Hypothetical: MVA enroute to the Hospital

[fiznat]

Something similar to this happened at my service, so I thought I'd throw this out there and see what you guys think.

You've got a critical patient in the back, someone who you feel needs to be at the hospital as soon as possible. While transporting lights + sirens to the hospital, your ambulance is involved in a minor crash with another vehicle. Neither your ambulance nor the other car sustained much damage, mostly just transfer of paint and a few scrapes.

What you know:

1. The MVA was minor and on a windshield assessment everyone is fine. No damage that would seem to prohibit driving either vehicle.

2. Police are immediately available.

3. Another ambulance is on the way but ETA is unknown. Could be anywhere between 1 and 10 minutes.

4. Your patient is critical (think trauma or severe respiratory distress).

5. Closest appropriate hospital is 2 miles away.

What do you do?

Edited April 28, 2009 by fiznat

[ncmedic309]

I'm going to add a reply, without the vote due to lack of other choices...

I would do the following:

1. Stop and immediately call dispatch and inform them of the accident, request an additional EMS unit along with PD - also requesting an EMS supervisor to the location.

2. Do a quick size-up, check to see if there are any injuries and see if we need any additional assistance.

3. Assess my vehicle to make sure it's safe to continue transport and if the other vehicle is able to be moved and the occupants aren't injured, have them remove the vehicle from the roadway.

4. Explain to the occupants of the other vehicle the situation, with PD and a EMS supervisor on the way and another ambulance if needed and then continue transporting the patient to the ED. I would also inform communications of the same and advise them to make sure that PD and the EMS Supervisor was also aware of the same.

This of course would all be done very rapidly in a few minutes time span and then immediately resume transport. I wouldn't delay waiting on another unit to continue care and transport, but you have the legal obligations to at least evaluate the scene and act accordingly before leaving. You could easily be charged with hit and run if you just yell out the window to the other vehicles and then continue the transport. This is the way I see it...

[fiznat]

1. Stop and immediately call dispatch and inform them of the accident, request an additional EMS unit along with PD - also requesting an EMS supervisor to the location.

OK. Also per the hypothetical the PD are immediately on-scene.

2. Do a quick size-up, check to see if there are any injuries and see if we need any additional assistance.

This one is interesting. Do we have an obligation to assess these patients or manage the scene in any way? If we were passing by an accident that had already occurred we would have no such obligation... Does it change since we were involved in it?

3. Assess my vehicle to make sure it's safe to continue transport and if the other vehicle is able to be moved and the occupants aren't injured, have them remove the vehicle from the roadway.

The hypothetical states that your vehicle is save to drive. PD is also on scene....

but you have the legal obligations to at least evaluate the scene and act accordingly before leaving. You could easily be charged with hit and run if you just yell out the window to the other vehicles and then continue the transport. This is the way I see it...

Do you? You're not an available ambulance, and some might argue that there are exigent circumstances prohibiting a full scene assessment. How is getting out to talk with the other driver different from communicating through the window? Does the presence of the PD matter?

[ncmedic309]

Ok, so my bad, PD is already on scene - that would speed things up quite a bit. Not very realistic, as in most cases like this PD won't be anywhere nearby since you need them right away. So if PD is already at the location, what is their response to you leaving the scene right away?

You shouldn't read to deep into it, doing a quick size-up to determine if there are any injuries is not breaking out the tools and performing assessments. It's fairly rapid, are you injured or not?

So I ask you this, show me anywhere in writing where it clarifies that an ambulance with a patient on board is exempt from the law when it comes to being in an accident and leaving the scene without any other regard? In my state, hit and run is illegal, and being on an ambulance with a critical patient is not an exemption. In all honesty, even going as far as I did in the initial reply could still land you in hot water.

I think either way your going to get a wide variety of responses from this one, there are legal obligations on both ends. You wanted to know what I would do, there you have it!

[Dustdevil]

If you stop to assess the occupants of the other car, you have essentially made "patient contact", and you now have a provider-patient relationship with them. Consequently, you can no longer leave.

Ignorance is bliss. And, of course, the scenario says there are no injuries.

Keep going and let the police and supervisor respond to the situation. Any information they need from you, they will get after the fact. It isn't exactly an emergent situation that they get your driver licence number. And your supervisor will be providing the insurance info.

