Legal Liability

[Guest rengaw87]

Hey everyone,

My partner and I were having a discussion and have a few questions regarding legal liability of EMS responders.

The scenario is as follows:

You are responding to one call (say a chest pain) which you have been assigned to by your dispatcher (or county dispatch) when you come upon a second incident while en route (say a car accident with serious injuries and no responders on scene yet). Legally are we responsible to continue to the initially dispatched call without stopping to render aid at the car accident, and simply call it in to 911 or are we legally required to stop and render aid to the patients at the serious car accident we came upon? Additionally, if we stop and or delay our response to the initial call (the chest pain) to render aid or evaluation at the car accident could the crew be held legally liable for abandoning or prolonging response the first patient? On the other hand, could we be held liable for failing to render aid at the auto accident if we continue on to the chest pain without stopping?

Now take the same scenario except make the initial dispatch for a lift assist (lower priority), would the legal responsibility still be the same, or are we now obligated to render aid at the car accident? Keep in mind that no EMS has arrived to evaluate or assist the patient requiring lifting assistance, so their status cannot be confirmed as stable or critical, the only information is the lower priority given during the dispatch and that information obtained by the 911 operator taking the call over the phone. If we were to stop at the auto accident and the patient on the floor ends up going into respiratory arrest because they are a CHF patient and went into pulmonary edema because of being supine, can we be held legally responsible for not continuing in to aid that patient immediately and instead rendering aid at the car accident?

How would you personally handle these two situations (both EMTs and medics)? If anyone reading this has a legal background (ie a lawyer) that would be even more helpful to us as we are concerned with our legal responsibilities and liabilities.

Thanks for any help!

[Guest alsfirefighter]

My first instinct is when you start thinking of scenarios in regard to liability....something is wrong. While there is a certain level of liability in all that we do, I hear the word liability and lawyers in far too many conversations in the EMS realm. However, I do have to say you pose a good question here but to be honest I don't see how you can't or in a way didn't answer your own question. Sometimes unfortunately things come down to what is ethical vs. what is policy or legality. The situations you state actually happens occasionally for my agency, particularly with MVA's or when we make decisions to divert to a higher priority call when our ALS resources are running thin.

First...as with anything else documentation is the key to both your scenarios. And I'm going to say this even if you do the right thing legally or ethically there is always the possibility of litigation. There are not always hard answers. The other thing that will help is an accurate radio transmission as well..that is if its recorded...this is also a form of documentation. In regard to your first given scenario if there were serious injuries...and I mean your heading to a level 1 trauma center serious I'm staying at that scene and requesting the appropriate resources for it and another medic unit to pick up my original call. If I were to pull up to the scene and did a through a window triage and people gave the indication of BLS level injuries or routine neck/back pain or no injuries at all....I would let them know I'm already assigned to a serious call and that I will contact my dispatch to have "xyz sent." I don't go to lift assists, however...this one also comes down to common sense. Get another unit going to the lower priority call.

Best advice I can tell you is to check your agency's policy and/or procedures for the situation you ask. If they don't have one see if the state has an EMS policy on it. However no state policy will be in grand detail of separating call types like you did in your post and to stop wondering what you "legally have to" do and deal with each situation as the come with some ethics, experience and a little common sense.

One of the best things I ever heard a lawyer..who happened to be a medic...say was this "if you do your job worrying about legality and liability is exactly when your chances of doing something to cause a wrong will occur."

So in the end..like I said..just do your job with good faith, ethically with common sense, good documentation as why you made the decision you did. There isn't a jury in the world that would find an agency or its employees wrongful IF (note I said if) the reason you stopped and stayed at one scene was warranted due to injuries present and you documented that fact. (and IMO they have to be tangible observable injuries requiring a trauma center).

[ny10570 745]

You are to render aid at the emergency you have, not the emergency you might have. It doesn't matter what you are going to you, if you are presented with a patient requesting help you are to help that patient. I'm just an lowly field paramedic but this is coming from a former partner's patient abandonment hearings after he ignored the civilian flagging him for the same old drunk on the same old corner while he was headed to a cardiac arrest.

In the first scenario the chest pain patient is not your patient until you get on scene. The could no more hold you responsible for getting flagged than they could jam you for getting into an accident on the way. Now failing to respond or intentionally delaying your response is a different matter. Your second scenario is the reason why the law does not differentiate between call types of the potential patient. There may very well not even be a patient at the scene, but there is definitely a patient in front of you at the accident or whatever you've been flagged for.

