# Duty to act.



## ride2k (Nov 25, 2008)

So earlier today I was thinking about something. Maybe I am overthinking it, but I had a question... so I figured I would post it here. 

So about 2 years ago, before I got into EMS, there was a fight between my dad and his ex-wife (my former step-mom). And not caused by my dad, but as a result of the fight, my ex step-mom broke her arm on a bed post. At this point my dad decided to call and ambulance because of the broken arm, which was clearly deformed, and he also called the police. All the while I was in the house. Now there was a lot of... animosity between her and me. 

Say this same scenario happens now. I am in the house, she has a broken arm and EMS is called. I have the duty to act, and I am an EMT, but there is a lot of hard feelings between her and I and I am not at all comfortable dealing with her. What happens? Am I obligated to help her, even though I am rather feeling like punching the living daylights out of her? Should I wait until the police, or the ambulance shows up? 

Now a broken arm is in most cases not a life threatening injury. If it had been something life threatening it might have been different, and obviously there would be more urgency. 
There was nothing I could have done then, but I just wanted to know your opinions on it, if I HAD been certified.


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## BossyCow (Nov 25, 2008)

Part of this would be a judgement call. You do not have the right to force treatment on anyone. Is she going to allow you to treat her? Can you treat her safely without putting yourself at risk. For instance, if you attempt to treat her is she going to blame any pain she feels on you mistreating her or being the cause of the pain? Is you treating her going to cause her to move away possibly further damaging the arm? What about her emotional state. Will your intervention cause her greater anxiety or emotional distress? Being able to calm the patient and minimize movement is part of treatment. If your approaching her while injured, and in an emotional agitated state, is going to increase rather than decrease her anxiety, you are not helping. 

So, the answer is.. it depends. Like much in EMS it's a judgement call.


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## Code 3 (Nov 25, 2008)

Well said, BossyCow. Let's not forget the laws of consent. Seeing how she's fully conscious and has the ability to make a rational and informed decision, you will need expressed consent in order to treat her. I'm going to assume your feelings of animosity are mutual, in which case she probably doesn't want you treating either.


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## VentMedic (Nov 25, 2008)

If the situation is not life threatening or it another medical professional is present (or about to be) a family member can and in most cases should remove themselves from the case. 

If your personal feelings are as strong as you mentioned, your judgement may be clouded and may do more harm. The best you could do is get her medical help or reliable transport to the ED. 

You might also seek some type of anger management classes or counseling since there will be situations in EMS that may remind you of your own personal life. The urge to punch one's mother (step or otherwise) is not healthy baggage to carry when dealing with people.


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## flhtci01 (Nov 25, 2008)

Are you on the schedule to take call?  If not, then there would not be a duty to act.  If you are, it would probably be best to request another EMT to cover the call.


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## ride2k (Nov 25, 2008)

Thanks for the input. 
I mean, this whole stuation happened almost two years ago. The feelings of animosity were not quite mutual. 
And no, I do not need anger management. It was a unique situation.


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## BossyCow (Nov 26, 2008)

So, you have the tools to deal with the next 'unique situation' that comes along?


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## mycrofft (Nov 27, 2008)

*Is this the old "Would you resuscitate Hitler?" question?*

Think about the one-up you have if you get to help someone you have issues with! (Hey, I have that every day!!)


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## jochi1543 (Nov 28, 2008)

You don't have a duty to act unless you are in the very ambulance dispatched to that call. No one can make you perform EMS duties if you are not on EMS payroll at that very moment.


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## reaper (Nov 28, 2008)

jochi1543 said:


> You don't have a duty to act unless you are in the very ambulance dispatched to that call. No one can make you perform EMS duties if you are not on EMS payroll at that very moment.



That is a very bad statement! There are areas that have duty to act laws. Every state and country is different, so you need to check your areas laws, as they pertain to you!


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## flhtci01 (Nov 28, 2008)

reaper said:


> That is a very bad statement! There are areas that have duty to act laws. Every state and country is different, so you need to check your areas laws, as they pertain to you!




I agree!!!!!!  

For example, on the paid service, I do not have a duty to act unless it was my rig dispatched. (I probably would not be at the scene at that time.)  On the vollie service, I could be anywhere within 3 minutes of the rig (rural area short travel times).  If I was on the shift's roster, I could potentially be at the scene and have a duty to act.  If I was not on the shift roster, I could be there and would not have a duty to act.


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## Ridryder911 (Nov 28, 2008)

reaper said:


> That is a very bad statement! There are areas that have duty to act laws. Every state and country is different, so you need to check your areas laws, as they pertain to you!



