# Medicolegal Question?



## Lifeguards For Life (May 7, 2010)

* I was not a witness to these events, and have retold them as briefly as possible, to the best of my ability with the information given to me by a concerned parent. The first half is what was told to me, the second half, separated by dotted line, is fictional, and the question i pose to the readers

You are an EMT in your last semester of paramedic school. You are not on duty, but are at a local high school wrestling meet to cheer on a family member.

Everything has been going smoothly, until one of the final matches. One of the wrestlers puts his opponent in an illegal move.(described to me as a move with the intent of cutting off cerebral blood flow). This wrestlers father stands up and is yelling at the referee, telling him that it is an illegal move, and to call the match.

The referee lets the match continue, much to the fathers dismay.

At this point, the wrestlers body goes limp, and the father is escorted out of the gymnasium for interrupting the match.

The wrestlers limp body is held in this hold for "at least another minute or two" per the lady retelling these events to me. The father tries to re enter the gym several times, but is escorted back outside, by the coaches of his sons team.

The referee finally calls it, and the wrestler remains limp and motionless. Everyone in the stands is yelling for someone to "do something" though no one on the mat seems overly concerned. 
.............................................................
What would you do?

At this point, you have a lady next to you call 911, and make your way down to the floor, to see if there is anything you can do to help.

Upon reaching the mat, the referee tells you that this is his wrestling meet, he has been the head ref for 12 years, has seen incidents like this, does not need your help, and the wrestler is fine.

As far as you can tell, there has been no assessment, and from this distance, you can not tell whether the wrestler is breathing or not.

What authority does this referee have to stop you from providing any BLS care that may be necessary while waiting for an ALS ambulance to arrive?

Assuming you have no duty to act, what allows you to assess and treat this patient, with an EMT or Paramedic license?

Would a M.D, having a license to independantly practice medicine, have any more pull in a situation like this legally? 

Is he interfering with an emergency scene?

*Hinds sight tells us 911 was never called.

*The lady claims "it took around 5 minutes for the wrestler to return to consciousness"

* the move in question is the _cobra clutch_: 
The wrestler stands behind the opponent and uses one arm to place the opponent in a half nelson. The wrestler then uses his free arm to pull the opponent's arm (the same arm to which the wrestler is applying the half nelson) across the face of the opponent. The wrestler then locks his hand to his wrist behind the opponent's neck to make the opponent submit or lose consciousness as the carotid artery is cut off.

* I apologize in advance for the cluttered, and unorganized presentation of this 'scenario'.

* If any clarification is needed, let me know and I will do my best

Just curious to see others thoughts


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## Shishkabob (May 7, 2010)

Lifeguards For Life said:


> What authority does this referee have to stop you from providing any BLS care that may be necessary while waiting for an ALS ambulance to arrive?



None.  He has no authority to stop anything that does not pertain to the matches.  He cannot touch you, as that would be battery.  The kid is considered to be giving implied consent, and the only people that can legally stop you are his parents.

He *might* have the authority to eject people from games, but if you push to the point where he needs police, I'm sure the police won't stop you from doing your aid.




> Assuming you have no duty to act, what allows you to assess and treat this patient, with an EMT or Paramedic license?


  Being a lay person.



> Would a M.D, having a license to independantly practice medicine, have any more pull in a situation like this legally?


  I wouldn't believe so, as again, the ref has no authority in who can and cannot provide medical attention to anyone but himself. 





> Is he interfering with an emergency scene?


  Not an on-duty provider and as such I don't think it would be considered interference.



Depends on the situation, but if it's as described I'd want to make sure the kid was breathing before letting the ref make any determination of what is to be done.  If he throws a hissy fit, I'd show my license.  If he touches me I'd ask him to lay off, and if he doesn't, I'd get witnesses to say he was touching me against my will and he'd get shoved away.


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## Melclin (May 9, 2010)

I must be missing something..why would the ref have any authority at all? More than any other person, including the EMT/Paramedic in question. Since when does the umpy have any authority over anything (with the possible exception of the participants in the sport)?