[PFDRes47cue 653]

You are to render aid at the emergency you have, not the emergency you might have. It doesn't matter what you are going to you, if you are presented with a patient requesting help you are to help that patient. I'm just an lowly field paramedic but this is coming from a former partner's patient abandonment hearings after he ignored the civilian flagging him for the same old drunk on the same old corner while he was headed to a cardiac arrest.

In the first scenario the chest pain patient is not your patient until you get on scene. The could no more hold you responsible for getting flagged than they could jam you for getting into an accident on the way. Now failing to respond or intentionally delaying your response is a different matter. Your second scenario is the reason why the law does not differentiate between call types of the potential patient. There may very well not even be a patient at the scene, but there is definitely a patient in front of you at the accident or whatever you've been flagged for.

Is this the same rule of thumb or law when you know you are going to a confirmed emergency and you come across someone. For example, if I am responding to a cardiac arrest and then get updated by PD on scene that it is a full code and CPR is in progress, but I get flagged down for someone on a bike path who skinned his/her knee, I will held responsible and charged with abandonment for continuing onto the full code ad not stopping to apply a piece of gauze and some tape?

Or if you have a call for a stroke where symptoms began to occur say 30 minutes prior to the dispatch. You do not have much more of the left in the "Golden Hours" and while responding to get flagged down for a general malaise. If I stopped for the tummy ache and the stroke patient misses out on the "Golden Hour", the family of the stroke patient has no legal leverage on me?

What about if I am transporting a patient to the ER and while doing so I come across an MVA or man down on the side of the road and no emergency personnel is on scene. Do I legally have to do anything other than report it?

This is good to know. Thanks.

Edited March 19, 2011 by PFDRes47cue

[Guest rengaw87]

You are to render aid at the emergency you have, not the emergency you might have. It doesn't matter what you are going to you, if you are presented with a patient requesting help you are to help that patient. I'm just an lowly field paramedic but this is coming from a former partner's patient abandonment hearings after he ignored the civilian flagging him for the same old drunk on the same old corner while he was headed to a cardiac arrest.

In the first scenario the chest pain patient is not your patient until you get on scene. The could no more hold you responsible for getting flagged than they could jam you for getting into an accident on the way. Now failing to respond or intentionally delaying your response is a different matter. Your second scenario is the reason why the law does not differentiate between call types of the potential patient. There may very well not even be a patient at the scene, but there is definitely a patient in front of you at the accident or whatever you've been flagged for.

Just out of curiosity, do you know the outcome of the patient abandonment hearings? I am having a hard time grasping that I am required to stop and render aid to a "boo-boo" when I am headed to a more critical patient, say the cardiac arrest. My partner and I felt the complete opposite way, that we are first obligated to our initial patient that called 911 and without both patients side by side in front of us such that we may triage we need to continue in to the initial call. How many times have you had a priority 4 (no lights and sirens) turn into a priority 1 when you arrive? Or how often have you had the reverse of this, a priority 1 really turn out to be a priority 4 BLS call? We can't triage our patients without having them directly in front of us, and the EMTD triage is, to say the least, not always accurate.

[Guest FFD 246]

Is this the same rule of thumb or law when you know you are going to a confirmed emergency and you come across someone. For example, if I am responding to a cardiac arrest and then get updated by PD on scene that it is a full code and CPR is in progress, but I get flagged down for someone on a bike path who skinned his/her knee, I will held responsible and charged with abandonment for continuing onto the full code ad not stopping to apply a piece of gauze and some tape?

Or if you have a call for a stroke where symptoms began to occur say 30 minutes prior to the dispatch. You do not have much more of the left in the "Golden Hours" and while responding to get flagged down for a general malaise. If I stopped for the tummy ache and the stroke patient misses out on the "Golden Hour", the family of the stroke patient has no legal leverage on me?

What about if I am transporting a patient to the ER and while doing so I come across an MVA or man down on the side of the road and no emergency personnel is on scene. Do I legally have to do anything other than report it?

This is good to know. Thanks.

First off... I think this is a great discussion topic and would like to see posts by some of the most experienced members and chiefs for their experiences.

It is some what of a grey area, however, one clear rule is that once patient contact has been made, you are bound to that patient (except for transfer of care to same cert or higher). So, if you are transporting a pt to the ER, you may not stop for an MVA. You should call the accident into dispatch to avoid potential liability. Plus your service would get a very bad name if it came out that an EMS crew failed to report an MVA while driving by it (even w/ a pt in the back).

