was sent out of district for a PIAA for which dispatch had no additional information. Enroute, but also in that district, I came on a motorcycle into a guide rail, the rider unconscious. No fire, police, ems on scene. Dispatch couldn't tell me if they even knew about the motorcycle yet, they knew nothing about the call to which I was assigned, and when I asked if I should remain on scene or continue to the other PIAA the response was 'I can't tell you that, It's your decision.' [i stayed with the motorcycle on the grounds that whatever the other call was, it was going to be hard to top what I was looking at.]

That said, when, as a single provider, one does not know what units are assigned to either call or the severity, how does one make a good decision? Law should be clear at least on the starting point. Is the duty to act for the assigned call, or is the duty to act for the presenting call? We will hopefully all make the best decisions we can case by case, but we also ought to have a clearer basis from which to make that decision.

[INIT915 1,119]

Law should be clear at least on the starting point. Is the duty to act for the assigned call, or is the duty to act for the presenting call?

Agreed completely.

[ckroll 101]

How do other services handle this situation?

1. Does a fire truck stop enroute for a PIAA if it has been assigned to a car fire somewhere else?

2. Does a police officer stop for people in front of a bank that are waving him down if the unit is already assigned to a domestic dispute?

The only certain thing about dispatch information is that it will be inaccurate. The weakest link is almost invariably the civilian who panics and calls 911. What makes EMS different from fire and law enforcement, by and large, is that there is more depth, either in numbers of responders or in levels of supervision in the other services. As was brought up on another thread, EMS does not have the luxury of readily available supervision. Long distance triage is problematic but its solution is critical to EMS.

Consider another scenario. There is a natural disaster. There are multiiple calls for aid of all kinds over a large area. Do on duty responders start helping people as they find them, or do we handle calls as they are assigned to us? Just going out and doing what feels right is also known as freelancing.

When dispatch has assigned a unit, they have every right to assume that the unit is committed. If we in the field start picking and choosing what we handle, it will quickly become chaos.

[firemoose827 324]

I read a lot of you talking about abondonment if you dont stop to help a patient, and just felt like clarifying something to the newer EMS providers. The only time abandonment comes into play is if you start treatment of one patient but than stop without A) Transfering care to a higher level of care or Signing patient off AMA with the PT fully understanding the implications. If you are driving by someone with a bump or bruise enroute to another priority call, thats not abandonment. If that were true THOUSANDS of people would be on the phone daily with their lawyers stating that they have an injury and yet the ambulance just drove by their house and failed to stop.

In this scenario I treat the patient thats in front of me. If I am enroute to a call and see numerous people flagging me down for help to assist an accident victim or someone with a medical emergency, I stop, radio in the report to dispatch and have another unit check out the first call.

In court I would rather defend myself for what I did, rather than what I didnt do.

[ckroll 101]

.

In court I would rather defend myself for what I did, rather than what I didnt do.

As would we all. Point of the discussion is duty to act. The trifecta of negligence is injury, duty to act and malfeasance/nonfeasance. If a person is having an MI and you have been assigned to treat that person, and you never get there because you found something better to do along the way and if care is delayed even 10 minutes and the outcome is poor........ You are going to be explaining to a jury why you DIDN'T do something for that patient.

Not responding to a call to which you have been assigned is pretty much the gold standard of nonfeasance.

[firemoose827 324]

As would we all. Point of the discussion is duty to act. The trifecta of negligence is injury, duty to act and malfeasance/nonfeasance. If a person is having an MI and you have been assigned to treat that person, and you never get there because you found something better to do along the way and if care is delayed even 10 minutes and the outcome is poor........ You are going to be explaining to a jury why you DIDN'T do something for that patient.

Not responding to a call to which you have been assigned is pretty much the gold standard of nonfeasance.

There are also too many "What Ifs" for this particular scenario, as well as parameters that are different with each agency. Like with my volunteer agency we could very well have a crew of 5 people with 2 to 3 EMT's. For this scenario we would be able to drop an EMT with a kit and a radio to start treatment while we responded to the initial call. But in the commercial agency I worked for there were 2 of us, EMT and Paramedic. So as you see it all depends on the agency and the area, and their resources. I agree, if you are dispatched for a priority call, that call has precedence...but I would try to use whats available to at least try and start to help the second patient.

Stay Safe.

[ny10570 745]

Its nonfeasance if you stop for the flagged incident and do nothing to ensure another unit is enroute to the first call.

Once you initiate assessment that is your patient. Getting flagged for an abdominal pain on your way to a cardiac arrest, the abdominal pain is now your patient once you start assessing them. How do you know its not a real medical emergency unless you've properly assessed them?

[ONEEYEDMIC 68]

It's pretty simple. Your damned if you do, and your damned if you don't! I know what I have done and would do, just can't tell others what to do. I guess follow your gut. Who cares if you get sued. Can't get blood from a stone right? The end result is that all patients on either scene are tended too!