Even though this is very true, I would doubt that any official would actually take the time to even investigate on the given scenario or for that matters unless you are summoned to respond to take action. Really, does the D.A. have time to investigate and take time to prosecute one that is off duty? 

I have never thought forcing one to participate is good. Think about it; how good of care is one going to give and really is that one wants. Not to be rude, but really what and how in depth of care is one going to give? 

R/r 911


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## VentMedic (Nov 28, 2008)

Originally Posted by *jochi1543* 

 
_



You don't have a duty to act unless you are in the very ambulance dispatched to that call. No one can make you perform EMS duties if you are not on EMS payroll at that very moment.

Click to expand...

_ 


reaper said:


> That is a very bad statement! There are areas that have duty to act laws. Every state and country is different, so you need to check your areas laws, as they pertain to you!


 
Better yet, find out how you are covered by your employer or state workmen's comp laws if you do respond while off duty. That is something everyone in any public service or medical job should know. 

Questions like are you subject to call back and are you required to respond in *ALL or what* situations should be asked of an employer. Many hospitals and ambulance companies do have P&Ps on the topic but often they are covered in two separate manuals, one for HR and one for the work place, which can become confusing. Some companies even have policies about one is not to wear the uniform unless they are one duty to reduce liability. 

As far as the personal issues involving the OP, that could over rule a duty to act if professional judgement would be an issue when emotions get involved.


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## ride2k (Nov 28, 2008)

jochi1543 said:


> You don't have a duty to act unless you are in the very ambulance dispatched to that call. No one can make you perform EMS duties if you are not on EMS payroll at that very moment.



Also it is volunteer.


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## Level one trauma (Nov 29, 2008)

ride2k said:


> So earlier today I was thinking about something. Maybe I am overthinking it, but I had a question... so I figured I would post it here.
> 
> So about 2 years ago, before I got into EMS, there was a fight between my dad and his ex-wife (my former step-mom). And not caused by my dad, but as a result of the fight, my ex step-mom broke her arm on a bed post. At this point my dad decided to call and ambulance because of the broken arm, which was clearly deformed, and he also called the police. All the while I was in the house. Now there was a lot of... animosity between her and me.
> 
> ...


Assuming she would even consent to letting you treating her; out of compassion for the injured, you should make some sort of attempt at the very least to offer your help and stablize the injury. 

Otherwise, since EMS was notified the best action in this particular circumstance would be to observe the patient, try to ensure no further injury or life threat would present to the patient and wait for the EMS/police crews to arrive.

As with any EMS call that you may have during your career, documentation is the key. Upon the arrival of EMS/police if the question presents as to why you did not provided emergency care to this patient, I believe the circumstances as you have explained in this forum justify your not intervening.

If she did allow you to provide treatment to stablize her arm, documentation by the arriving EMS crew should detail what interventions were put into place prior to their arrival. This documentation should be done to protect not only the responding crew to this scene, but also to protect you should the patient later become vendictive towards you.

You should also look at this scenario as if you were the crew dispatched to this call; an EMS call to a domestic dispute. 

You would want to wait until the police arrived on scene before you entered the premises to began treatment for such a call.

Remember scene safety comes first.


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## jochi1543 (Dec 1, 2008)

My bad, didn't realize it's different elsewhere.


Here if you DO decide to respond, you are not allowed to act as anything above a first aider (no matter if you're a paramedic or a neurosurgeon and no matter what kind of equipment you might happen to have on you), and if you do, you could run into licensing issues.


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## Sasha (Dec 3, 2008)

jochi1543 said:


> My bad, didn't realize it's different elsewhere.
> 
> 
> Here if you DO decide to respond, you are not allowed to act as anything above a first aider (no matter if you're a paramedic or a neurosurgeon and no matter what kind of equipment you might happen to have on you), and if you do, you could run into licensing issues.



Same here, at the paramedic level. I think if it's a doctor they have to be willing to accompany the responding ambulance to the hospital if they intitated care beyond the FR level.


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## SemiMedic (Dec 10, 2008)

ride2k said:


> So earlier today I was thinking about something. Maybe I am overthinking it, but I had a question... so I figured I would post it here.
> 
> So about 2 years ago, before I got into EMS, there was a fight between my dad and his ex-wife (my former step-mom). And not caused by my dad, but as a result of the fight, my ex step-mom broke her arm on a bed post. At this point my dad decided to call and ambulance because of the broken arm, which was clearly deformed, and he also called the police. All the while I was in the house. Now there was a lot of... animosity between her and me.
> 
> ...





It also depends on the fact if she wants the treatment. Which is probably what 60 other people have posted, however, I read the op.


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