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## rescue99 (May 9, 2010)

Lifeguards For Life said:


> * I was not a witness to these events, and have retold them as briefly as possible, to the best of my ability with the information given to me by a concerned parent. The first half is what was told to me, the second half, separated by dotted line, is fictional, and the question i pose to the readers
> 
> You are an EMT in your last semester of paramedic school. You are not on duty, but are at a local high school wrestling meet to cheer on a family member.
> 
> ...




They're all idiots! Not one person, not even a parent bothered to call 911 but they all want to complain now?? Anyone, had the ability to make a phone call. 

As far a rendering care; there is no duty to act however, suggesting the news media might see it otherwise would have probably gotten the coaches to step aside and let the kid be looked at. What do we know about this type of situation where a victim is not assessable? Doc's would need to do the same thing as any other layperson / care provider. Issue the ultimatium then???? It's a very Basic EMT question.


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## mycrofft (May 9, 2010)

*What variety of question is this?*

1.Am I obligated?
2. Was this clinically dangerous to the subject?
3. How do I get treatment for this subject if authority says "no"??
4. Veracity of bystanders' accounts?
5. Now it is done what can be done to bring justice to their scurvey heads?

1. No you are not obligated legally. See your state's duty to act laws. You may _*feel*_ ethically or morally obligated.
2. The "choke hold" was discarded years ago by PD's due to unacceptable rate of brain damage and death. In  judo, at least in the past their versions were never done unless the _sensei_ was appropriately trained. _*YES.*_
3.  Depends. You can identify yourself, ask for the ref's name and tell him you are officially advising him of your opinion the subject needs care. You can do that to Security and they will call. You can stop and make the EMS call yourself. It is a matter of gaining safe access to the subject then being able to try to do something..but with this sort of event as an unprepared EMT there isn't much except maybe try to prevent unnecessary movement before EMS arrives. BTW, a call to the police saying a kid had been strangled and a guy is preventing treatment might get you some muscle, but also some trouble later.
4. Bystanders always think stuff takes longer than it does (and there is more blood on the floor than there is), unless it is their fault. "Five minutes" may have been forty five seconds. 
5. In the aftermath, ask what sort of trouble versus benefit you are trying to bring down? Will it benefit the family? Will they be upset you get involved? Are you sure enough about your impresions (including that bystander's lady's stopwatch) to maybe get someone fired, blacklisted, or arrested, and will it stand up when he counter-sues you?


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## redcrossemt (May 28, 2010)

While we have no duty to act (while off-duty), Michigan law vests the authority of patient management to the licensed healthcare professional on-scene with the most relevant training to the patient's condition. It doesn't matter whether that person is off-duty. Many states probably have a similar law.

Once an on-duty provider from a licensed life support agency arrives, authority is transferred to them.

In all reality, you should be pretty sure about the situation before pulling any "card" like a law to back you up. Mycrofft covered it pretty good.


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## FLEMTP (May 29, 2010)

as far as I'm concerned... if the hold is an illegal hold per the wrestling match rules... there is a good reason for it being illegal. Another poster pointed out that LEO's are not allowed to "choke people out" any more because it would lead to death on occassion. 


Now, with that said... the hold is against the wrestling rules... and I'm sure the wrestler entered the match in good faith & with the understanding that choke holds are not allowed. Once the ref allowed the choke hold to continue, the match is now over, and I look at this as a use of force issue. In the state of florida the law is very specific. I would have intervened well before the victim was let go, but after he was obviously unconscious. Many times a spectator has a poor view, and in wrestling, sometimes things look worse off than they are... however once the victim lost consciousness it is obvious he is now in "medical distress" and an emergency situation exists. I would have contacted 911 and informed them than a kid was being strangled and people were on scene preventing it from being stopped, and that Law enforcement and EMS are both needed. I would have then told then ref he can either step aside or be arrested as an accessory to the crime... and then tell the wrestler he needs to release his hold and let the victim go..

Now.. should he decide not to... that leaves some very interesting options on the table... since technically this is a use of incapacitating force... may even be deadly force depending on how long he keeps the hold in place. In the State of Florida.. you can use force to stop another person's attack in defense of yourself or another person up to and including deadly force should you fear for other person's life.. and since the wrestler is using what can be construed as deadly force.. . well.. he would get a couple of very clear loud verbal commands to release the hold, and then at that point I would feel justified in stopping the threat to the unconscious wrestler using whatever force is prudent and necessary to the situation. 

