# Duty to Act while on duty



## Sunsetter37 (Mar 25, 2011)

Hi everyone,

I'm a fairly new EMT in southern CA, LA county area, and I had a question about Duty to Act...while on duty. I'm sure this has been covered many times regarding off duty/good Samaritan, but I haven't been able to find any info specific to my situation. I work for an ambulance company that does primarily IFTs, but is working to get a 911 contract. They recently tried to install a new policy that essentially states that we cannot stop at emergencies or render aid unless directed by a law enforcement officer or our dispatcher. Regardless of what kind of emergencies. One of our units was on scene at a serious car accident, stopped and assisted until the paramedics arrived, and was reprimanded by our supervisors for doing so. I can understand not stopping if we already have a patient (I guess it makes sense), but they don't want us to do anything whether or not we have a patient. And if there is no law enforcement or we can't get a hold of our dispatch, we are supposed to just continue on our way and inform our dispatcher whenever we can. I've been looking for somewhere where this is spelled out as being legal or not, but I haven't been able to find anything specific. If someone knows or could point me in the right direction, I would be very grateful. 
Thanks, Sun


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## DesertMedic66 (Mar 25, 2011)

I don't know where you could find that but I have heard of that policy before. You have to be cleared by your dispatch to stop and render aid. I wanna say that question was on the CA ambulance certificate exam but I'm not 100% sure. Or it could have been on my companies exam.


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## jgmedic (Mar 25, 2011)

firefite said:


> I don't know where you could find that but I have heard of that policy before. You have to be cleared by your dispatch to stop and render aid. I wanna say that question was on the CA ambulance certificate exam but I'm not 100% sure. Or it could have been on my companies exam.



It's not in AMR's policy, other than to notify dispatch. Obviously if you are attached to another call or transporting a patient then you cannot stop. It seems like a liability check for the owners, being that you most likely have EMTs who may have never seen a collision scene outside of their ride-along, running around like chickens with their heads cut off.


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## usalsfyre (Mar 25, 2011)

Sunsetter37 said:


> Hi everyone,
> 
> I'm a fairly new EMT in southern CA, LA county area, and I had a question about Duty to Act...while on duty. I'm sure this has been covered many times regarding off duty/good Samaritan, but I haven't been able to find any info specific to my situation. I work for an ambulance company that does primarily IFTs, but is working to get a 911 contract. They recently tried to install a new policy that essentially states that we cannot stop at emergencies or render aid unless directed by a law enforcement officer or our dispatcher. Regardless of what kind of emergencies. One of our units was on scene at a serious car accident, stopped and assisted until the paramedics arrived, and was reprimanded by our supervisors for doing so. I can understand not stopping if we already have a patient (I guess it makes sense), but they don't want us to do anything whether or not we have a patient. And if there is no law enforcement or we can't get a hold of our dispatch, we are supposed to just continue on our way and inform our dispatcher whenever we can. I've been looking for somewhere where this is spelled out as being legal or not, but I haven't been able to find anything specific. If someone knows or could point me in the right direction, I would be very grateful.
> Thanks, Sun



So what your wanting is the ability to jump calls? Not likely to happen. Our policy is stop if it's in our response area, notify dispatch if it's not.


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## steveshurtleff (Mar 25, 2011)

I admit to not knowing all the ins-and-outs of how things are done on the street, but from this angle, it sounds like a decision that came from the bureaucratic side of the business rather than the medical side.


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## usalsfyre (Mar 25, 2011)

steveshurtleff said:


> I admit to not knowing all the ins-and-outs of how things are done on the street, but from this angle, it sounds like a decision that came from the bureaucratic side of the business rather than the medical side.



Not opening your company up to unneeded liability and keeping your unit available for calls that actually pay is indeed bureaucratic, but also keeps a paycheck coming.


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## steveshurtleff (Mar 25, 2011)

I can see both sides.  I'm just looking at it from the standpoint of the TA victims as those who are conscious watch a medic unit approach and keep going.

