Would you stop?

[scratrat]

In California, violating protocols, would be against state law. If I had special circumstances, that'd be fine. This scenario would not qualify, as it's exactly what the protocols would have been created for.

Also, my understanding of abandonment is that you must have a duty to act. If protocols say you have a duty to stop (I know yours don't, but you originally said you would keep going even if protocols told you to stop), and then you don't, you're getting into abandonment of driver of the accident.

My whole point is that it might not be 100% clear-cut and it's not a whacker issue.

Allow me to elaborate on whits post if I may :

Abandonment and Negligence

Terminating care of a patient without making sure the patient is in the hands of a provider at the same or higher level of training is considered abandonment.

Negligence is deviation from the accepted standard of care that results in injury to a patient.

There are four components to a successful negligence action

or lawsuit:

*The EMT-B had a duty to act. This means that the

E M T-B was in a situation through employment,

position in a volunteer squad, or other position

in which the EMT-B is re q u i red to provide care

and . . .

HERE : The EMT/medic had a duty to respond to the seizure pt. They responded and had that pt on board the ambulance. This part they did correctly.

* The EMT-B breached, or failed to perform, that

duty and . . .

HERE : The EMT now breached, or failed to perform. He was expected to transport someone's sick family member to the hospital. He was no longer doing so.

* Injuries, which may be physical or psychological,

or damages were inflicted and . . .

HERE : Being shot at? I'm going to go out on a limb, and say this definately fits this criteria.

* The actions or lack of action caused the injury or

damage.

HERE : Actions caused the injury. Um, yes. The driver stopped. He is directly responsible for the action that caused them to be shot at.

Now on to the abandonment aspect of the issue.

Abandonment of a patient, in medicine, is where a health care professional (usually a physician, nurse, dentist, or paramedic) has already begun emergency treatment of a patient and then suddenly walks away while the patient is still in need, without securing the services of an adequate substitute, or giving the patient adequate opportunity to find one.

hmmmm...sounds like abandonment to me. You did not secure further treatment for this individual by taking them to a hospital. Services were no longer being rendered because you were no longer transporting that pt to definitive care. Sounds like a win-win situation in a court of law.

On to your next comment.

In California, violating protocols, would be against state law.

Your protocols prohibit you from continuing patient care?

Protocols are guidelines and nothing more.

I realize that everyone is set against "what-ifs" but I have to do it in order to make my point.

Same case, only this time you stop at the scene. The driver gets out and shoots your pediatric patient then takes his own life. You stopped because your protocols say you must stop at an accident scene, even if already treating a patient.

Now the family sues you for wrongful death, and possibly negligent homicide (but I'm not sure about that one). You will definately be sued for the first one.

Do you think a court is going to say, "Well, Mrs. Jones, we're sorry that they placed your child in harms way and as a DIRECT result, you're child was shot. However, their protocols say they are to stop and render aid."

Let that one sink in for a minute. Then tell me, honestly, protocols or not, do you think for a minute the court will side with you or with the mother whose young child was shot? Sorry for the horrible scene description that I'd never wish on anyone, but this could have been a real possibility.

As Dust says....if you protocols say that you are to stop no matter what, then your system sucks arse. I think I spelled that one right for you Dust.

[scratrat]

I smell poo poo......

[tskstorm]

Allow me to elaborate on whits post if I may :

Abandonment and Negligence

Terminating care of a patient without making sure the patient is in the hands of a provider at the same or higher level of training is considered abandonment.

Negligence is deviation from the accepted standard of care that results in injury to a patient.

There are four components to a successful negligence action

or lawsuit:

*The EMT-B had a duty to act. This means that the

E M T-B was in a situation through employment,

position in a volunteer squad, or other position

in which the EMT-B is re q u i red to provide care

and . . .

HERE : The EMT/medic had a duty to respond to the seizure pt. They responded and had that pt on board the ambulance. This part they did correctly.

* The EMT-B breached, or failed to perform, that

duty and . . .

HERE : The EMT now breached, or failed to perform. He was expected to transport someone's sick family member to the hospital. He was no longer doing so.

* Injuries, which may be physical or psychological,

or damages were inflicted and . . .

HERE : Being shot at? I'm going to go out on a limb, and say this definately fits this criteria.

* The actions or lack of action caused the injury or

damage.

HERE : Actions caused the injury. Um, yes. The driver stopped. He is directly responsible for the action that caused them to be shot at.

Now on to the abandonment aspect of the issue.

