Medico/legal liability in EMS in regards to protocols

[Ace844]

"Rid,"

Well put, and I agree with you entirely. I will further add that in the instances of a 'WRONG ORDER', you would be better to refuse to do the intervention, than cause harm to a patient. In my own practice I have encountered this a few times and each time I refused it caused me a 'headache,' yet when it went to the Medical Director, it turned out I did the right thing.

Here's a rough example (not necessarily my call):

EMT-I level Crew transports a 'GI Bleed' who is hypotensive to a local ER. No Paramedics were available for the intercept. Pt had a systolic pressure of 60. The intermediate did everything they were suppossed to, Large bore-line, bolus, etc...

The intermediate did an 'entry notification' to the recieving facility only to get what turned out to be a 'resident' on the line who id's himself as 'Doc So& So'. After hearing the report he directs the 'I' to put MAST Trousers on the PT and INFLATE THEM to 'FULL' pressure. To help treat the hypotension. The intermediate asked the 'doc' to repeat his 'Order 2x,' then refused to do the intervention. This caused the 'Intermediate,' a serious SHORT TERM HEADACHE, He got reamed at the ER by said MD, etc.. Yet, when it went to the Med Director, and the state. The "doc' who gave the inappropriate order ended up 'getting in trouble'.

Now had this 'I' blindly followed this 'docs' orders he would have been potentially 2x as screwed as the 'doc' who gave the wrong order. As the 'I' is just as responsible to know what the appropriate uses, etc.. for the MAST are as the doc.

Food for thought,

ACE844

[whit72]

Want to discuss legal issues that could arrise. We still have EPI for injection for COPD pt's in our protocols for the EMT-B. I do agree that in a small amount of pts in severe distress this still can be difinitive care. However I believe the risks far outweigh the benefits, and the protocol should be removed.

[Ace844]

Want to discuss legal issues that could arrise. We still have EPI for injection for COPD pt's in our protocols for the EMT-B. I do agree that in a small amount of pts in severe distress this still can be difinitive care. However I believe the risks far outweigh the benefits, and the protocol should be removed.

"whit,"

Could you elaborate on this soem more to include answering the following questions..

Anyhoo...

If you follow a protocol to a T, regardless of medical literature being against the action you take, can you be held liable as a medical practioner? Or does the region and designer of the protocol take the hit from (insert greasy haired lawyer type here). Thoughts?Also, lets toss in the certification vs. licensure differences in the discussion. Would someone licensed be held more liable that someone certified?

[streetsmart]

AHA ACLS Protocols are nationally accepted guidelines. However, ultimately you are under the control of your medical director. If he is suggesting giving a medication that is not consistent with those guidelines you have every right to question them to determine what rationale they are using to deviate from the accepted standard. Calcium choride is used to treat hyperkalemia, one of the frequent causes of PEA, in addition to treating hypocalcemia and calcium channel blocker toxicity.

Unless it's a total act of negligence in following your medical director's standing or voice orders, that's the stance I would take. Your medical director is responsible for reviewing any of their standing orders and making changes as necessary, usually on an annual basis.

It will always be a question of how, when or what we can be sued for. Did we administer Atropine exactly 5 minutes after the first dose or was it 5 minutes and 10 seconds, either way this is not negligence. If we administered 5 mg of Atropine however it would probably be considered negligence since it is 5 times or more the appropriate dose.

If you didn't have standing orders and had to use the radio to get an order for epinephrine in VF and your medical director denied the order where do you stand? Do you give it anyway since it is an accepted guideline or do you follow medical direction? Of course you follow medical direction and chart appropriately.

[Ridryder 911]

Actually, I would not give it.. I would clarify it although. Although, it is a personal issue, I rather err not giving something rather than giving something that is out of reason. As well, I would make sure I painted the clear picture for them as well. Maybe there is a lack of communications..

AHA more rather ECC is the accepted national studied guidelines, however don't be confused that they the national standard of care .. in which they are not. I heard the old saying ' they better follow ACLS protocols" which really means nothing. As long as the physician can verify their experience, knowledge they relatively safe. Where do you think the new ones came from ?

R/r 911

[whit72]

In that state in which the EPI sq is a protocol. You dont need medical control to administer it. It is at the EMT's discression. As with most of the protocols in that state, Medical control is more of an advisor, if you have a question or complicated issue that you need some asst. with. As far as some of the other protocols that have been removed. Racemic EPi. was in the protocol up to about two years ago. It has since been removed due to the severe rebound affect associated with the medication. As for medical control in the state I work in the EMT is really not allowed to do much. ASA, albuterol tx, oral gluclose, so med control really never factors into the issue. At the medic level im sure they run into more instances where it could become an issue. As for dropping an entry note, the triage nurse answers so we really dont interact with the doctors until arrival.

I believe you are more liable with licensure, because you are resposible for your own actions. The protocols are more guidelines then law. Where as with certification you are more or less and extension of your medical control. So the medical control is ultimitley responsible for your actions.

[PRPGfirerescuetech]

Good thoughts Whit.

So your liability changes in this circumstance variant to if your certified or licensed?

If thats the case, why wouldnt more medical directors be pushing for licensed EMS providers...?

[whit72]

Absolutely the LIC. providers seem to take it more on the head when a mistake is made. More direct control over pre-hospital care. I am not really sure. I do however notice that the protocol changes in the certified state are at a snails pace compared to the lic. state.

[IanJ]

my 2 cents for the sake of redundancy...

What it comes down to is who is directly responsible for pt care. While you are in the back of an ambulance and you are the one administering the care it is you. So if you kill the patient for what ever reason you killed the patient. So, as it is hammered into us in school, if the doctor is wrong and you know it refuse the orders. Contact you supervisor for "CYA" points and transport to the best of you abilities. Odds are a few extra minutes wont hurt as much as the improper medications. Even if you get to the hospital and get chewed out and the Dr. gives the meds anyway, then they killed them and you are released from liability after you sign them over.