Treating minors

[chappy]

Our church has a security focus and is getting a focus on providing for emergent medical needs. As the only one with any real experience in the area, I have been drafted to lead the medical team. So, at the moment, we are working on developing policies for this medical team. I am writing because I have a policy question.

We have a regular congregation of about 450 people. During revivals and other special services, attendance may reach 550-600. In addition to that, we run buses and bring in an additional 250-300 children. These children are predominately from impoverished / low income areas. We plan to incorporate ‘consent to treat’ into the standard permission form these children’s guardian sign already. My question is: when we cannot locate a guardian, when should we call EMS? Of course, with that many kids running around, we have the usual bumps and bruises which really do not require EMS, but without parental input, should we make that call? Over the last year, we have had two incidents which I feel required a little more care than was provided. One was a 5 year old who ran into the corner of a table. He had a small (about .5cm) head laceration with a small hematoma. He was scooped up and taken home to mommie. The other was a sixteen year old female who was brought to me complaining of chest pain and shortness of breath. She had a good, strong and regular pulse, no obvious respiratory distress, no sign of apnea, etc. Against my better judgment, we drove her home also. What if the head lac represented and underlying head injury? What if the chest pain was more serious? We would have been sued!

I have spoken to our local EMS director seeking guidelines, but the only answer I could get from him was, if you have any doubt, call 911. Well, I obviously don’t want to abuse EMS. However, it is often difficult to locate a guardian for these bus kids. So, if we cannot locate a guardian, and there is a seemingly minor complaint, what would you do? What guidelines would you suggest for activating EMS as opposed to treating and releasing a minor child. I would like to put a policy in place which does not require any thought, at all, on behalf of our responders. As I said, I don’t want to abuse EMS, but I am also looking for a way to defer liability from our church. My thinking is: if EMS shows up and recommends no transport, it becomes their decision (and liability), not ours. However, that leaves us with the prospect of our church being labeled as an abuser and potentially displacing a truck which could respond to a serious call. Our church is in the middle of nowhere, on the county (and state) line. Assuming everything is in place, the nearest BLS crew is 10 minutes away, the nearest ALS crew is 15-20 minutes out.

Also, how does your service handle minors when you cannot locate a guardian?

[Just Plain Ruff]

Call EMS when in doubt. They can call medical control and get permission to transport if no parent is to be found.

Call EMS when you think you need them, you can always cancel them enroute.

Lifethreats - call 911 but that's a given

In this day and age with everyone including the kids having cell phones, there really shouldn't be hardly ever a situation where you cannot find the parent or guardian.

Think of it this way with the reputation of churches being what it is and bad publicity all over the news, would you want to be that church who didn't call 911 when it was warranted but you waited to find the guardian?

[chappy]

In this day and age with everyone including the kids having cell phones, there really shouldn't be hardly ever a situation where you cannot find the parent or guardian.

Think of it this way with the reputation of churches being what it is and bad publicity all over the news, would you want to be that church who didn't call 911 when it was warranted but you waited to find the guardian?

Thanks. Most of the kids I'm talking about are indigent and do not have cell phones. While their parents may have a phone somewhere, it is likely that their phone number may change every month and we may not have the correct telephone number for them on file. It is also likely that the parent may be as much as 45 minutes away, if they are home when we get there.

Also, there is little doubt that we would call EMS in the event of any injury or illness which is even slightly more than minor. The question is in how to respond to the very minor injuries. The county I worked for had a policy of transporting any person under the age of eighteen, unless a guardian could be located to refuse transport. This was a complete waste! Are you suggesting we defer every injury (skinned knee) or illness to EMS? That would seem like a waste of resources. My quandary is in finding that balance between a need for EMS and a waste of resources, then defining that line in a policy which would protect the church.

The other issue is in defining minor. My perception of a "minor injury" would be different than the perception of one of my team members who has had no experience.

Thanks!

[Just Plain Ruff]

Are you suggesting we defer every injury (skinned knee) or illness to EMS?

I don't think I said anything of the sort of deferring every injury to EMS. Nope, didn't.

I said, when in doubt call EMS.

And with your church taking indigent children in, (which is admirable) consider the legal ramifications and the negative publicity your church would receive if you had a child injured or sick and you waited to get a hold of the parent before you called EMS. Would not be pretty especially since you have already identified that you are going ot have a medical team that should be trained to some sort of competence to determine if a injury or illness requires 911. If you wait till the child's parents can be located which you said could be at least 45 minutes or darn near next to impossible to get ahold of them, then you run the risk of putting your Church at the bad end of negative publicity and a nasty lawsuit.

When you put a medical team together you put yourself at a higher level than many churches and you open yourself up to a higher level of scrutiny in a legal and medical arena.

[paramedicmike]

If you're looking for a way to defer liability for your church then you need to get a lawyer involved. Or, if that's not possible, see if you can convince one of the local docs to donate some time to the first aid tent you will have set up. Even better, if you have a doc as part of your congregation see if you can get him/her to handle the medical tent.

But seriously, if you're concerned about legal issues surrounding your church and its practices then you need a lawyer. Try to find someone with experience in medical liability issues.