Once the wrestler let the victim go, I would then begin assessment and/or treatment as appropriate for an EMS bystander, whether it be one patient I have.. or now two depending on the compliance of the wrestler.


In this situation the ref has NO authority to stop you from acting in this situation and depending on how intent he is on stopping your intervention, is now an accessory to at the very least aggravated battery, possibly attempted homicide, and up to homicide depending on the outcome.

 As I said, once the wrestler begins to use an illegal move outside of the rules, and the ref did not stop him, then a crime is now in progress that could result in the permanent disability or death of the victim, and the wrestling meet is over. 

As far as the duty to act, I dont understand why you would not feel there is a duty to act in this situation. You have witnessed another person choked into unconsciousness and are unsure if they are even still breathing. If you were not medically trained at all I would still say you have a legal obbligation to act, seeing as how the victim is now involved in a medical emergency, and knowingly not calling 911 to report this at the very least would open you to both criminal and civil liabilities. I would also think that a jury of your peers would feel that you do indeed have a duty to act in this situation... now whether you felt it was a safe situation to act upon is another story. This is why I carry a pistol off duty 110% of the time, so should the need to defend myself or someone else arises, should things ever escalate to deadly force.

As far as someone not calling 911 in your scenario... this is exactly why I call 911 myself, or designate a specific person to call 911... and I follow through to make sure they have done so. I would have more than likely contacted 911 myself as I approached the situation.

I think in a situation like this, a doctor would have no more "authority" unless he were present as a representative of the EMS agency that has jurisdiction over the location of the wrestling match.

This is a very interesting scenario, and I plan on reposting this on another board.. im interested to see how people would handle it from a layperson's view.


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## Lifeguards For Life (May 29, 2010)

FLEMTP said:


> This is a very interesting scenario, and I plan on reposting this on another board.. im interested to see how people would handle it from a layperson's view.



After reading most of the posts, I was under the impression that I was missing something, and it was a silly post. 

Can you post or PM me a link to where you repost this?


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## mycrofft (May 29, 2010)

*Not me. I've seen it and been it.*

I saw a girl knocked unconscious by being thrown into the air at a cheer competition and landing on her back on a hardwaoor floor, bouncing her head, and just picked up and carried off by her coach. I've been the medical standby at practices and games for jr peewee football and their cheerleaders, and a parent at little leauige games, where I had to prevent such stuff. Good question, sparked discussion.


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## hagemc (Jun 4, 2010)

FLEMTP said:


> As far as the duty to act, I dont understand why you would not feel there is a duty to act in this situation. You have witnessed another person choked into unconsciousness and are unsure if they are even still breathing. If you were not medically trained at all I would still say you have a legal obbligation to act, seeing as how the victim is now involved in a medical emergency, and knowingly not calling 911 to report this at the very least would open you to both criminal and civil liabilities. I would also think that a jury of your peers would feel that you do indeed have a duty to act in this situation... now whether you felt it was a safe situation to act upon is another story. This is why I carry a pistol off duty 110% of the time, so should the need to defend myself or someone else arises, should things ever escalate to deadly force.



There is no duty to act since he is not working.  There most likely is a moral and/or ethical obligation as a human being, but since he was not working under a medical director at the time, there is no duty to act.

I'm not going to pull out my EMT card and flash it around if I'm not on the clock due to the fact that if I were to do something wrong, Good Sam law WILL NOT protect me since I am not ignorant about what I am doing.  I have no liability insurance off the clock, therefore I will not step in.

Carrying a pistol around is different than providing someone with care.


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## MonkeySquasher (Jun 6, 2010)

hagemc said:


> I'm not going to pull out my EMT card and flash it around if I'm not on the clock due to the fact that if I were to do something wrong, Good Sam law WILL NOT protect me since I am not ignorant about what I am doing.  I have no liability insurance off the clock, therefore I will not step in.



Depends on your state.  I know that in NYS, the "Good Samaritan" -type law extends to anyone providing service "without expecting compensation".  The only thing it doesn't cover is blatant gross negligence.


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