Put another way, suppose a cop and his partner were to witness a mugging but were unable to do anything about it until dispatch told them to go ahead.  That agency would be looked upon with no confidence in short order.


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## usalsfyre (Mar 25, 2011)

steveshurtleff said:


> Put another way, suppose a cop and his partner were to witness a mugging but were unable to do anything about it until dispatch told them to go ahead.  That agency would be looked upon with no confidence in short order.



Different situation, they're obligated to act within a particular area. Similar to how if I happen upon one in my contracted response area I'm obligated to stop. However, you'll also notice LE from out of jurisdiction doesn't usually do traffic stops.


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## HotelCo (Mar 25, 2011)

I stop regardless of where I am. 
If it's in one of the counties my company is licensed in, and FD hasn't arrived on scene by the time I've assessed, treated, and (if needed) packaged the patient, then I transport.

If I'm outside of the counties, and FD hasn't arrived on scene by the time I've assessed, treated, and (if needed) packaged the patient, then I transport. 

I've yet to run into a problem.


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## dixie_flatline (Mar 25, 2011)

usalsfyre said:


> Different situation, they're obligated to act within a particular area. Similar to how if I happen upon one in my contracted response area I'm obligated to stop. However, you'll also notice LE from out of jurisdiction doesn't usually do traffic stops.



May be a slightly different situation, but look at it from a layman's point of view.  Until I got involved in EMS, an ambulance was an ambulance as far as I cared.  I didn't know the difference between a paramedic and an EMT, nor did I even really consider that some ambulances were part of companies that just did transport between facilities (IFT).  

Back then if I was involved in an accident (or stopped as a citizen to render aid) and I saw an ambulance go by, I wouldn't take note of what agency/company it was affiliated with.  I would just remember that an ambulance failed to stop at the scene of an accident and direct anger/frustration/loud complaints wherever I thought someone would listen.

It's not really a situation that has a one-size-fits-all solution.  Reminds me a little of the Mel Brooks quote, "Tragedy is when I cut my finger; comedy is when you walk into an open sewer and die."  My suffering is always greater and more urgent than Yours.  So what if you have a guy coding in the back of your rig?  He's already dead, stop and set my broken finger wouldn't you?


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## firetender (Mar 25, 2011)

Logic dictates that if you come across the scene of an accident or injury while on-duty, you would call in to dispatch, advise them and request permission. If you need to speak with a Supervisor in your company then do so. It's really not your call -- someone else may already have it, nor is it your call to make; you're a foot soldier, remember?

What that means is be ready to JUSTIFY why you want to/need to stop and be ready and okay with being turned down.

It's kind of like a "Duty to Act" when dispatched thing.


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## HotelCo (Mar 25, 2011)

firetender said:


> Logic dictates that if you come across the scene of an accident or injury while on-duty, you would call in to dispatch, advise them and request permission. If you need to speak with a Supervisor in your company then do so. It's really not your call -- someone else may already have it, nor is it your call to make; you're a foot soldier, remember?
> 
> What that means is be ready to JUSTIFY why you want to/need to stop and be ready and okay with being turned down.
> 
> It's kind of like a "Duty to Act" when dispatched thing.



I don't ask. I tell dispatch. "Dispatch: 24 is out at an accident on NB I-75 at exit 1234 on the right shoulder. Two vehicles involved. Contact Fire and PD." Then I just get out of the truck, and do what I need to do.


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## Akulahawk (Mar 25, 2011)

Sacramento County basically takes this out of the individual company's hands. Here's what I mean...

From SCC EMS 2055.07 On-Viewing Medical Emergencies...


> If no EMS responders are on scene and  the on-viewing unit is not enroute to
> another emergency, or not transporting a patient, the crew of that unit must stop
> and render aid including transport, if  appropriate, or wait until other EMS
> resources arrive.


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## looker (Mar 26, 2011)

Are you asking if you can disobey your company policy? Sure but you can also get fired and/or reprimanded. Basically the company is covering its *** by having this policy. 