[Bernhard]

With some experience in event standby medical service, responding to surrounding youth camps (even completely evacuating two of them since) and in EMS: if you're thinking a tenth of a second to consult EMS, call them!

Some additional advice:

• a decent medical post with somewhat trained people (at least frequent first aid courses, maybe there are EMTs or other medical personnel with your guests available, at least on short notice) is a good idea.
• tell the EMS providers in this area that your camp is there. Makes finding easier and they may understand your problem. Maybe they're even willing to assist with good tips, supplies or staff (provde free lunch! ).

I don't think that you will gain a bad reputation from EMS providers if calling EMS frequently. They may be better prepared if they know, that there is a gathering.

Transport policy is locally different as I understand. Ask the locals then, let them handle this.

Setting up standards is difficult and will require professional advice (both, medical and law). Some general advices would be enough for the start ("if unconcious any time...", "still bleeding after 5 minutes...", ...), I think. A good thing may be to educate your first aid staff with several practical training examples before (or even during) the gathering.

Good luck!

[Just Plain Ruff]

If you're looking for a way to defer liability for your church then you need to get a lawyer involved. Or, if that's not possible, see if you can convince one of the local docs to donate some time to the first aid tent you will have set up. Even better, if you have a doc as part of your congregation see if you can get him/her to handle the medical tent.

But seriously, if you're concerned about legal issues surrounding your church and its practices then you need a lawyer. Try to find someone with experience in medical liability issues.

I agree Mike, so many churches in their push to get congregants and people in their door and provide good services, many often forget the basics and just do what feels right. Sort of they do what jesus would do.

But to forget or overlook the basics is to open yourself to liability beyond compare.

My church is quite security conscious. We have many paramedics and emt's as members and they are the members of our medical team. We also have retired and current law enforcement officers who help out with security, especially with large gatherings like Vacation Bible School with a expected attendance of around 500 kids.

A focus on liability must also include your insurer in the mix. They are the ones who will foot the bill for any liability that the church is insured against.

We also have several physicians in the congregation and they have been involved with helping out the medical team with what they can or can not do.

We do not think twice about calling 911. When a medical issue or security issue is discovered 911 is called immediately, the medical team is dispatched and we go from there. You can always cancel or disregard the EMS Team that's on the way.

[uglyEMT]

A couple of things to assist you.

1. Get your insurer involved, find out what they need as far as "covered medical team"

2. Lawyer, get an ironclad permission slip. I would including wording along the lines of.. if ____ gets injured EMS will be notified immediately and treated initially on site by our medical team. If said injury is minor and treatment and /or transport is not needed do you _____ give _____ permission to sign a RMA. If transport and / or further treatment is necessary do you ____ give ____ permission to allow said interventions.

3. Contact your local medical director. Get him onboard and see what he will allow and or guidlines for you.

4. Contact your local EMS agencies as has been stated. They may be able to help w/ staffing OR are at least prepared for the added call volume. I know in our area the local state park hosts mountain bike races with their own staff. On that day, being my squad would be the responding squad, we put on extra crews just in case. Hell we have responded to numerous RMAs during the events and don't think twice about it.

Beyond that.. when in doubt call us out!

[chappy]

a decent medical post with somewhat trained people (at least frequent first aid courses, maybe there are EMTs or other medical personnel with your guests available, at least on short notice) is a good idea.

Thanks. We have an ER Nurse, me (re certifying) and some folks with AHA First Aid.

1. Get your insurer involved, find out what they need as far as "covered medical team"

We have found that, since our medical team will be providing incidental medical services, as opposed to operating a clinic as a part of the ministry, we are covered for what we do to provide immediately necessary medical treatments. Additionally, no one is getting paid for participating in our response team. Therefore, Good-Sam laws cover us in our state.

2. Lawyer, get an ironclad permission slip. I would including wording along the lines of.. if ____ gets injured EMS will be notified immediately and treated initially on site by our medical team. If said injury is minor and treatment and /or transport is not needed do you _____ give _____ permission to sign a RMA. If transport and / or further treatment is necessary do you ____ give ____ permission to allow said interventions.

Got that in hand...

3. Contact your local medical director. Get him onboard and see what he will allow and or guidlines for you.

Haven't thought of that... I did contact the EMS director ... shall we say, cranial-anal impaction.

4. Contact your local EMS agencies as has been stated.

see above.

Hey, everyone, thanks for the input!

[Just Plain Ruff]

We have found that, since our medical team will be providing incidental medical services, as opposed to operating a clinic as a part of the ministry, we are covered for what we do to provide immediately necessary medical treatments. Additionally, no one is getting paid for participating in our response team. Therefore, Good-Sam laws cover us in our state.

Are you sure about that. I'm not familiar with your states law but I would suspect if you are associated with the Church for this I would double check that.

I'm not trying to hold you down on this but I think that since your team is sanctioned by your church that you might need to revisit that discussion.

I hope you are right but I'd hate to have you be wrong.

I really admire what you are doing, our church has had a medical team up and running for a couple of months, near a year and in that time they've responded to about 10 incidents.