Drive By Medics - Are You At Risk

[mikeymedic1984]

We have all been there, you are either enroute to an emergency or you are transporting a patient emergency, and you come upon an MVC. Let's take the lowest extreme and say it is a minor fender bender and everyone is out of their vehicles and walking around. You slow down, yell out the window are you OK, and everyone says yes. You state that you will call in their wreck to 911 and get help to them, and you continue on your call.

Are you at any risk for not stopping and waiting on help to arrive. Is it abandonment ? Can you cite a specific law in your jurisdiction that protects you should one of the accident victims later sues and says they had neck injuries that were worsened by your lack of care, and/or the delay in care ? I realize that you may have a policy in place, but does that policy protect you ? What do you do ?

[DwayneEMTP]

I can't cite specific law, but you not only, to the best of my knowledge have an obligation to stop in most places, but you have no right to stop.

You have a duty to act with the patient that you're currently caring for, stopping, particularly for a fender bender is neglecting that duty.

This topic has been often discussed, but instead of referencing another thread I hope that we can have it again with the new providers that we have one the site.

[paramedicmike]

I'm interested in seeing if anyone has any specific legal insight on this.

I've always worked under the practice that if I was responding to a call, and especially if I had a patient on board, I was committed to that call. Anything I came across may, or may not depending on the patient's status, warrant at least a slow down to ask if additional help was needed. On more than one occasion I've called in an accident while responding to another call or on the way to the hospital.

Dwayne, I'm not sure I understand what your first sentence is saying. Clarification, please?

[mobey]

The specific law is covered in a few places here in Canada.

First to clarify.

The charge you are asking about is negligence.

In order to be true negligence there must be 3 criteria met.

1) Must be a duty to act

2) Must be a breech of that duty

3) Must be adverse outcome as a direct result of that breech

Duty to act: If we are already on a call, we are classified as "not for hire", then we have no duty to act.

That was easy....

Now the grey part: If we are enroute to a low priority call, and we witness a potential patient, we must advise our dispatch or call 911. At that point we may get re-routed to respond to that scene instead of that original low priority call. The legal responcibility at that point is on dispatch.

Now if you stick your head out and ask if everyone is OK..... well then, you have created a relationship with the potential patients and you're back on the legal hook. You have put yourself in a tough position, as you now have to triage between the people at the crash and the patient you are responding too.

Of course you can always give the crash-patients information to dispatch, and let them advise you which call to attend too, giving them back legal responsibility.

[DFIB]

Duty to act is king. Once the call comes in not only are the Medics obligated to respond but the entire system is held responsible, from the Medical Director down.

Also, as far as I know we are not allowed to freelance for many different reasons that I am sure I don't remember all of but one that comes to mind is scene safety because dispatch is not informed of location and resource efficiency, particularly if your unit is located in an area that has a deficit for EMS.

EDIT: I agree with Mobey. If I cannot stop and help then there is no reason to ask any questions.

Edited July 19, 2012 by DFIB

[JakeEMTP]

I agree with Mike on his thought process. I have always assumed if we were on a call, we were on THAT call. Especially if we were transporting so we need not stop at a minor MVC.

I should say, I have on a couple of occasions, called dispatch whilst enroute to a call when we came across an MVC or a higher priority call came over the radio. I'd inquire if the wanted us to stop at the MVC, or respond to the higher priority call if we were the closet unit. I will give dispatch the option on what they want us to do.

[chappy]

It would seem that if you make contact with persons at the scene of the MVA, you have initiated patient care. If you leave the scene without transferring patient care or obtaining written refusals, you would be guilty of abandonment.

So, the question is: whether to make contact or not. I would have to say in most cases, you should make contact and wait for other responders to arrive. Of course, you will have to weigh that decision in the light of your current patient as well as the potential for injury of those in the MVA. In any case, be prepared to document and defend your decision.

It is an ugly hypothetical.

[paramedicmike]

It is an ugly hypothetical.

What about this is hypothetical? I've run into this on multiple occasions.

[mikeymedic1984]

I see it as no different as being dispatched on a chest pain call, and before you leave the station a patient drives up with chest pain. Do you tell them to wait on a second ambulance to respond to the patient ? I know it is easy for us to say that since the patient we have just come across is not critical (in the wreck scenario -- but how can you claim that with no physical assessment performed), that is OK for us to defer them to someone else and leave, but no hospital is allowed to do that, they can be working 5 cardiac arrests, but if another one comes in you just cant let the 6th one wait in the lobby; once a patient has presented to the hospital property, the hospital has a duty to act. Do we not have a duty to act when we are less than 20 feet from a patient ? I know our answer, but I am guessing lawyers would have a much different answer.

[DwayneEMTP]

It is a really confusing situation.

I was dispatched to the local detox once for a well known EMS abuser with a complaint of 'twitching eye.' ( I usually don't describe people in such a way, but this man, his family and friends used to all get drunk on the same night and call the police on each other so that they could sober up in detox with decent good and a warm clean bed.)

I was the only ambulance on duty in the county during the nighttime hours. Enroute a second call is dispatched for 'unresponsive, not breathing.'

I notified dispatch that we should divert to the apparent arrest call, they refused and called in the second unit, approximate time to the ambulance bay, 15 minutes. I disregarded dispatches instructions and went to the arrest instead. Upon arrival at the 'arrest' it turned out that there was no patient on scene. A mom had tried to wake her drunken adult son, couldn't, believed him to be dead, and called 911. He'd heard her call, didn't want to deal with them so got dressed and left the scene.

I left there, and went to the twitching eye, which turned out to be a minor tic, as I'd suspected, but what if it had been an early stroke instead?

I took a pretty good beating for diverting, which I accepted gracefully, and to the best of my knowledge my cert was never in danger, but I'm still not sure if that was a good decision on my part or not.

When the late Dust Devil was here he posted a thread about a crew transporting an infant secondary to seizure. They witnessed a car hit head on into a telephone pole. The crew stopped, the driver of the ambulance went to see if the driver of the car was ok, the driver of the car started shooting at them forcing them and their patient out of the ambulance and into a cafe until police could clear the scene for them.

They were lauded as heroes, but I, and Dust, kind of thought that they were off in the ditch. My main complaint being their claim that the child wasn't in danger because it was simply a febrile seizure. How did they diagnose that in the back of an ambulance do you suppose?

Is stopping for a moment the right thing to do if you have a non critical patient onboard? Morally I think so, ethically the issue is as clear as mud, and legally, well, then it's just a crap shoot.