Abandonment

[paraloco]

A well known EMS instructor who is also an attorney posted on this subject on another listserv. This issue was taken to court, and the ruling was that you must stop at the first emergency that you encounter. Notify dispatch of course, so that they can send another unit to your original call.

[Dustdevil]

Other well known attorneys who are also paramedics have emphatically disagreed with that advice.

I tend to agree with those other attorneys, although, as always, your local protocols will prevail.

But they won't keep you out of court. No matter which choice you or your protocols make, somebody is going to sue. And because there is no absolute agreement on which is right or wrong, you'll probably lose either way. Welcome to EMS!

[SSG G-man]

This is a Lose-Lose situation. If you stop and get signed refusals and the original accident had a high priority patient you are screwed. If you pass the accident, call it in and go get the refusals and the accident you passed ad the high priority pt, you are screwed. This is a situation that I do not think will ever be a black or white situation. Has not happened to me, yet.

Almost did. On way to call told to stage in area because police in route, history of domestics at location. We were preparing to turn on the street to stage at corner, and caused an accident. One car saw us in the turn lane and stopped car behind did not. Minor fender bender. While checking them out one of the passengers started asking why we stopped if we were on way yo another call. One pt signed refusal because he did not want to miss the Redskins game. Had to get there to tailgate!!

Sarge

[Dustdevil]

There *might* have been the slightest justification for stopping about 20 years ago, before everybody had cellfones. Not anymore. If, by some uber slim chance, the people in the new wreck need an ambulance, they can call for one and wait their 8 minutes like everybody else. Meanwhile, I'm not making the people in the original incident now wait 20 minutes for their ambulance because somebody else bumped fenders. Not even if it was my fender that they bumped.

There are plenty enough BS runs out there without going trolling for them.

[whit72]

Captbp wrote"

Dispatch can determine if you stopping is for the best.

Umm.......... I'm happy if they can get the address right, and maybe the chief complaint.

Like Dust said everybody waits their eight minutes. I haven't arrived on scene of the original call to be able to evaluate who is in more need. So my responsibility lies with the call I was dispatched.

[Just Plain Ruff]

Let me throw this wrench in

you have just picked up a very very very stable patient from a fall. She has a hurt wrist only.

You come up on a very very serious accident. You have a EMT Driver and a Medic in the back and a student(emt-p) who works for your service also.

Your closest unit is 30 minutes away.

Do you put the emt in back with the patient?

Do you put your medic student in the back with the patient and you and your partner go out to the wreck

You have 5 critical patients, 3 eventually die of their injuries(2 are children). You fly 3 of them out of the scene. (Car versus Semi Head on Highway speed)

or do you the medic stay in the ambulance and let the emt's take care of the patients?

I had this happen to me about 5 years ago.

YOu have a duty to your patient in the back and they are definately BLS. Is it abandonment if you the medic leave that patient in the care of a bls provider?

I was told by my supervisor at that time that it was considered abandonment to leave a patient this patient with an EMT becuase as a medic I initially took care of the patient and I dropped the patient down to a bls status. He said it was abandonment.

I told him he was full of shit and told him to ask our legal department. What do you think his answer was?

Heck I might just put this into a scenario for ya all. I'll include the pics that a bystander took of us working.

[DwayneEMTP]

From what we were taught as basics, and the scenarios I've seen since, I'm guessing legal had to say it was abandonment...

No release to a lower level provider after contact...

Though, I'm guessing there is a twist here...I can't wait!!

Dwayne

[medic001918]

My guess is that it would depend on your protocols regarding a BLS downgrade. There are services in our area that require the highest level of provider to tech every transport. And there are others that allow for downgrades. If you have no provision for the downgrade of a BLS patient than you have violated established protocol and abondon your patient. If you are allowed to downgrade, write an assessment form detailing the call and the events and submit it as your documentation. I work for a service that allows me to downgrade a BLS call to the BLS transport ambulance but I am required to write a run form detailing my ALS assessment for every patient I come into contact with. And just for the record, my ALS assessment run forms are just as thorough as my transport forms since it's actually more liability in downgrading a patient.

Shane

NREMT-P

[Dustdevil]

Umm.......... I'm happy if they can get the address right, and maybe the chief complaint.

Hehehehe...

I was told by my supervisor at that time that it was considered abandonment to leave a patient this patient with an EMT becuase as a medic I initially took care of the patient and I dropped the patient down to a bls status. He said it was abandonment.

My answer would be, it is only abondonment if the patient accuses you and you are found guilty. Otherwise, it's just an MCI.

Remember what we teach about medical documentation? If it isn't documented, it didn't happen. It's the same as the old question about the tree falling in the forest. If nobody is there to hear it, there is no sound. Same applies to this situation. If your patient complains, then the abandonment issue is pretty well cut and dried. If they don't, then it isn't an issue at all. I think the chances of a complaint in your situation were extremely low. But yeah, if it happened, I think the killer personal injury trial lawyer would have ripped your company's defense lawyer apart.

During these situations is not the time to start trying to figure all of this out in your racing mind. That is why any agency worth working for has already done exhaustive and competent legal research and established policies governing such situations.

[Just Plain Ruff]

Well Legal said like Dwayne and Dust noted - yes it was abandonment and don't do it again. that's it

I told them, I could not be sure what I'd do in the future but it did bring up the fact that there did need to be a new policy for this type of incident and that service is able to drop level of provider from als to bls if the patient is stable.

In the end, nothing detrimental came of it towards me nor towards anyone on the call.

There were three fatalities on the call, 2 people will never be the same.

You know what I did find out about myself is that it's a different story when you happen on a call like this rather than get called out. when you get called out on a call like this when you know it's bad you can already call for extra help but to drive up on it just about minutes after it happens all that prep time is gone. There is no prep time. so in essence you become a bystander with skills because you didn't get to mentally prepare for the call.

Granted, the training and my knowledge kicked in and we worked the call and it went pretty smoothly, we were able to extricate 2 of the victims (one of which died) prior to other units getting there. We had some pretty good bystanders to help us. I even taught one bystander to ventilate a patient with a bvm at 12 breaths per minute while I worked to get them stabilized. My emt partner worked on the 2nd patient the one who lived.

On arrival of the first fire truck which we ended up having 3 fire trucks there, 4 ambulances and 3 helicopters, we were able to remove the 3rd and 4th patient from the wreckage. the 3rd got tubed and the 4th was a trauma code which we did not work. The 5th victim was the driver of the car and he was drt.

So in the end, helicopter 1 took the 1st patient out (not the one who died) to trauma center 1, helicopter 2 took the 2nd patient(who died) we got out to a trauma center in a different city. The first unit in took patient number 3 out of the car who was class I to our hospital for stabilization and helicopter 2(they took a little longer to get to the scene) and took him from the er.

Patient 4 and 5 died, but number 4 was transported to our hospital but died in the ER. Patient 5 was was dead in the car.

Patient 6 (our wrist patient) was taken to our hospital by my unit and could not stop talking about what she saw. She is now a cop in a city about 200 miles from my old coverage area.

We ended up having the 4th ambulance take the truck driver (NO INJURIES imagine that) to that ambulances hospital nearest their base for a check and mental health workup.

All in all it worked out pretty smoothly yet it seemed like a cluster durning the incident.

When you don't get to prepare for something like this you basically go by instinct until you know what you have. If this seemed a little disjointed remember it was 5 or so years ago.