Multiple patient, single ambulance transport scenario..

[Just Plain Ruff]

So if we stop, render care and delay transport for the patient in the back.

That said patien in the back crashes and codes while you are doing whatever to the patient in the car.

The patient dies.

Is that not negligence.

1. you had a duty to act - your duty was to your patient not anyone else.

2. You breached that duty - you left your patient or delayed transport to take care of the other victim

3. your patient suffered harm

4. The patient suffered harm based on your actions

Doesn't that make you negligent? I think that all 4 of the criteria for negligence have been met.

Or am I wrong?

[HERBIE1]

I'm going to split hairs on this one, Dwayne. I will differentiate between medical and trauma patients. Normally you would never have 2 critical patients- someone may get the short end of the stick in terms of attention. If I MUST take 2 critical patients, I would feel a bit better if they were traumas vs an unstable medical or cardiac. Generally if a trauma patient crashes. it's not a problem you will fix with a cardiac medication. Has it happened to me? Yep. MCI's. Multiple critical patients, and a couple cases of poor triaging where patients go from green to red after we assess them. Is it rare? Also yep- the luxuries of having lots of help in an urban area.

In terms of what you did- it's easy to play Monday morning QB, but as we all know, the best laid plan- and sometimes even a few "rules"- in EMS usually go out the window when things really go to shit. As long as you are trying to do what's best for your patient, to the best of your abilities, with the resources you have available, and notify medical control of the situation- we improvise. That is what we do.

So if we stop, render care and delay transport for the patient in the back.

That said patien in the back crashes and codes while you are doing whatever to the patient in the car.

The patient dies.

Is that not negligence.

1. you had a duty to act - your duty was to your patient not anyone else.

2. You breached that duty - you left your patient or delayed transport to take care of the other victim

3. your patient suffered harm

4. The patient suffered harm based on your actions

Doesn't that make you negligent? I think that all 4 of the criteria for negligence have been met.

Or am I wrong?

You are correct. Stopping enroute to a call or while you have another patient IS negligence. I know someone here who took a "long vacation" because they did just that. Call it in, give as many particulars as you can and move on.

[DwayneEMTP]

Yeah..though I know beyond a shadow of a doubt that you are all right...

I'm thinking that the school bus would be the end, or likely end of my EMS career. I can't imagine any way that I'm not going to stop and try and render what aid I can...30 minute response to that type of scene is going to cause all sorts of unnecessary morbidity/mortality likely, much of which can be easily mitigated...

It's not the same as choosing whether or not to stop in my car. I've got an ambulance full of shit, the MOI makes it likely that I can make a difference here for many...

I know the right anwer, but I also knew it in the last job that got me fired when the right answer conflicted with what I believed to be the right treatment. I just always have this silly awareness that I can find another job, but I can't ever go back and undo a terrible thing, when I could have avoided it, to the best of my ability to see such things, from a human point of view as well.

I've had to triage...and I hate it worse than anything in the world when lives are possibly at stake...but I can and will do it...I'm thinking that this would become a triage situation for me...not the car possibly, but the bus. And I will move on, after they jerk my cert, to something else..

Yeah, stupid answer I know...but it's as honest as I know, at this point in my life and career.

Dwayne

[DFIB]

The bus scenario makes me wonder, What if we are passing the scene of a school bus MCI and explain what we are seeing to our patient in the ambulance, try and get their consent to stop and render aid. Would patient consent reconcile the disparity between Duty to Act to our patient and the moral desire to help the many? Would this negate neglect?

[RaceMedic]

Why is an MCI more important that an single car roll over ?

Race

Didnt edit anything ... hit the wrong button

Edited October 26, 2011 by RaceMedic

[DwayneEMTP]

From a triage point of view, the most good for the most number.

If I've got a critical patient onboard, and one in the care I've not improved the triage situation by stopping. But one for many? Man, like I said, I know the right answer, I'm just not sure that I could ever just drive by, wait 15 mins for a radio signal, or whatever the scenario states, and then know that I'm 15 mins down the road and EMS has only just been activated...tough call..