Lets for example assume that you driving down the road and come upon head on collision between two vehicles. You're just IFT ambulance and only have basic supplies. After everything is said and done one of the person is paralyzed for life. Guess what that person will be doing? That is right he/she will be suing everyone they can including you asserting that because of your lack of experience/skills you were negligent which resulted in that person becoming paralyzed.

Basically unless your dispatch directs you stop and/or emergency dispatcher or someone else with authority to order you to stop you notify your dispatch and maybe call 911 to report the accident and continue on your way. 

A lot of companies have similar policy simple because of extra liability.


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## looker (Mar 26, 2011)

usalsfyre said:


> Different situation, they're obligated to act within a particular area. Similar to how if I happen upon one in my contracted response area I'm obligated to stop. However, you'll also notice LE from out of jurisdiction doesn't usually do traffic stops.



I have some bad news for you but cops are not obligated to stop or even help. US Supreme Court had ruled that cops have no obligation to protect citizens. 

Basically unless there is specific law that requires non contracting ambulance to stop without being directed to do so by authorized personal they are required to follow the policy of the company. If that policy says contact dispatcher for permission to stop that is what they must do or face being reprimanded and/or just fired for violating company policy.


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## ffemt8978 (Mar 26, 2011)

looker said:


> I have some bad news for you but cops are not obligated to stop or even help. US Supreme Court had ruled that cops have no obligation to protect citizens.



Before anyone asks, here are a couple of cases pertaining to this:
Town of Castle Rock v. Gonzales


Warren v. District of Columbia


DeShaney v. Winnebago County


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## Akulahawk (Mar 26, 2011)

looker said:


> I have some bad news for you but cops are not obligated to stop or even help. US Supreme Court had ruled that cops have no obligation to protect citizens.
> 
> *Basically unless there is specific law that requires non contracting ambulance to stop without being directed to do so by authorized personal they are required to follow the policy of the company. If that policy says contact dispatcher for permission to stop that is what they must do or face being reprimanded and/or just fired for violating company policy.*


Correct. Though I do know of 2 EMTs that got their certs pulled back in 2000-ish for failure to stop and render aid... required by a County Policy that was similar to what Sacramento has. This was in Santa Clara County. I clearly remember the EMTs being asked by County Comm for their cert numbers... over the air. As to whether or not they got their certs back, I do not know. 


ffemt8978 said:


> Before anyone asks, here are a couple of cases pertaining to this:
> Town of Castle Rock v. Gonzales
> 
> 
> ...


Basically, those and a few other cases, law enforcement can not be held liable for injury or death to someone for failure to provide adequate police protection unless they extend that Police Protection to you specifically. You'll rarely hear a dispatcher actually promise a response by their Police/Sheriff/Troopers because of this. Similarly, unless you have a specific duty to act, you do not have to... Sacramento County is creates this duty to act (stop and render aid & transport if necessary) by policy, as long as you're on duty. There's also a requirement that the unit contact Fire Dispatch about the incident as well. This is to prevent poaching of system calls by private non-contracted companies.


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## Sandog (Mar 27, 2011)

Akulahawk said:


> Sacramento County basically takes this out of the individual company's hands. Here's what I mean...
> 
> From SCC EMS 2055.07 On-Viewing Medical Emergencies...



How on earth did you find that? I would like to check that out for San Diego county but have no idea what search terms to use.


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## looker (Mar 27, 2011)

Sandog said:


> How on earth did you find that? I would like to check that out for San Diego county but have no idea what search terms to use.



Here you go
http://www.sacdhhs.com/CMS/download...ical_Emergencies_by_ALS_and_BLS_Providers.pdf


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## Akulahawk (Mar 27, 2011)

Sandog said:


> How on earth did you find that? I would like to check that out for San Diego county but have no idea what search terms to use.


I found it because I used to work in this system. That was one of the policies I had to be intimately familiar with.

If a county will have a policy about that, it'll be usually pretty obviously titled. Santa Clara County's policy is found in Policy 607 "BLS Ambulance Utilization" but since they authorize private ALS now, the "still alarm" policy used for BLS providers applies to non-911 ALS providers. Until a few years ago, the only ALS providers Santa Clara County had were 911...

