Drive By Medics - Are You At Risk

[DFIB]

I still have to follow the logistics thought and that Medical Direction, through standing dispatch orders, is in control of where and when units are dispatched.

They have to have this control because of the corporate duty to act. It is not our choice to stop at a secondary. It is not our choice to divert to a secondary. We are employed by a company, driving their rig, using their equipment and practicing medicine under their license, permits, accreditation and Medical Direction. We are contractually obligated to the company's duty to act and must conform. Our employer decides where we go and even what we do through protocols, standing orders and Medical Direction.

When we volley we are trusted by Medical Direction as an extension of their permits and obligations to the community. We cannot freelance.

I believe this discussion stems from confusing sentimentality with ethics. Ethics dictate we should honor our contracts and duty to act that derive from them.

Sentimentally we feel the need to stop and help. It is in our very nature, the tapestry of devotion to mankind that first motivated us to be medics.

I think that if we succumb to our emotional need to stop at a secondary incident I am pretty sure that legally we would be in the ditch and absolutely on our own if the original patient decided to sue.

If the secondary decided to sue then duty to act is our protector as well as our constraint.

[mikeymedic1984]

OK, so you see a child drowning in a lake that has a sign posted that says "No Swimming". Do you honor the rules and let the child drown ? EMS is all about gray areas that lie in between the rules.

[paramedicmike]

OK, so you see a child drowning in a lake that has a sign posted that says "No Swimming". Do you honor the rules and let the child drown ? EMS is all about gray areas that lie in between the rules.

Seriously? Do you think you can identify someone who's drowning that quickly? I worked many years as a life guard and I'm not so sure I could identify someone drowning in a split second as I drive by on my way to either a call or to the hospital.

Of course, if you notice something like that I'd have issue with why your eyes weren't on the road especially if running lights and sirens or with a patient on board.

[mobey]

OK, so you see a child drowning in a lake that has a sign posted that says "No Swimming". Do you honor the rules and let the child drown ? EMS is all about gray areas that lie in between the rules.

I would call the lake owner to quantify if that is recreational swimming, or lifesaving swimming to save a drowning child.

This is as likely as seeing someone choking on the side of the road on the way to a call.

You're reaching.

Please see my signature below.

Edited July 22, 2012 by mobey

[mikeymedic1984]

Not reaching at all. Dispatch can prioritize calls made to them because they have a scientific method that is an industry standard for triaging patients by phone. A patient is a patient, and all patients are equal until proven otherwise. So if this patient in the new MVC has called 911, and has been triaged as a low acuity, you have some grounds for passing them by, but if not, and you are the highest level of medical care passing by them, I think you have a duty to stop and at least assess.

To me, it is similar to ER triage. Imagine if the triage nurse assigned acuity to every patient in the ER by how they looked, without taking v/s or doing any assessment other than they are "up and walking", so they can wait behind everyone else.

The statement about the kid drowning in the lake was in response to someone who said you had to blindly follow protocols and policies.

[Eydawn]

Of course you don't blindly neglect something that is right in front of you... we have the ability to advise dispatch of circumstances that arise, thereby placing the "walk up" or "drowning child" into our duty to act.

This puts me in mind of the thread where we discussed an interfaclity transport of a critical patient on 'pressors and came across an MVA in the middle of the boonies and there's nobody around, what do you do... the honest answer is you do the best you can based on the judgement call you make given the circumstances you find yourself confronted with. That's what we do, every day, except sometimes the circumstances can be atypical or extreme.

The patient you are already treating comes first; if you have that 6th cardiac patient roll up to your hospital, you don't abandon the folks you're working on, you just pull in more resources. That's the beauty of a hospital, you have more resources at your disposal. In the field, you don't necessarily have that luxury. You can end up in a damned if you do, damned if you don't situation, but those are the exception.

In general, in non-rural areas, with good expectation of a reasonably fast second unit to respond to the witnessed MVA, your priority should be on responding to the "known" patient (as much as a patient can be "known" through dispatch...) because that is your contractual obligation. In the hairier, more rare situations? It's up to you, your dispatcher, and the best you can do. If you're the only provider in a hefty time-to-response radius, I would think your obligations may differ. Arckticat?? Remote guys? What's your take?

Wendy

CO EMT-B

RN-ADN Student

[DFIB]

@ Eydawn. My previous post was directed at the first world where additional resources are available. In the third world we really have no rules as far as stopping in a practical sense.

It is a very rural environment where we are the only EMS ambulance in town since the FF wrecked their ambulance. The service covers 9 counties. I have transported as many as four patients, dropped an EMT off at a MVC when we are already en rout to the hospital with another patient and almost always stop to see what we will be coming back to. Sometimes we triage and have LE transport in pickup trucks.

It is an entirely different ball game in areas where resources are so extremely limited. But in a world where there are rules and regulations they must be adhered to.

[MikeEMT]

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 ?

I won't give legal advice, but having been a cop and PI I am very well versed in the law. Here is my interpretation and what I would do. The law may vary based on your area so consult your protocols and company lawyer for clarification.

The law is pretty clear that you cannot abandon your patient. This includes both while enroute to the scene and enroute to the hospital. Sounds simple.