Abandonment of a patient, in medicine, is where a health care professional (usually a physician, nurse, dentist, or paramedic) has already begun emergency treatment of a patient and then suddenly walks away while the patient is still in need, without securing the services of an adequate substitute, or giving the patient adequate opportunity to find one.

hmmmm...sounds like abandonment to me. You did not secure further treatment for this individual by taking them to a hospital. Services were no longer being rendered because you were no longer transporting that pt to definitive care. Sounds like a win-win situation in a court of law.

On to your next comment.

In California, violating protocols, would be against state law.

Your protocols prohibit you from continuing patient care?

Protocols are guidelines and nothing more.

I realize that everyone is set against "what-ifs" but I have to do it in order to make my point.

Same case, only this time you stop at the scene. The driver gets out and shoots your pediatric patient then takes his own life. You stopped because your protocols say you must stop at an accident scene, even if already treating a patient.

Now the family sues you for wrongful death, and possibly negligent homicide (but I'm not sure about that one). You will definately be sued for the first one.

Do you think a court is going to say, "Well, Mrs. Jones, we're sorry that they placed your child in harms way and as a DIRECT result, you're child was shot. However, their protocols say they are to stop and render aid."

Let that one sink in for a minute. Then tell me, honestly, protocols or not, do you think for a minute the court will side with you or with the mother whose young child was shot? Sorry for the horrible scene description that I'd never wish on anyone, but this could have been a real possibility.

As Dust says....if you protocols say that you are to stop no matter what, then your system sucks arse. I think I spelled that one right for you Dust.

well Yes given most of what you said could be considered accurate, although certainly not all of it. Further more, arguments could be made that driving past an mva/mvc is negligent and abandonment. Perhaps you are leaving the original patient with 1 tech instead of 2, 50% of the total amount of care, but you are also leaving the 2nd patient, 1 tech instead of none, so what is that a 100% increase?

The FDNY crew (Believe its been said before is one of if not the largest EMS system in the US) has a policy/procedure/protocol to stop they did just that, the "heroic" actions would be being cool headed while in a dangerous situation, keeping there patient stabilized, and trying to stabilize the new patient as well. I don't think thats all that heroic, just their job, but I don't agree with the way you all jumped on the crew before, trying to discredit the policy. If the parents of the child decide to sue I hope someone follows this closely and can report the results. The results of the court case will most likely end most of this argument. If the parents of the Child don't sue, I guess they didn't feel they were mistreated in anyway.

[scratrat]

I respectfully disagree.

You already had a duty to respond to the first patient. Your duty to this first patient does not end until you transfer them to the hospital or to another ambulance of equal or greater level of care. You cannot abandon your initial patient. Once you initiate that care, you are bound to see it though. Unless you haven't made patient contact, you cannot leave.

Some of you may say it's abandonment not to stop, but I don't see it that way, and I don't think the courts would either. If you already have a paitent, your only duty to act would involve calling it in to dispatch and advising them of the situation.

The only time I could EVER see a deviation from this, would be an MCI.

I am also curious to see if the family sues and what the outcome will be. If that were my kid, I certainly would have someone's arse on a platter. They directly put my kid into a line a gunfire. That is unacceptable.

[AnthonyM83]

Scrat, following protocols is often what saves you in lawsuits. If you saw the gun was out and then tried to stop, that would be ridiculous. But if you have a stable patient in the back and stop to help, you'd be doing exactly what the state wants you to do. The liability falls on the state. That protocol was written exactly to tell you to stop even if you had a stable patient in the back.

It'd be different if you had an exception or some reason why you should have disregarded that protocol, but not only was there no exception, but it was specifically what the protocol was written for.

Also, we were taught you could be in trouble for abandonment from the moment you're dispatched to the call, even if you haven't made contact yet. Seeing the accident and having standing orders to stop, then you've already been given that person as a patient.

[vs-eh?]

You already had a duty to respond to the first patient. Your duty to this first patient does not end until you transfer them to the hospital or to another ambulance of equal or greater level of care. You cannot abandon your initial patient. Once you initiate that care, you are bound to see it though.

Again scratrat, you are speaking from the perspective of your current system. If you moved to a system that didn't follow these rules (like mine), your opinion will change. If you held these views tried and true, you would not be able to function long in my system. Maybe we play in a more subjective system? Judging by the posts here it appears we do. Again, as long as I can rationalize and it is reasonable...

Why can't an ALS crew hand off a BLS patient to a BLS crew? Especially one that you're babysitting in hospital? Again, this happens many many times daily here...

Also, we were taught you could be in trouble for abandonment from the moment you're dispatched to the call, even if you haven't made contact yet.