Just remember that for a lawyer to prove BASIC negligence, they must prove 4 elements:

1. The Plaintiff suffered injuries

2. The Defendant owed a duty to the plaintiff

3. The Defendant breached that duty

4. The Defendant's beach was the actual and proximate cause of the Plaintiff's injuries

Each element must be proven for a cause of action to continue to a jury.

Although you did not cause the actual injury (i.e. the MVA), the law recognizes a duty to act based on reasonable foreseeability that injury will occur.

The law views duty to act cases as "difficult" duty cases and many items have to proven as a matter of law. That is, the judge decides if the duty existed. It becomes a factual dispute for the jury when the knowledge of the defendants comes into question (i.e. did the crew know that they had a duty to act but still failed to do so).

After thinking about this question for some time, everything relates back to your EMT-B training. Remember those early sections on duty to act? When you are in uniform you have a duty to render care. You have a duty to not abandon. ETC...

The most important things I remember hearing during this section of training was the use of discretion and do no harm...

Just act in good faith and be true patient advocates. It will be very hard for a lawyer to go after you for most of the situations posted (except for the one when you have a pt and are en route to the hospital) so long as you exercise sound discretion. You can "What If" scenarios ALL DAY! Experience is the BEST way to learn the most appropriate course of action.

(NOTE: This post should not be relied upon for legal advice. It is simply to add to an educational discussion. Please consult a lawyer in your respective jurisdiction for any/all legal advice.)

[Jybehofd 85]

I have personally been caught in a couple of these scenarios and some one ones too, to cya i stopped, checked things out and called for another unit if i had a patient and my patient was stable. when my patient wasn't stable... make sure there is nothing life threatening and at worst leave my partner and ask a cop or something to drive the bus to the hosp.

The new situations i have been getting into is where there are no medics available in a fly car system all on minor BLS calls and a true ALS call comes in. You can't leave the scene because you and the cops are the only ones there... they need to peel off and go to the serious call now and you are left there waiting? what do you do? and the ambulance goes to the higher call and don't take the 1st call which is a minor BLS call? while they scream for a medic at the other job.

[PFDRes47cue 653]

First off... I think this is a great discussion topic and would like to see posts by some of the most experienced members and chiefs for their experiences.

It is some what of a grey area, however, one clear rule is that once patient contact has been made, you are bound to that patient (except for transfer of care to same cert or higher). So, if you are transporting a pt to the ER, you may not stop for an MVA. You should call the accident into dispatch to avoid potential liability. Plus your service would get a very bad name if it came out that an EMS crew failed to report an MVA while driving by it (even w/ a pt in the back).

Just remember that for a lawyer to prove BASIC negligence, they must prove 4 elements:

1. The Plaintiff suffered injuries

2. The Defendant owed a duty to the plaintiff

3. The Defendant breached that duty

4. The Defendant's beach was the actual and proximate cause of the Plaintiff's injuries

Each element must be proven for a cause of action to continue to a jury.

Although you did not cause the actual injury (i.e. the MVA), the law recognizes a duty to act based on reasonable foreseeability that injury will occur.

The law views duty to act cases as "difficult" duty cases and many items have to proven as a matter of law. That is, the judge decides if the duty existed. It becomes a factual dispute for the jury when the knowledge of the defendants comes into question (i.e. did the crew know that they had a duty to act but still failed to do so).

After thinking about this question for some time, everything relates back to your EMT-B training. Remember those early sections on duty to act? When you are in uniform you have a duty to render care. You have a duty to not abandon. ETC...

The most important things I remember hearing during this section of training was the use of discretion and do no harm...

Just act in good faith and be true patient advocates. It will be very hard for a lawyer to go after you for most of the situations posted (except for the one when you have a pt and are en route to the hospital) so long as you exercise sound discretion. You can "What If" scenarios ALL DAY! Experience is the BEST way to learn the most appropriate course of action.

(NOTE: This post should not be relied upon for legal advice. It is simply to add to an educational discussion. Please consult a lawyer in your respective jurisdiction for any/all legal advice.)

Agreed, this is a great discussion. I have always called in incidents that I have come across while transporting a pt to the ER. I have also always stopped while coming back from the ER and back in service when I have come across signs of distress. A lot of EMT-B students think that the material presented in the beginning of the course is "stupid" or "a waste of time." This is unfortunate because the information is very very very important to know and exercise properly.

