The EMT Liability Pop Quiz

There really is a dizzying array of stuff we can do to get ourselves in legal hot water in EMS. I was considering a few this afternoon and I got this idea.

Let’s play a game. I’ll give you a whole list of scenarios and you match the legal transgression to the act. OK, that was a really boring and overly technical way to describe my game.

I’ll say what they did; you tell me what they did wrong. Sound like fun? I agree. Let’s begin.

Here are all the possible answers:

  • Sounds OK to me
  • Negligence
  • Battery
  • Abandonment
  • Assault

Jot your answers down on a scrap of paper. I’ll be back on Thursday with my answers and the rationale behind them.

1 ) An ambulance crew arrives on scene of a heart attack patient and discovers that their oxygen tank is empty. The patient endures the first twelve minutes of care, including being carried down three flights of stairs, without oxygen. He arrests enroute to the hospital.

2 ) An EMT administers a dose of nitroglycerin to a patient having chest pain and the patient has a precipitous drop in blood pressure.

3 ) A paramedic supervisor arrives on scene of an auto accident and finds two non-life threatening injuries. While waiting for a BLS crew to arrive he hears a call for a cardiac arrest near-by. With the sight of the BLS crew in the distance he jumps in his vehicle and heads for the other call.

4 ) An EMT splints a fractured wrist in the field incorrectly. The patient, a well known concert pianist, suffers nerve damage and permanent numbness in three fingers.

5 ) EMT’s respond to a man having abdominal pain in a snow storm. The ambulance is unable to travel up the street in the snow. They contact dispatch and request the man walk to the ambulance. When he is unable to do so, they leave.

6 ) An ambulance crew leaves an elderly female in her wheel-chair in her nursing home room. She is restrained with a waist belt. They give a hand-off report to the nursing home staff and depart. When the nursing home staff check on her 15 minutes later she has slid from the chair and strangled to death in the belt.

7 ) An EMT wearing her uniform, on the way home from a shift, witnesses a car accident in front of her. It looks serious. She is tired and the first due ambulance is probably minutes away. She calls the accident in on her cell phone and continues home without stopping.

8 ) A dispatcher takes a call for a patient with difficulty breathing and then rushes on to several other callers. In his rush, he forgets to dispatch an ambulance to the respiratory patient. When the family calls back 20 minutes later, the patient is in cardiac arrest.

9 ) A lucid, oriented, appropriate patient tells an EMT that he does not want any assistance of any kind for his abdominal pain. The EMT lays a caring hand on the patients shoulder and says, “Why not just let us look at you?”

10 ) The same patient says, “Get your hands off me and leave me alone, I’m fine.” The EMT steps back, looks the patient directly in the eyes, crosses his arms and sternly says, “Look, we can do this the easy way or the hard way.”

OK have at it: If you want to be bold, feel free to put your answers in the comments section and see how you fair against everyone else. But no peaking until you’ve finished answering for yourself! good luck.

Just want to read more stuff? Here:

Medicine Between The Frames

Beyond the 1-10 Pain Scale

The Ultimate EMS Protocol

Test For Unconsciousness: The Hand Drop

What Is Nystagmus?

Comments

  1. 1. Negligence
    2. Sound ok. Drop in BP is an expected side effect of Nitro. It’s only a problem if the tech administers nitro again, and bp is below 100 systolic.
    3. Abandonment
    4. Negligence
    5. Abandonment
    6. Abandonment/Negligence
    7. This is the only one I’m not sure about. It depends on the local protocols. In my area (as a volunteer – I’m not sure about paid), we are not required to stop. Ethically? Probably wrong. But it depends. If anything; its negligence.
    8. Negligence
    9. Assault
    10. Battery

  2. Brittany says:

    1. Negligence
    2. Sounds okay to me, but it’s all relative to the original BP.
    3. Abandonment
    4. Negligence
    5. Abandonment
    6. Assault
    7. Sounds okay to me, but as Jamie said, it all depends on local protocol. Around here, if you’re off duty, you have no obligation to the accident. I’d be the first to stop, because not doing so would be morally wrong.
    8. Battery
    9. Assault
    10. Battery

  3. 1. Negligence
    2. Negligence – it states EMT and in most sates a paramedic must administer drugs.
    3. Abandonment
    4. Negligence
    5. Abandonment/Negligent Indifference
    6. Negligence/Abandonment
    7. Ok depending on state i.e. GA only requires action only if being payed in any form.
    8. Negligence
    9. Ok depending on interpretation/state law could be construed as assault.
    10. Assault seeing as no contact is being made just a show of force demonstrating intent to harm.

  4. 1) Negligence.
    2) Would like to hear what Hx Pt presented with and initial findings.
    3) Abandonment.

    4) Negligence. For further clarification, were there any extenuating circumstances? Did the wrist fracture occur during an accident causing Rapid-Transport category injuries? Perhaps the EMT immobilized in position found and packaged for “load and go”?

    5) Abandonment/Negligence. With the caveat of scene safety. If, in their judgment, they could not operate the apparatus within the current conditions they made the correct decision not to continue advancing the vehicle. What type of “street” was the residence located on? If a residential area with adequate sidewalks and of a reasonable distance they should continue on foot. Remembering to bring additional blankets/media to protect the Pt from environmental exposure during return. If not in an area which would allow them to safely/reasonably progress on foot they should remain on-scene and request additional apparatus. Perhaps an F/D bush/rescue unit with BLS equipment? Or assistance from the municipality/public works if feasible?