Sorry? I don't quite understand how that would work but....You are driving to a sprained ankle across the city and are being redicted to a cardiac arrest that you are closer too? This doesn't happen? Happens many many times daily here. Hell, I have even pulled up to a call (no actual patient contact yet) and been pulled off for a higher priority patient. Even to the point of having to shout or tell family/by standards that we have a higher priority call and another ambulance will be by shortly.

It happens man, all the time. Different perspectives from different systems and ways of thinking.

[AnthonyM83]

Not sure on that. Perhaps it's because you're being officially reassigned and a closer unit can take it. The example our instructor used to prove his point was a police officer who called medics for a mandown in a park. As fire dept was arriving, cop just walked up to them and said, "You can cancel guys, he's just drunk". The medics hadn't even gotten to the patient, but they canceled themselves without providing an assessment. I forgot what ended up being wrong with the drunk.

The point was, they hadn't made physical contact with the patient, yet. They had simply been assigned that patient by dispatch.

[scratrat]

Scrat, following protocols is often what saves you in lawsuits. If you saw the gun was out and then tried to stop, that would be ridiculous. But if you have a stable patient in the back and stop to help, you'd be doing exactly what the state wants you to do. The liability falls on the state. That protocol was written exactly to tell you to stop even if you had a stable patient in the back.

It'd be different if you had an exception or some reason why you should have disregarded that protocol, but not only was there no exception, but it was specifically what the protocol was written for.

Also, we were taught you could be in trouble for abandonment from the moment you're dispatched to the call, even if you haven't made contact yet. Seeing the accident and having standing orders to stop, then you've already been given that person as a patient.

I was never taught that. We are rerouted all the time for other more priority calls. The dispatch someone else to the less severe call.

But I still firmly believe it's abandonment if you do not continue to transport your patient to the hospital or at least transfer them to someone else of the same or higher certification.

[scratrat]

Again scratrat, you are speaking from the perspective of your current system. If you moved to a system that didn't follow these rules (like mine), your opinion will change. If you held these views tried and true, you would not be able to function long in my system. Maybe we play in a more subjective system? Judging by the posts here it appears we do. Again, as long as I can rationalize and it is reasonable...

Why can't an ALS crew hand off a BLS patient to a BLS crew? Especially one that you're babysitting in hospital? Again, this happens many many times daily here...

That's how every place I've ever worked at operated. The only time we actually stopped was when my idiot partner nailed someone at an intersection. Any other time, you call it in and keep driving. I feel you are obligated to. But I guess thats just me.

I never said ALS couldn't hand off a BLS pt. That was my point. Transfer to EQUAL or greater medical authority. You could certainly do that.

In New Jersey, we weren't allowed to split, like someone else mentioned, I think from Texas. If we had two ALS pt's, you could begin treatment but you had to call a second ALS unit and transfer to them when they got on scene.

[pacman]

Not sure on that. Perhaps it's because you're being officially reassigned and a closer unit can take it. The example our instructor used to prove his point was a police officer who called medics for a mandown in a park. As fire dept was arriving, cop just walked up to them and said, "You can cancel guys, he's just drunk". The medics hadn't even gotten to the patient, but they canceled themselves without providing an assessment. I forgot what ended up being wrong with the drunk.

The point was, they hadn't made physical contact with the patient, yet. They had simply been assigned that patient by dispatch.

If I read this correctly, you're saying that the police officer on scene cancelled the responding EMS unit prior to patient contact. I don't see anything legally wrong with that. If anything serious goes down, it all falls on the police officer for cancelling. Am I agreeing with you? I can't tell your stance on the issue from this post.

The very same thing happened to me a few weeks ago. I got toned out in the middle of the night for an unresponsive male in the parking lot of a mall. My BLS unit and my supervisor responded and we were cancelled via radio by PD as we were pulling in to the parking lot. It turns out the guy was drunk and was being arrested for driving while intoxicated and trespassing.

Since we responded from across town and were already there, we decided to at least talk to PD on scene. The officer came up to us as soon as we stepped out of the truck and said he was the one that cancelled us because the guy was drunk and was under arrest. However, he jokingly suggested that we could have the pleasure :roll: of assessing him if we wanted to. He also said he was going to take him to a local hospital ( where most of the drunks and psychiatric patients go). I never saw the patient so I got on the radio:

"EMS 1 to Dispatch:..... We are cancelled by PD on scene prior to patient contact. We'll be available and returning to quarters"

"Dispatch to EMS 1:.... Received"

I didn't see anything wrong with that. What do you guys think? Please enlighten me if my crew was wrong.