I have personally been caught in a couple of these scenarios and some one ones too, to cya i stopped, checked things out and called for another unit if i had a patient and my patient was stable. when my patient wasn't stable... make sure there is nothing life threatening and at worst leave my partner and ask a cop or something to drive the bus to the hosp.

The new situations i have been getting into is where there are no medics available in a fly car system all on minor BLS calls and a true ALS call comes in. You can't leave the scene because you and the cops are the only ones there... they need to peel off and go to the serious call now and you are left there waiting? what do you do? and the ambulance goes to the higher call and don't take the 1st call which is a minor BLS call? while they scream for a medic at the other job.

This is a topic for another thread and is by no means an attempt to "bash" any ALS providers. But I have noticed/heard of Paramedics riding calls that could go BLS and then having a true ALS call come in and no ALS be readily available. I also think this is due to a visible lack of confidence on the faces of new EMT's. ALS providers need to feel confident in the BLS providers and know that they are leaving the patient in good, capable hands.

Edited March 19, 2011 by PFDRes47cue

[Guest rengaw87]

Just found this very pertinent article on JEMS:

http://www.jems.com/article/industry-news/patient-abandonment-what-it-an-0

Abandonment can also occur when the EMS system as a whole fails to respond to a patient s call for help. This can occur if dispatch refuses to send a unit, or when units from the local service are not available and no mutual aid is sought. Another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur. Appropriate use of priority dispatching systems and the development of mutual aid agreements will go a long way towards limiting liability for abandonment. Abandonment may occur in systems that do not have adequate mutual aid agreements, or priority dispatch systems, and instead stack calls in the order they come in, without regard to severity, until an EMS unit becomes available.

[Guest rengaw87]

This is a topic for another thread and is by no means an attempt to "bash" any ALS providers. But I have noticed/heard of Paramedics riding calls that could go BLS and then having a true ALS call come in and no ALS be readily available. I also think this is due to a visible lack of confidence on the faces of new EMT's. ALS providers need to feel confident in the BLS providers and know that they are leaving the patient in good, capable hands.

I also feel that this comes back to many private companies encouraging their medics to ride everything in for billing and liability purposes...don't get me wrong, I'm not saying it's right, but we all know it happens. Every time I turn something over to BLS I get scrutinized, sometimes it is just easier to ALS everything.

[Guest FFD 246]

This is a topic for another thread and is by no means an attempt to "bash" any ALS providers. But I have noticed/heard of Paramedics riding calls that could go BLS and then having a true ALS call come in and no ALS be readily available. I also think this is due to a visible lack of confidence on the faces of new EMT's. ALS providers need to feel confident in the BLS providers and know that they are leaving the patient in good, capable hands.

Yeah I know what you mean but remember that medics have a higher standard of care.

When a pt displays what seems to be a basic BLS call to an EMT-B, a medic may still have to ride the call in even if the call is without incident and could have been transported BLS in the end. A medic should (and does most of the time) have great discretion to decide downgrading. This is very important for their legal liability as licensed providers (as opposed to being certified). Once again, experience comes into play.

[helicopper 1,050]

Just out of curiosity, do you know the outcome of the patient abandonment hearings? I am having a hard time grasping that I am required to stop and render aid to a "boo-boo" when I am headed to a more critical patient, say the cardiac arrest. My partner and I felt the complete opposite way, that we are first obligated to our initial patient that called 911 and without both patients side by side in front of us such that we may triage we need to continue in to the initial call. How many times have you had a priority 4 (no lights and sirens) turn into a priority 1 when you arrive? Or how often have you had the reverse of this, a priority 1 really turn out to be a priority 4 BLS call? We can't triage our patients without having them directly in front of us, and the EMTD triage is, to say the least, not always accurate.

I do know the outcome of one abandonment case from many years ago. A Chicago FD EMS crew was sued for abandonment and wrongful death after a pediatric asthmatic patient died and they "didn't" respond. In a nutshell, the call was in a housing project and the crew was harassed and menaced upon arriving. When they got to the building, rocks/bottles and other air mail were thrown at them from the rooftop. They retreated, got back to the ambulance and left the area to await PD support. They were sued (and if I remember correctly the city didn't indemnify them and terminated or suspended them). The court ruled that there was no abandonment because they had not made patient contact and there was no wrongful death because they retreated for their own safety and returned once the scene was safe. It was the child's pre-existing medical condition that resulted in his or her death, not the actions or inactions of the EMS crew.

So, that's one case where the decision proves the point - they're not your patient until you make contact with them.