Here is theirs:


> Still Alarms
> In the event that a private ambulance, other than the County-contracted provider, arrives on the scene of a collision, illness, or injury by coincidence; the crew shall provide appropriate care and immediately dial "911" or notify County Communications.


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## CAOX3 (Mar 27, 2011)

looker said:


> Here you go
> http://www.sacdhhs.com/CMS/download...ical_Emergencies_by_ALS_and_BLS_Providers.pdf



Sounds reasonable to me, then again do we really need a policy to determine if an unoccupied ambulance should should stop at the scene of an emergency where no others responders are present.

Seems like common sense to me but I don't work in an area with ongoing turf wars 
, if there is an emergency you stop, initiate treatment if need be and hand off to the local ems provider when they arrive, its professional courtesy.

I have arrived at many many scenes where out of town ambulances or IFT trucks have stopped to assist, initiated treatment and so on.  I thank them for their assistance and get on with it.  There have even been times where they have formed a rapport with the patient and initiated treatment, there is no point starting over again.  I assist them with packaging help them pick up there equipment or whatever and then they transport.  I advise dispatch what s going on, if I think its logical for them to continue treatment and transportation that's what we do.  I don't need an ok from any dispatcher, I make the decisions on scene.  If its in the best interest of the patient to continue on with that provider, rather then having me start over from point a, that'd what we do.

Its about patient care, not about beauracratic politics and imaginary lines drawn in the sand.


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## looker (Mar 27, 2011)

CAOX3 said:


> Sounds reasonable to me, then again do we really need a policy to determine if an unoccupied ambulance should should stop at the scene of an emergency where no others responders are present.
> 
> Seems like common sense to me but I don't work in an area with ongoing turf wars
> , if there is an emergency you stop, initiate treatment if need be and hand off to the local ems provider when they arrive, its professional courtesy.
> ...



Unfortunately that type of policy is needed. Mainly from company liability point of view. If inexperienced crew stops at an accident scene and screw something up badly to the point where it is determine that crew were negligent, the company will get sued. With this type of city/county policy in effect the company got some defense. Yes our crew wasn't experience in this type of emergency but according to xyz city policy we were legally required to stop and assist.


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## Akulahawk (Mar 27, 2011)

looker said:


> Unfortunately that type of policy is needed. Mainly from company liability point of view. If inexperienced crew stops at an accident scene and screw something up badly to the point where it is determine that crew were negligent, the company will get sued. With this type of city/county policy in effect the company got some defense. Yes our crew wasn't experience in this type of emergency but according to xyz city policy we were legally required to stop and assist.


The other reason why they'd put such a policy in place is that private companies will generally prohibit their crews from stopping to render aid. This is due to the perceived liability issue and a high likelihood that the company won't get paid for the service. Sacramento ALSO put in a "must contact the SRFECC" (aka 911) to advise of the incident so that they can keep track of who is stopping to render aid. This way they know who is actively jumping system calls and who just stumbled onto an incident...

There was a company out here (not any more) that got into trouble for actively jumping calls... and nearly lost their ambulance operations permit... oops.


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## Sunsetter37 (Mar 28, 2011)

looker said:


> Basically unless there is specific law that requires non contracting ambulance to stop without being directed to do so by authorized personal they are required to follow the policy of the company. If that policy says contact dispatcher for permission to stop that is what they must do or face being reprimanded and/or just fired for violating company policy.



Yes, and that's exactly what I'm trying to find out; if there is a specific law in LA county or LA city. I'm not actively seeking out accidents or anything like that, but we come across them often enough. If there is a law and my company still tries to install this policy, then that's illegal and unethical.


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## Akulahawk (Mar 28, 2011)

Sunsetter37 said:


> Yes, and that's exactly what I'm trying to find out; if there is a specific law in LA county or LA city. I'm not actively seeking out accidents or anything like that, but we come across them often enough. If there is a law and my company still tries to install this policy, then that's illegal and unethical.


You're going to want to look at the LA County EMS policies and you'll also have to look at local ordinances. Frankly, I doubt that there's a County or City ordinance that directs an ambulance's actions per se.


