Changing Transport Code & Legality

[Dominion]

Ok, real quick here is what happened at a service here locally that has stirred up a bit of controversy.

A unit was toned out during mid-day in a large urban setting for a full arrest. They arrived to a very very upset family, pt is a 31 yo male who has been down long enough for family to initiate 911 response and for the truck to get there, approx 10-15 minutes. The crew begins working, get everything together and then begin transport code 3. While on the way to the nearest hospital with a firefighter driving the EMT assisting the medic in the back noticed that the family is following literally 2 feet behind the ambulance through all red lights and basically matching every move the ambulance makes in traffic blowing their horn when people get in the way, and screaming at other drivers. Feeling the safety of his crew and other bystanders in jeopardy the paramedic tells the firefighter to radio for police assistance. There are no LEO in the area who will be able to make it before they arrive to hospital which is approx 15-20minutes depending on traffic. So he slows the truck to code 1, this occurs about 10 minutes out, traffic is fairly light for the area.

Now, the aftermath. The family pretty much flips out when they do this. Before they arrive the crew has also requested security meet them at the ambulance bay. The family is now lobbying hardcore for everyone involved to lose their job. This is including the medic, his EMT partner, the firefighter in the back doing compressions, and the firefighter driving. The problem is no one can find in the legislature or our protocols where they've done anything wrong. The crew was suspended with pay until this is resolved and there is already a lawsuit in the process.

I wanted to ask primarily because A. it's such a huge controversy right now. B. IF in the same situation I probably would have done the same. I am of the opinion that as angry as the family was after they slowed to code 1 that they were five times as dangerous tailgating the ambulance and following around in traffic. Once they slowed Code 1 they still tailgated the truck but were no longer running red lights or weaving with the traffic.

Thoughts?

 

[Aidey]

Our company protocol is exactly what the driver did. Call for PD and lower the code. By continuing to go code you are facilitating the family breaking numerous traffic laws and endangering everyone on the road. If the family had caused an accident it's possible the ambulance could be held responsible.

I doubt the family's lawsuit will succeed. It is unlikely there is a law requiring an emergency vehicle to use its lights and sirens. Most laws/regulations I've seen about driving code have some sort of clause that says it is up to the crew to determine if it is safe or not to use the lights and sirens and that their decision is final.

For example, in my company's contract with the local government it says that we will go code to X,Y and Z. However, we can choose not to go code if we feel it is unsafe, we just have to write up a report saying why we deviated from the contract. The only time I've done it is once when we were having freezing rain and all traffic was going about 30mph on the highway.

 

[Shishkabob]

Unless there is specific company policy for BOTH the Fire agency and EMS agency, I don't see any of the people getting fired. If they do, I see a hefty wrongful termination lawsuit on those agencies hands.

Sounds like the crew did the right thing, putting the lives of the public ahead of a dead person.



In the state of Texas our emergency vehicle code says "With due regard" to public safety. We can pretty much do anything so long as it's safe, the moment it's unsafe we're liable. If an accident were to happen because of us driving code, we're responsible.

 

[dmc2007]

Not speaking from any sort of EMS legal experience here, but couldn't you also articulate that 1) the patient wouldn't have been significantly helped by running L/S 2) because ACLS requires standing, that it was a crew safety issue to drive lights and sirens, and 3) for the same reason as 2), running L/S would have resulted in lower quality patient care?

 

[Tincanfireman]

The potential for gain in the case (ROSC w/o impairment and discharge to home) is infinitesimal compared to the potential for loss (panicked family members tailgating and being involved in an MVC with another vehicle resulting in injuries/death). I agree the crew did the correct thing in reducing code and thereby the overall level of hazard. By continuing the transport emergently, they placed themselves, the family, and other innocent parties at risk. Good call on the part of the crew, and I hope their supervision agrees. They should be commended, not reprimanded.

 

[WolfmanHarris]

Even in an arrest it's important to take the time to care for the family. One thing I always do when family are going to be following immediately after us is instruct them to drive safe, obey all traffic laws and if they feel stressed to pull over where safe and call for a cab or someone to drive them. This is for non L&S transports. For L&S transports if the family is out of sorts I consider taking them along or preferrably I give them a list of things to collect and bring to the hospital, then tell them not to try to follow us closely as we don't want them to get into an accident en route. We rarely have L&S returns though.

 

[Flight-LP]

I always explain to the family exactly how they drive to the hospital. SLOW AND OBEYING ALL LAWS. This means stopping at the lights, not following the unit, and not using their 4 way flashers either. I make the expectation very clear and add the consequences of failure to comply. I usually don't have a problem.