[CBEMT]

We knocked a mirror off a car enroute to the hospital with a non-critical (I was in the back). We stopped, informed the other driver that PD was enroute, and continued transport. Dispatch notified our chief and the PD in that city, and when we cleared the ER we went to their headquarters to provide our info.

[fiznat]

I've read the state statutes and there is no specific exception for emergency vehicles or exigent circumstances that I can find. The law is fairly clear, and it says if you are involved in a MVA you must stop, offer assistance, and provide your information to the other person involved. There may be some common (case) law that I have not yet found, though.

The scenario says that it appears there are no injuries from a windshield assessment. ...Meaning you're not talking to the other driver, but everything looks fine. The other vehicle occupant still *may* be injured.

[Donavan]

What you know:

1. The MVA was minor and on a windshield assessment everyone is fine. No damage that would seem to prohibit driving either vehicle.

2. Police are immediately available.

3. Another ambulance is on the way but ETA is unknown. Could be anywhere between 1 and 10 minutes.

4. Your patient is critical (think trauma or severe respiratory distress).

5. Closest appropriate hospital is 2 miles away.

You shouldn't read to deep into it, doing a quick size-up to determine if there are any injuries is not breaking out the tools and performing assessments. It's fairly rapid, are you injured or not?

So I ask you this, show me anywhere in writing where it clarifies that an ambulance with a patient on board is exempt from the law when it comes to being in an accident and leaving the scene without any other regard? In my state, hit and run is illegal, and being on an ambulance with a critical patient is not an exemption. In all honesty, even going as far as I did in the initial reply could still land you in hot water.

If you stop to assess the occupants of the other car, you have essentially made "patient contact", and you now have a provider-patient relationship with them. Consequently, you can no longer leave.

Ignorance is bliss. And, of course, the scenario says there are no injuries.

Keep going and let the police and supervisor respond to the situation. Any information they need from you, they will get after the fact. It isn't exactly an emergent situation that they get your driver licence number. And your supervisor will be providing the insurance info.

In Connecticut ambulance are allowed to take four exemptions while running hot:

1. Exceed speed limits while using due regard for safety

2. Travel the wrong way on a one way street

3. Expect right of way from other vehicles

4. Park in otherwise restricted areas

None of these include leaving the scene of an accident. Check your local laws.

I do agree with Dustdevil, ignorance is bliss. Making patient contact and leaving without obtaining a refusal or turning patients over to equal or higher level providers is abandonment.

The whole situation sucks. You are bound to do what's best for your patient, but the law is the law, and we are usually held to a higher standard, especially when driving.

In Connecticut our ability to practice is limited to working in our ambulance service as part of a full crew (MRT and EMT, or EMT and paramedic). Therefore, transporting in the police cruiser would be absolutely out of the question for me. I would walk the two miles to the hospital first.

The last choice is an interesting one. I've always wondered about the potential ethical conflict of transporting people from an accident you are involved in. If any civil or criminal action were taken, you would be privy to information about that party that normally you wouldn't have, but you are still bound by HIPAA and privacy laws. I don't think I would transport the patients on my own, but I have the advantage of working in an urban environment, where I can usually get backup pretty quickly.

[Dustdevil]

Just for some anecdotal perspective, I have been in probably ten or twelve ambulance wrecks, of varying degrees, during emergent runs, over the years. The only time we have stopped at the scene was when we were hurt or the ambulance was disabled. Not once has there ever been any problem with this from the police or our administration. In fact, it has always been policy to proceed.

Of course, your mileage may vary.

[reaper]

Just for some anecdotal perspective, I have been in probably ten or twelve ambulance wrecks, of varying degrees, during emergent runs, over the years. The only time we have stopped at the scene was when we were hurt or the ambulance was disabled. Not once has there ever been any problem with this from the police or our administration. In fact, it has always been policy to proceed.

Of course, your mileage may vary.

Well, if PD is on scene already, then they know what happened and it would not be leaving the scene, plus you have notified dispatch. Roll the window down and inform PD that you have a critical Pt and you will be back after you are done. As stated, if you get out an assess, you then have abandonment. Your first obligation is the pt in the back.

Now, if there were serious injuries, then that may change the scenario.