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## Sunsetter37 (Mar 29, 2011)

Akulahawk said:


> You're going to want to look at the LA County EMS policies and you'll also have to look at local ordinances. Frankly, I doubt that there's a County or City ordinance that directs an ambulance's actions per se.



Thanks, that's pretty much what I thought, but I hoped someone here would know for certain. 

And thank you to everyone who answered.


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## looker (Mar 29, 2011)

Sunsetter37 said:


> Thanks, that's pretty much what I thought, but I hoped someone here would know for certain.
> 
> And thank you to everyone who answered.



I am not aware of any regulation that requires an ambulance in the city of LA to stop at an accident scene. I checked the latest revision to the rules of ambulance and there is nothing about that issue.


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## Farmer2DO (Mar 29, 2011)

looker said:


> Are you asking if you can disobey your company policy? Sure but you can also get fired and/or reprimanded. Basically the company is covering its *** by having this policy.
> 
> Lets for example assume that you driving down the road and come upon head on collision between two vehicles. You're just IFT ambulance and only have basic supplies. After everything is said and done one of the person is paralyzed for life. Guess what that person will be doing? That is right he/she will be suing everyone they can including you asserting that because of your lack of experience/skills you were negligent which resulted in that person becoming paralyzed.
> 
> ...



In New York State, an ambulance is an ambulance, and they all must be certified by the State Department of Health.  That means they are all stocked with essential supplies, and at least one of the people on board must hold a valid EMT card.  Is it different elsewhere?  If you are only doing IFTs, does that mean you don't need to carry the same supplies an ambulance does that takes 911 jobs?  If it's not different, then there's no reason any ambulance can't provide BLS.  If you have a concern that your crew is so inexperienced that they can't handle the BLS of an MVA, then they shouldn't be on their own.

If you drive by, in your big billboard on wheels, and ignore an accident, I would think that would very much set you up for "my {baby, mother, husband} died because XYZ ambulance didn't stop!"  It would also be bad press to be on the 11 o'clock news after a bad patient outcome.  Sure, liability is always an issue.  If the company is THAT worried about it, I suggest they get out of the EMS business.

My response would be "We're being waved down by bystanders.  Stopping to check.  Will advise with more info."


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## looker (Mar 29, 2011)

Farmer2DO said:


> In New York State, an ambulance is an ambulance, and they all must be certified by the State Department of Health.  That means they are all stocked with essential supplies, and at least one of the people on board must hold a valid EMT card.  Is it different elsewhere?  If you are only doing IFTs, does that mean you don't need to carry the same supplies an ambulance does that takes 911 jobs?  If it's not different, then there's no reason any ambulance can't provide BLS.  If you have a concern that your crew is so inexperienced that they can't handle the BLS of an MVA, then they shouldn't be on their own.
> 
> If you drive by, in your big billboard on wheels, and ignore an accident, I would think that would very much set you up for "my {baby, mother, husband} died because XYZ ambulance didn't stop!"  It would also be bad press to be on the 11 o'clock news after a bad patient outcome.  Sure, liability is always an issue.  If the company is THAT worried about it, I suggest they get out of the EMS business.
> 
> My response would be "We're being waved down by bystanders.  Stopping to check.  Will advise with more info."



In California an ambulance do not get "certified" by the state. EMT's get their license from the state in addition to any local certification that might be required. The only certification if you even want to call that, that an ambulance get is inspection by California Highway Patrol and also by some city. If i recall correctly emt in California can administer  asa,o2, epi, nito,ipecac, ,  im atropine,charcoal. No IV starting or anything like that. Yes an Ambulance have enough supply to do BLS 911 but 1) There is no regulation/requirement that they stop unless given permission and 2) Even if they stop they are required to call 911 and 99.9% of the time either 911 contracted ambulance will come or LAFD ambulance will. You going by will not result in any liability as there is no requirement for you to do so. Now if you get flag down and you're not on any call you must follow company protocol. Notify dispatcher and call 911. At the end of day it's all about money and liability.


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