How do you know the cardiac arrest is a cardiac arrest and not a sleeping drunk or a non-viable DOA? If you're flagged down for a patient, I think you have to tend to that patient and get the other job reassigned.

In the first scenario the chest pain patient is not your patient until you get on scene. The could no more hold you responsible for getting flagged than they could jam you for getting into an accident on the way. Now failing to respond or intentionally delaying your response is a different matter. Your second scenario is the reason why the law does not differentiate between call types of the potential patient. There may very well not even be a patient at the scene, but there is definitely a patient in front of you at the accident or whatever you've been flagged for.

Thanks, ny10570, very well said.

alsfirefighter also made the point very well.

Great thread!

[helicopper 1,050]

I also feel that this comes back to many private companies encouraging their medics to ride everything in for billing and liability purposes...don't get me wrong, I'm not saying it's right, but we all know it happens. Every time I turn something over to BLS I get scrutinized, sometimes it is just easier to ALS everything.

That's pathetic and you should stick to your training and protocols. If it's BLS, it's BLS and a paramedic "riding with it" doesn't make an ALS call for billing purposes. Insurance companies are smarter than that and they look at admiiting diagnosis and treatment rendered before they pay. If it wasn't ALS it won't get paid for ALS (the same is being done for helicopter trips).

I can't believe that the F&B and Unity Ambulance Services are still alive and well in the 21st Century.

[Guest FFD 246]

Just found this very pertinent article on JEMS:

http://www.jems.com/article/industry-news/patient-abandonment-what-it-an-0

Abandonment can also occur when the EMS system as a whole fails to respond to a patient s call for help. This can occur if dispatch refuses to send a unit, or when units from the local service are not available and no mutual aid is sought. Another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur. Appropriate use of priority dispatching systems and the development of mutual aid agreements will go a long way towards limiting liability for abandonment. Abandonment may occur in systems that do not have adequate mutual aid agreements, or priority dispatch systems, and instead stack calls in the order they come in, without regard to severity, until an EMS unit becomes available.

Great article. Key to evaluating these issues is looking at who the author is. This particular author is an EMT-P AND a J.D. A rare combination of medic/lawyer. This article implicitly answers the initial question posed in the thread by stating, "another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur." The author seems to be implying an understanding that you may stop for the MVA.

Side Note: Since we are talking law here. MVA is not the best term to use. MVC - Motor Vehicle Collision. You don't know if it was an accident but you DO know that it was a collision. I never write MVA on run forms. I can see the lawyer now..."Sir, you wrote that it was a motor vehicle accident, correct?" (Yes) "So while you were eating lunch you witnessed this accident?" (No) "So you can't say for sure that it was an accident" (i guess sooooo).... lol

[helicopper 1,050]

Yeah I know what you mean but remember that medics have a higher standard of care.

When a pt displays what seems to be a basic BLS call to an EMT-B, a medic may still have to ride the call in even if the call is without incident and could have been transported BLS in the end. A medic should (and does most of the time) have great discretion to decide downgrading. This is very important for their legal liability as licensed providers (as opposed to being certified). Once again, experience comes into play.

I'm not sure I follow you. Yes, paramedics have higher standards of care as they relate to ALS interventions but they are still EMT's and if the call is BLS, an EMT is an EMT is an EMT.

Paramedics in NYS are still (and this is definitely for another thread) just certified and not licensed as they are in CT. I don't know if that somehow figures in to your point but a paramedic doesn't have to accompany a BLS patient if there is an EMT present. If you're talking about a patient in that gray area of maybe there's something more going on but right now they're stable, that's a different story and not (I believe) the premise we're discussing.

Using your logic a nurse or other licensed healthcare provider who is also an EMT would always have to accompany the patient by virtue of their advanced training but that isn't the case either.

[Guest rengaw87]

Great article. Key to evaluating these issues is looking at who the author is. This particular author is an EMT-P AND a J.D. A rare combination of medic/lawyer. This article implicitly answers the initial question posed in the thread by stating, "another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur." The author seems to be implying an understanding that you may stop for the MVA.

Side Note: Since we are talking law here. MVA is not the best term to use. MVC - Motor Vehicle Collision. You don't know if it was an accident but you DO know that it was a collision. I never write MVA on run forms. I can see the lawyer now..."Sir, you wrote that it was a motor vehicle accident, correct?" (Yes) "So while you were eating lunch you witnessed this accident?" (No) "So you can't say for sure that it was an accident" (i guess sooooo).... lol

I interpreted that line of the article a little differently. I believe that they were implying that if you divert to the MVC or a higher priority call, it is abandonment of the original caller. "If nothing is done for the initial caller, abandonment may occur."

