Duty To Act?

[Bernhard]

Addendum: I just addressed the "duty to act" for random bystanders (lay person or professional). If you're on-duty shift here, you have 100% duty to act when called and can be held reliable dependent on your level/professional possibilities for almost anything. But I considered this as usual, so I restricted my answer to the random passer-by in t-shirt and shorts.

[Richard B the EMT]

Scenarios:

1) Person in car with EMT plates by man who collapsed. Person in car does nothing but call 9-1-1.

No problem, as person is adult son of vehicle owner, who is an EMT. She lent the car to him while his was in the shop.

2) 2 EMTs in uniform, either call takers or dispatchers, decline assisting woman having severe asthma attack in coffee shop in building's lobby where the EMS EMD is located, advise store crew to call 9-1-1, as they have no equipment, and leave, as their break time is over

Problem. IN MY OPINION, they should have called upstairs to get an ambulance assigned, and attempted to keep the woman calm until the ambulance arrived, even if only applying the so-called "Stare Of Life". It also would have informed their supervisors they'd be late returning from their break, but with good reason. (Actual case, pregnant woman died)

3) Ambulance crew in the ambulance sees a patient having CPR done on him, bystanders approach the team expecting help. Crew declines, tells bystanders to call 9-1-1. Responding ambulance actually has to pass the first ambulance, who's crew claimed to be on meal break.

Problem. Man died. Vehicle number published in newspapers. Unit, usually identified by radio ID, for all tours after this crew, had to move their posting location a mile away, and a spare vehicle activated, as the actual vehicle involved got parked outside HQ for a month, in fear neighborhood locals would attack, mistaking anyone aboard for the crew that didn't help. Crew had both legal and moral duty to act, both fired, and EMT "certs" pulled by state Department of Health. (Actual case. Radio designation Two One David, renamed by the press corps as Two One Delicatessen.)

4) Ambulance crew, with a stable injury patient aboard, brings the ambulance back to their base, as the tech driving didn't want overtime, and wanted his relief crew to complete the transport.

Problem. We can always expect Murphy's Law to kick in, particularly the part that says "everything takes longer than expected". This bloke (he's a Brit, otherwise I'd say dude) should have just done the call to completion, done the paperwork for the O/T, and put the money into the bank. The patient was not harmed by the delay in getting to the ER, but the tech was suspended without pay for a period. The tech riding "shotgun" was not charged, as his attention was, properly, on the patient for the duration.

[Bernhard]

Richard, I agree with all of your scenarios. #1 wouldn't be a problem here since help is rendered by people, not by cars or stickers (even if the car is an ambulance happening to be driven by a mechanic). #2 would be a no-go here - EMS dispatchers usually are EMTs/medics and even if not I sincerely hope they all know their general as well as their special duty to act in uniform which does not respect coffee breaks. It would be a valuable excuse to the employer. #3 would be a total violation of multiple laws, the ambulance would have been excepted to call dispatch for a "self witnessed incident, responding" and getting their coffe break afterwards. #4 sometimes happens here but more and more gets followed by a talk to the supervisor...meanwhile there is a clear written company policy against that. Overtime is paid here, so no excuse.

Another interesting case, where the solution is not so obvious:

Ambulance crew is standby duty on some big sport event (horse riding, motor race), where an ambulance is required to be at the field. They witness an emergency nearby, outside of the sport event area. Leaving the area means the (paying!) organizer has to stop the event. What should they do?

We regularly discuss this in our classes for new EMTs. Would be interested what you would do. All possibilities open.