    6) Negligence. I would be hesitant to apply abandonment, not because that charge is any more or less grave. It just does not seem they specifically abandoned the Pt as in terminating care prematurely. Although they abandoned her in the sense that they exited the room and left her unattended they, apparently, did so with the intent to complete the Pt handoff, albeit erroneously. And with grave consequences.

    7) I agree with Jamie and Brittany in adhering to local laws/protocols. Within Canada these laws are a mix of provincial/federal jurisdiction. Within BC, as a bystander, you are duty-bound to respond to your level of training at which point all other “normal” EMS-type laws and requirements come into effect (abandonment, negligence, etc).

    8) Negligence. The dispatcher was in clear breach of protocol by not assuring adequate resources were on route and/or the correct procedures initiated.

    9) Seems OK to me. Steve as you have posted about (Ex. Get anyone to come to the hospital with you) sometimes the people who need medical aid the most refuse care. Realistically, how many of us would submit ourselves to an assessment after a “minor’ish” car crash? Be honest. I would count the personal contact as part of the process trying to win the Pt’s trust. I suppose, technically, in a very letter of the law view, it is physical contact. But the description hints at this occurring earlier on in the call. It is not as if the Pt has been steadily refusing for 20 minutes…

    …10) I am not an expert on interpretation of the law and hopefully an expert (Star of Life Law?) can sound off on the issue. That grain of salt taken, my understanding of US, federal, law is that while Battery constitutes actual physical harm a charge of Assault can be levied on a threat to harm. This threat to harm, though, must represent an intent to harm, a capability to harm, the intention for the harm to be of a violent nature and that all of the above be directed towards another person. I suppose this counts clearly as 3 out of the 4, would providing unwanted care count as a gross violent act?

    BeaverMedic

  5. 1- Negligence

    2- Depends on a few variables: What’s the Pt’s baseline BP? How much of a drop? Was this the first dose administered?

    3- Abandonment

    4- Negligence

    5- Tricky, but could be negligence.. It definitely would not be abandonment, because no Pt contact has been made.

    6- Negligence

    7- Sounds ok to me.. I live in California ;)

    8- Negligence

    9- Battery (that’s putting your hands on someone, folks)

    10- Assault (that’s threat of bodily harm)

    What do I win?????

  6. Question #2 was on Trauma

  7. 1. Negligence will be the allegation in the civil suit, but they’ll never prove the O2 would have saved him.
    2. Sounds okay to me, so long as protocol for administration of that med was followed.
    3. Abandonment
    4. Negligence
    5. Abandonment IF they left of their own decision.
    6. Sounds ok to me. They took protective measures to ensure that the patient didn’t fall out of the chair, which is by far the greater/more common risk. After the crew gave report it was the facility’s responsibility to look in on the patient and see if there was anything she needed.
    7. Sounds okay to me. A tired EMT makes mistakes or gets herself killed.
    8. Negligence
    9. Battery
    10. Assault (look it up, folks)

  8. This is a great post!

    1) Negligence – It is the oncoming crews responsibility to maintain their equipment.

    2) OK – as long as it was the patient’s prescription for nitro (in my agency assisting the patient with their own nitro is in my EMT scope of practice). A drop in BP is expected and as long as the systolic wasn’t below 100 at time of administration.

    3) Abandonment – It would have been abandonment even if the paramedic had waited until the BLS unit arrived because you can’t hand patient care over to person with less certification.

    4) Negligence – but it does depend on the situation, was this a rapid treatment, load and go situation (I tend to doubt it because if the person was traumatically injured I’m not sure time would have been spent to spint a wrist).

    5) Abandonment – why didn’t the EMTs get out a walk to the man? A snow storm does not necessarily equal an unsafe scene.

    6) OK – the crew handed over care to another agency, it is that agency’s responsibility to check on the patient.

    7) OK – this depends heavily on local protocols. Probably not morally correct, but she did at least call it in.

    8) Negligence – that’s just sloppy.

    9) Battery – The scenario doesn’t specifically say the pt didn’t wany anyone to touch him, just that he didn’t want help. Even so, if a pt doesn’t want help, we should take a wider bearth around them.

    10) Assault – The EMT is threatening physical violence on the patient.

  9. Australian ideas!!!
    1) Negligence
    2) Vital sign survey first B4 Rx but to be expected
    3) Assesment made moved on to life threatening incident, would wait and give handover though.
    4) Negligence
    5) Unload stretcher and walk, we have sandy soils that often prevent ambo getting in!!
    6) Handover complete, written, not responsible.
    7) Ethical decision, wouldn’t be the first. Law here says to raise the alarm.
    8) Huge media circus here at the moment for just this sort of scenario. Negligent and sloppy.
    9) Battery and dangerous, places the paramedic too close to a possibly volitile pt.
    10) Assault, sign the refusal and clear the scene.

  10. 1. Negligence
    2. Negiligence
    3. Abandonment
    4.Negligence
    5. Abandonment
    6.Battery
    7.Abandonment
    8. Negligence
    9. Assault
    10. Battery

Trackbacks

  1. [...] to a few thoughts about assessment and scope of practice. Then we spent a few suspenseful days on the EMT liability pop quiz followed up with some thoughts on failure and a request to tell The Discovery Channel about The [...]

Speak Your Mind