[helicopper 1,050]

Is this the same rule of thumb or law when you know you are going to a confirmed emergency and you come across someone. For example, if I am responding to a cardiac arrest and then get updated by PD on scene that it is a full code and CPR is in progress, but I get flagged down for someone on a bike path who skinned his/her knee, I will held responsible and charged with abandonment for continuing onto the full code ad not stopping to apply a piece of gauze and some tape?

Or if you have a call for a stroke where symptoms began to occur say 30 minutes prior to the dispatch. You do not have much more of the left in the "Golden Hours" and while responding to get flagged down for a general malaise. If I stopped for the tummy ache and the stroke patient misses out on the "Golden Hour", the family of the stroke patient has no legal leverage on me?

What about if I am transporting a patient to the ER and while doing so I come across an MVA or man down on the side of the road and no emergency personnel is on scene. Do I legally have to do anything other than report it?

This is good to know. Thanks.

What if you crashed enroute to the call? Could you be held liable for not getting there? I sincerely doubt it. If you're not there, you're not there and they're not your patient.

On the subject of flagged down while transporting, I would say you have to follow your agency's policies on the subject (if you don't have policies on the subject it's a good time to get one). Unless your patient is critical (and that isn't the case 95% of the time), I would say stop. Driving by with that big orange and white billboard is bad advertising. If you have a crew of more than two you can always leave someone pending the arrival of additional help. If you're a crew of two you can simply inform them that you already have a patient but help is coming. In Westchester County an additional first responder is never more than a few minutes away.

[Guest FFD 246]

I'm not sure I follow you. Yes, paramedics have higher standards of care as they relate to ALS interventions but they are still EMT's and if the call is BLS, an EMT is an EMT is an EMT.

Paramedics in NYS are still (and this is definitely for another thread) just certified and not licensed as they are in CT. I don't know if that somehow figures in to your point but a paramedic doesn't have to accompany a BLS patient if there is an EMT present. If you're talking about a patient in that gray area of maybe there's something more going on but right now they're stable, that's a different story and not (I believe) the premise we're discussing.

Using your logic a nurse or other licensed healthcare provider who is also an EMT would always have to accompany the patient by virtue of their advanced training but that isn't the case either.

Sorry, Forgot to mention that I work in Connecticut. And yes this is a different topic from what we're discussing and should go to a different post.

What I was getting as was: At least in my medical region, if a pt displays certain criteria, a medic must ride the call even if he/she does not have to take any ALS interventions. This occurs even if the call could have been downgraded in hindsight. They would still obtain IV access and EKG monitoring. Its more precautionary. But also we have several medics in the region and it is very rare to hear "No medic available." - Something for another thread

Also, a nurse or other LHP who is also an EMT is bound to the standard of care for their service. EX: Nurse volunteering on an ambulance for his/her local ambulance corp can only operate as an EMT-B if EMT-B is the corps highest standard of care. If it was an ALS ambulance service, things get a little gray. THen again, in practice all changes on critical calls...Medics tend to use the nurses for ALS assistance.

[Guest FFD 246]

I interpreted that line of the article a little differently. I believe that they were implying that if you divert to the MVC or a higher priority call, it is abandonment of the original caller. "If nothing is done for the initial caller, abandonment may occur."

I think she was talking about the dispatcher failing to obtain another unit to cover that call.

[Guest FFD 246]

What if you crashed enroute to the call? Could you be held liable for not getting there? I sincerely doubt it. If you're not there, you're not there and they're not your patient.

On the subject of flagged down while transporting, I would say you have to follow your agency's policies on the subject (if you don't have policies on the subject it's a good time to get one). Unless your patient is critical (and that isn't the case 95% of the time), I would say stop. Driving by with that big orange and white billboard is bad advertising. If you have a crew of more than two you can always leave someone pending the arrival of additional help. If you're a crew of two you can simply inform them that you already have a patient but help is coming. In Westchester County an additional first responder is never more than a few minutes away.

Agreed with the crash enroute. You MUST call and notify dispatch that they need to find another unit

I disagree with regard to stopping while transporting a PT. This, at least where I work, is a BIG NO. Once again though, we can what if this all day.