Hmmmmm, 31 years old, a lot of drama on scene, I wonder about this particular arrest. Was it a primary arrest, congenital issues perhaps? Or was it secondary to the Darwinism of society? Either way, it sounds as though the family could benefit from some grief counseling.

Regardless, if I were to arrive 15 minutes into a known arrest without interventions, I wouldn't put more than 20 minutes worth of effort into that arrest unless we achieved ROSC. I would have terminated on scene. Was that an option for this crew?

 

[Dominion]

We do have on scene determination but one requirement is asystole, in this case as I understand it he was a brady PEA nearly the entire time until they arrived at the hospital.

Not sure of the cause of death, I don't know the details surrounding the arrest as far as past history, drug use, suicide etc.

 

[reaper]

Have had this happen a couple times. The crews did right. If LEO is not in area to handle it. You down grade and drive normal. I have pulled over and got out and explained to family that we will sit here until they obey the laws. I will not put the crew of bystanders in harms way, because of them or the pt.

They will normally back off. If not, we sit there. In a code the treatment is not changing, so I will sit there.

 

[TransportJockey]

Unless I had ROSC I never would have transported, but sicne you did... Dropping to code 1 was the right thing to do. It was too much of a risk for everyone to continue L/S with the family doing what they were. If it were me I would make sure PD issued them a citation for that as well, but I'm an ***

 

[FLEMTP]

The first advice I would give is if you are a union agency, contact your union rep ASAP regarding the discipline.

Second of all I would gather as much information as you can. Obtain statements from the fire personnel involved, and the EMS crew involved that state the events leading up to the decision to downgrade.

I would search for information regarding the service in texas that no longer transports a cardiac arrest lights and sirens, see if they cite a specific study in the article or from the agency that gives rationale for not transporting lights and sirens.

Third of all I would make it clear to management that the patient did not improve with ACLS procedures, and include the final disposition of the patient in the ER, whether they were successfully resuscitated or not. See if the ER doc or nurse who received your patient could write a statement that downgrading your transport would not have effected the outcome of the patient if they are so willing.

And last of all I would put a spin on the decision like this:

1. The family was behaving irrationally, emotionally, and operating a vehicle in an impaired manner as a result of the situation

2. The family was putting not only themselves at risk, but also your agency from a legal liability standpoint by following your vehicle in a reckless and impaired manner, and that by allowing them to continue to follow you in the manner they were, would have aided in their reckless endangerment of the general public.

3. You terminated your lights and siren transport to prevent further laws from being broken and to protect the safety and security of the general public.

4. You are not a law enforcement officer and therefore had no legal authority to tell them to stop their reckless pursuit of your vehicle, and that you felt given their emotionally charged state, that you and your crew would have been in grave personal danger by attempting to do so.

5. You took every reasonable step possible up to the point of reducing your transport to a non-emergency transport to stop the family from engaging in the behavior they did, and none of which were successful. I would list out the items you did leading up to the decision, such as telling them prior to leaving the scene not to follow you as they did, calling for a LEO to stop the vehicle, etc.

It would have been much more feasible I believe to call the ER or Medical control in this situation and explained the situation to them on a recorded line, letting them know you will be reducing your transport and cite the reasons above as your rationale, and THEN requested security to meet the family in the bay to prevent them from reacting in negative way due to their emotionally charged state. It may have been prudent also to request that law enforcement meet you at the ER given the situation.

I would also possibly contact the local/county/state DOT and see if they have any traffic cameras that may have caught the family driving in a reckless manner as they followed you lights and sirens. If you can show this to your supervisor, or to a court of law, then the family will have no leg to stand on as a legal defense, and may be subject to prosecution for criminal and/or traffic charges as a result of their actions.

You could even suggest that as part of the "punishment" that the medic and the crew involved do a Public Safety awareness campaign on the dangers of following an ambulance lights and sirens, so that the general public can be made aware that it is not legal or acceptable to do this.

Last of all after the family has calmed down and had a chance to mourn the passing of their loved one, suggest a sit down meeting with the crew involved, and the supervision from the agency involved, and try and work through an explanation of what happened and why to the family. If there is an agency attorney, involve him or her, and if legally smart, the attorney that represents the family if they already have retained one.


Hope this helps some... sometimes a third party not involved can help look at things from a clearer perspective than those involved.

 

[Dominion]

Well this wasn't my run, I was inquiring from others here while they are deliberating around here on what the proper way to do things are and what I could use in the future if I ever ran into the situation.

 

[MusicMedic]

Well this wasn't my run, I was inquiring from others here while they are deliberating around here on what the proper way to do things are and what I could use in the future if I ever ran into the situation.

They were Driving with "Due Regard" which is the #1 defense they have


let us know the outcome

 

[Aidey]

Any update on this?