However, the law is not about what is written but rather how it is interpreted. If it were based solely on how it was written, everyone convicted of murder would get life in prison and there would be no need for judges and lawyers (ah, what a perfect world that would be).

Interpretation comes down to a legal standard called the Reasonable Person Standard. Basicly, what would a reasonable person do in the same situation and given the same information that you had at the time.

Unfortunately, saying "I couldn't stop because I had a patient" is likely not going to fly. Stopping is also not going to fly either.

The simple answer is there is no simple answer. You need to make your decision to stop based on information you have at the time. The ability for you to justify your actions will save you. If you are responding to a call (we all know how accurate dispatch info is) do you think the call can be delayed or another unit respond? If you have a patient, will your actions be depriving your patient of the care they deserve? The public doesn't know or care if you have a patient, they just see an ambulance and EXPECT you to help.

When you are out and about and you see a cop do you ever think about the fact they might be on a call, or do you ASSUME that you can always go up to that cop for help? I can't tell you how many times I was on a traffic stop or working an accident only to have someone come up and ask me for directions. Nothing like having your gun drawn on a felony traffic stop and some old couple walks up and asks you where the nearest mcdonalds is.

Unfortunately the public expects you to help them. Whatever you do you need to be able to justify your actions. There is no way to accurately give a definitive answer on this.

[Bernhard]

We have pretty clear rules (I can cite the laws and regulations, but they're in german):

• If causing an accident en route you're obliged to stop and wait until things are regulated (exchange of addresses and such), even if there are no injuries. You have to inform dispatch who will dispatch another unit to your initial call.
  
• If you just come by an incident with injured persons en route to another call, you're obliged to stop and help. You have to inform dispatch who will dispatch another unit to your initial call.
  
• If you come by an incident with apparently no injured persons, then you can drive on after assessing the situation. Since we're allowed to rule out injuries (especially neck or such) and if not making a totally crazy error, there is no danger for beeing sued.
  
• Causing an accident with a (critical) patient on board: decision is based on actual settings. If there is noone else injured and you can drive further on, you just have to leave your ID number and can go on, notifying dispatch (they will send a supervisor to the scene taking care). If there are other injuries you have to handle them all and call dispatch to get in backup fast. In Germany resources usually are not a problem, see below.
  
• Same with coming by an incident with a (critical) patient on board - stop, render aid for all and call for getting help.
  

Usually backup is available within 15 minutes or even sooner. Whole Germany is covered by a dense net of EMS, HEMS and additional volunteer first responder units who may bridge time or even have spare transport capabilities. For example, my district has 4 ALS ambulances and one emergency physician. There is mutual help available from all neighbouring districts (obligation to assist by state regulation!), which makes at least another 14 ALS ambulances and 7 emergency physicians within 15-20 minutes. Additionally we have 2 helicopters within 10 minutes, 3 others within 15-20 minutes. Plus the volly branches alone in our district are available with around 8 ALS/BLS ambulances on short notice, by pager. Not to speak about the MCI squads and some medical trained fire depts (however, no transport just on-scene treatment). One supervisor is available 24/7, even there backup is possible. So, the problem is not whom to call but just to quickly decide what option you want to draw - and even this you can leave to dispatch (they are tactically in charge until a supervisor is on scene)...

This said, even there are grey areas in our reality. I already experienced accidents of ambulances within sight of the initial scene. On one occasion, the then injured ambulance driver assisted the opposite injured POV driver, the injured medic took the mobile eqipment and rushed to the house the initial call came from to start treating the patient there. Just after calling in backup forces, naturally.

On another occasion there was an ambulance on an interhospital transport with a severe stroke patient. They wittnessed a radio call for another unit stating an emergency just two streets away from where they just were driving. They offered help since their patient was stable and dispatch accepted, advised them to do first responding until the other unit arrives. Sadly, they had an accident on the way there, beeing t-boned by a POV. Both medics injured, patient injured, POV driver injured. Medic#1 cared for injured POV driver and collapsed soon after backup arrived, medic#2 cared for injured patient. Additional help was there within 15 minutes (one of the additional units was mine), however, the interfacility-transported patient died soon after. This did went to court, but they were found not guilty: they HAD lights&sirens on other than the POV driver stated and the death of the initial patient couldn't be directly related to the accident. Most probably I wouldn't have done first responding to another call not direct on my way, having a critical patient on board, even if stable at the moment. And very sure, I wouldn't have driven the high speed in totally heavy rain. The driving medic had luck that this was not addressed in court...

[BillKaneEMT]

We have just under a hundred rigs, maybe 18 of them ALS, to cover all 911 services in about 70% of the 2 counties in our operating area. Plus all prescheduled transports, long distance runs, fairs/festivals/parades/concerts and so forth. They don't all run 24/7, in fact most of them aren't going between 2200 and 0300. We have enough to cover our areas and give us leeway in the event of unforeseen problems and our rules are identical to Bernhard's with one exception: coming by an incident with a (critical) patient on board - stop, render aid for all and call for getting help. If we see an MVA with a critical patient on board we will tell dispatch and they will swap to the local pd channel and let them know. Assuming it's in our coverage area they will also dispatch a rig or 2 to the scene. If we are code 3 to a hospital due to patients condition we're not stopping unless we are physically involved in the MVA.