[Guest rengaw87]

I just emailed the author of the JEMS article at the email address provided on her biography. Let's see if she responds. I think it will be very helpful to get the interpretation of an individual who is both a paramedic and works in the legal field. I will keep you all updated if she does reply.

http://www.jems.com/article/industry-news/patient-abandonment-what-it-an-0

[helicopper 1,050]

Great article. Key to evaluating these issues is looking at who the author is. This particular author is an EMT-P AND a J.D. A rare combination of medic/lawyer. This article implicitly answers the initial question posed in the thread by stating, "another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur." The author seems to be implying an understanding that you may stop for the MVA.

In context, the author specifically states (emphasis added):

Abandonment can also occur when the EMS system as a whole fails to respond to a patient s call for help. This can occur if dispatch refuses to send a unit, or when units from the local service are not available and no mutual aid is sought. Another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur. Appropriate use of priority dispatching systems and the development of mutual aid agreements will go a long way towards limiting liability for abandonment. Abandonment may occur in systems that do not have adequate mutual aid agreements, or priority dispatch systems, and instead stack calls in the order they come in, without regard to severity, until an EMS unit becomes available.

So, if I get flagged down for call 2 while responding to call 1 but get on the radio and inform my dispatcher and they assign call 1 to another unit (even if mutual aid), it is probably not going to be an issue.

Another situation highlighed by this article is if you're enroute to one call you can be redirected to a higher priority call. If we can (and should) do that according to priority dispatch systems you'll be hard pressed to make a case for abandonment or other wrong-doing when you encounter a patient while enroute to another.

[helicopper 1,050]

The new situations i have been getting into is where there are no medics available in a fly car system all on minor BLS calls and a true ALS call comes in. You can't leave the scene because you and the cops are the only ones there... they need to peel off and go to the serious call now and you are left there waiting? what do you do? and the ambulance goes to the higher call and don't take the 1st call which is a minor BLS call? while they scream for a medic at the other job.

This is a system problem and you have to consider why are all the ALS units tied up on BLS calls? Is it because there is no priority dispatching and medics go on everything? Is it because there aren't enough EMT's and the medic is serving as a BLS provider? Or is it because the system doesn't have enough ALS units for the call volume (if the existing medic units are tied up on BLS calls I'm guessing that this isn't the problem).

Cops are first responders too and I would like to hear a discussion about whether or not you could triage a low-priority BLS patient to them to await transport so you can respond to a higher priority job (interesting premise).

The EMT's "screaming for the medic" need to cut the umbilical cord and start being EMT's. Many of us remember when ALS was an urban novelty and not the standard of care. Back in those days EMT's took critical patients to the hospital and did... (wait for it)... BLS. Instead of screaming for a medic they should be an EMT and transport expeditiously. Hospitals are ALS providers too and the remotest part of Mount Pleasant isn't more than 10 minutes from 3 or 4 different ones.

[helicopper 1,050]

Agreed with the crash enroute. You MUST call and notify dispatch that they need to find another unit

I disagree with regard to stopping while transporting a PT. This, at least where I work, is a BIG NO. Once again though, we can what if this all day.

Sometimes these calls have two crews (4 people) on one vehicle. In that case why can't you stop and drop one or two of them off until other help arrives? The other point I made is that you need to have and follow agency policy on this subject. Your agency has a policy on the subject but I'm willing to bet there are many many more that don't.

I agree that you can't stop and commit to treatment but you can stop and inform them that help is coming and at least inquire about the conditions. I just think driving by in a big billboard is bad public relations.

I just emailed the author of the JEMS article at the email address provided on her biography. Let's see if she responds. I think it will be very helpful to get the interpretation of an individual who is both a paramedic and works in the legal field. I will keep you all updated if she does reply.

http://www.jems.com/...nt-what-it-an-0

Great idea!

[PFDRes47cue 653]

This is a system problem and you have to consider why are all the ALS units tied up on BLS calls? Is it because there is no priority dispatching and medics go on everything? Is it because there aren't enough EMT's and the medic is serving as a BLS provider? Or is it because the system doesn't have enough ALS units for the call volume (if the existing medic units are tied up on BLS calls I'm guessing that this isn't the problem).

Cops are first responders too and I would like to hear a discussion about whether or not you could triage a low-priority BLS patient to them to await transport so you can respond to a higher priority job (interesting premise).

The EMT's "screaming for the medic" need to cut the umbilical cord and start being EMT's. Many of us remember when ALS was an urban novelty and not the standard of care. Back in those days EMT's took critical patients to the hospital and did... (wait for it)... BLS. Instead of screaming for a medic they should be an EMT and transport expeditiously. Hospitals are ALS providers too and the remotest part of Mount Pleasant isn't more than 10 minutes from 3 or 4 different ones.