Dwayne

[RaceMedic]

But let me ask this now,

So you have stopped for the MCI, at what point do you send the ambulance on its way 15 min (or farther) down the road to get radio signal without you in the back with the original PT? as was pointed out once you pull out your bag of toys your stuck. Then your ambulance has to come back and wait till the cavalry arrives to continue on with your original mission. As i see it that is additional time for your critical IFT to be completely left alone.

I see this the opposite way,I would stop and help the single car roll over. and drive by the MCI. purely because i feel that the impact and alone time on the original PT would be minimal. And i can transport and provide cares for both if the roll over can be rapidly extricated. (life over limb).

Where as the MCI needs requires more people, more equipment, more time. As you said its triage. For me i think in these scenarios that i can do more good for the 2 than the many, due to time, logistics, and ability. Also by doing as accurate scene sizeup as i drive by as i can then the responding agencies can bring the appropriate response from the initial call and actually be there faster and with whats needed than if i stopped and delivered what little care i could with what i had.

At least this is what i think i would do.

Race

Some one mentioned asking permission, always if the PT is alert!!!

[DFIB]

Some one mentioned asking permission, always if the PT is alert!!!

AO x 4 would be good.

I don't know why MCI tugs at the heartstrings. That is a good question. Many of the decisions I make outside of EMS are oriented around doing "The greater good for the most people". I guess this sentiment bleeds through while on the truck as well.

I can't deny the disparity between the rules and what I think is best. I think Dwayne said it more eloquently in one of his post. Possibly it is the human suffering I know is out there. Possibly somewhere inside I want to be a hero.

Possibly because in my dreams I am always Batman and never Robin. I simply don’t know.

.

[DwayneEMTP]

...

But let me ask this now,

So you have stopped for the MCI, at what point do you send the ambulance on its way 15 min (or farther) down the road to get radio signal without you in the back with the original PT?...

Yeah...that was pretty much my plan.. :-)

...Then your ambulance has to come back and wait till the cavalry arrives to continue on with your original mission. As i see it that is additional time for your critical IFT to be completely left alone.

I know! But....(add something really smart here.)

...I see this the opposite way,I would stop and help the single car roll over. and drive by the MCI. purely because i feel that the impact and alone time on the original PT would be minimal. And i can transport and provide cares for both if the roll over can be rapidly extricated. (life over limb).

Screw you...and the horse your argument rode in on...

...Where as the MCI needs requires more people, more equipment, more time. As you said its triage. For me i think in these scenarios that i can do more good for the 2 than the many, due to time, logistics, and ability. Also by doing as accurate scene sizeup as i drive by as i can then the responding agencies can bring the appropriate response from the initial call and actually be there faster and with whats needed than if i stopped and delivered what little care i could with what i had...

Man, I was so far off in the ditch on this it's ridiculous. I was sort of trying to free associate and just posted an opinion that seemed like the actual course I may followed had I been actually presented with this situation. And I'm glad I did. Because I think I would have...and been completely, horribly wrong. Awesome answers all..thanks for taking the time to explore this. I know the 'a bus load of nuns was hit by a plane full of infant hemophiliacs, there's no flight and the radios are down' scenarios can be silly, but sometimes they pay dividends I think.

...Some one mentioned asking permission, always if the PT is alert!!!...

Yeah, I kind of imagined asking this over my shoulder as I'm running down the street with my jump bag, yelling to my partner, "Ask them if this is ok! If they say no, touch em with a little Versed and then ask again! Don't forget to get them to sign!!")

(Of course in this nightmare Flaming jumps out of the bushes, jumps into the ambulance screaming, "He's retarding your treatment! I am hereby notifying you that this is not an optimal treatment plan!!") (Having a little fun at the expense of your argument brother, wasn't meant to be a cheap shot. Funny, though, right?)

Can you tell that it's really past my bedtime at the end of a long day?

Great discussion all, thanks for playing. Though, apologies to whoever's thread we hijacked to have it.

Dwayne

[Eydawn]

Dude. It's your thread. ROFL.

No response to my analysis? Sad me. Can someone at least clue me in to the risk of Nipride drips? It is a vasopressor, right? So... you need close monitoring to prevent tanking the patient and to keep good perfusion, right? Or am I off in the ditch with the nuns and hemophiliac orphans?

Wendy

CO EMT-B