Great points. I agree that ALS is often to heavily replied upon by BLS providers. But I do not think that the lack of ALS availability and the fact that a lot of BLS calls are going ALS is is anyone one level of cares fault. It is a combination of a lot of things. I know some EMT's that rely on ALS because of confidence/experience issues. I also know some ALS providers that make almost every call ALS for the same reason because they second guess themselves, or worry that perhaps they missed something, and the call could infact turn into an ALS call.

And yes, Mount Pleasant does have nice proximity to hospitals...it is nice for a transport to take 3 minutes when you just jump on the parkway.

[ny10570 745]

Is this the same rule of thumb or law when you know you are going to a confirmed emergency and you come across someone. For example, if I am responding to a cardiac arrest and then get updated by PD on scene that it is a full code and CPR is in progress, but I get flagged down for someone on a bike path who skinned his/her knee, I will held responsible and charged with abandonment for continuing onto the full code ad not stopping to apply a piece of gauze and some tape?

Or if you have a call for a stroke where symptoms began to occur say 30 minutes prior to the dispatch. You do not have much more of the left in the "Golden Hours" and while responding to get flagged down for a general malaise. If I stopped for the tummy ache and the stroke patient misses out on the "Golden Hour", the family of the stroke patient has no legal leverage on me?

What about if I am transporting a patient to the ER and while doing so I come across an MVA or man down on the side of the road and no emergency personnel is on scene. Do I legally have to do anything other than report it?

This is good to know. Thanks.

If you are flagged, you are flagged. That is now your patient. What if you were on scene at a skinned knee and hear a call go out across town for that confirmed arrest? You're still obligated to either transport or RMA that patient.

You have no legal liability in that case unless you were to delay notification that you were flagged. What if that CVA were actually Bells Palsy and your general malaise was a massive MI? You assessed the sick, blew it off as just being a sick and hurried on to the stroke. Now you are in trouble because YOU denied the sick definitive care in a timely manner. If you get into a wreck on the way to call, its not your fault the patient didn't get the ambulance. If you stop for a sandwich then it is your fault the patient didn't get their ambulance.

If you're transporting a patient then once again the patient you have is your priority. if they're stable feel free to get involved. If they're unstable document accordingly. Accurately describe the situation over the air. Continue on to the ER. If stopping will cause harm to the patient in the bus, you must continue to the ER.

Edited March 19, 2011 by ny10570

[ny10570 745]

Just out of curiosity, do you know the outcome of the patient abandonment hearings? I am having a hard time grasping that I am required to stop and render aid to a "boo-boo" when I am headed to a more critical patient, say the cardiac arrest. My partner and I felt the complete opposite way, that we are first obligated to our initial patient that called 911 and without both patients side by side in front of us such that we may triage we need to continue in to the initial call. How many times have you had a priority 4 (no lights and sirens) turn into a priority 1 when you arrive? Or how often have you had the reverse of this, a priority 1 really turn out to be a priority 4 BLS call? We can't triage our patients without having them directly in front of us, and the EMTD triage is, to say the least, not always accurate.

He lost a few days pay and spent several weeks on a patient care restriction because he was wrong. He may have also been reprimanded by the state but I'm not sure.

The gist of the argument was that because we really don't know what we have till we actually get there we have to treat the patient we have in front of is. If you're on scene with a booboo and you hear a cardiac arrest get dispatched a few block away can you just leave the booboo for the arrest? Thats the way the state looks at it. It doesn;t matter where you were going, you are now on scene with your patient.

[ny10570 745]

Just found this very pertinent article on JEMS:

http://www.jems.com/article/industry-news/patient-abandonment-what-it-an-0

Abandonment can also occur when the EMS system as a whole fails to respond to a patient s call for help. This can occur if dispatch refuses to send a unit, or when units from the local service are not available and no mutual aid is sought. Another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur. Appropriate use of priority dispatching systems and the development of mutual aid agreements will go a long way towards limiting liability for abandonment. Abandonment may occur in systems that do not have adequate mutual aid agreements, or priority dispatch systems, and instead stack calls in the order they come in, without regard to severity, until an EMS unit becomes available.

This is an issue for the agency to handle. The liability here doesn't apply to the individual units as long as they're operating according to agency guidelines.

Edited March 19, 2011 by ny10570

[ny10570 745]

I can't believe that the F&B and Unity Ambulance Services are still alive and well in the 21st Century.

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.

[Guest rengaw87]

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!