Duty to Act Questions

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jessicaj

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This may be a silly question but its somewhat haunting my mind so worth voicing/getting advice about.

I work for Parks and Rec, with children. Each of us, as employees through the city, are required by state to be first aid/cpr certified (a little redundant because I am an EMT-B as it is).

In our summer program we take the children to swim twice a week through our own district on the same property so we have a lot of comfort with the area and the lifeguards.

With that being said, this is the first summer i'll be there as an EMT. We have been instructed to 'pass the buck' to the lifeguard staff while in the swimming area if any incidences occur with our children.

My concerns are in regards to my level of training verses the life-guarding staff and whether or not i'm liable/required to take charge of the scene/patient.

I know California does not have a Duty to Act law requiring me to help, but at the same time is it not abandonment for me to swoop up a 7 year old kid with a busted face and hand him off to a lifeguard? (just an example, not an isolated incident)

I know I should talk to the aquatics supervisor, and I intend to its just I kinda wanted some advice to whether or not its worth bringing up my concerns to her. If its just me being overly cautious or thinking too much i'll leave it be but if its worth bringing up I will.

Thanks!
-Jessica
 
jessicaj said:
This may be a silly question but its somewhat haunting my mind so worth voicing/getting advice about.

I work for Parks and Rec, with children. Each of us, as employees through the city, are required by state to be first aid/cpr certified (a little redundant because I am an EMT-B as it is).

In our summer program we take the children to swim twice a week through our own district on the same property so we have a lot of comfort with the area and the lifeguards.

With that being said, this is the first summer i'll be there as an EMT. We have been instructed to 'pass the buck' to the lifeguard staff while in the swimming area if any incidences occur with our children.

My concerns are in regards to my level of training verses the life-guarding staff and whether or not i'm liable/required to take charge of the scene/patient.

I know California does not have a Duty to Act law requiring me to help, but at the same time is it not abandonment for me to swoop up a 7 year old kid with a busted face and hand him off to a lifeguard? (just an example, not an isolated incident)

I know I should talk to the aquatics supervisor, and I intend to its just I kinda wanted some advice to whether or not its worth bringing up my concerns to her. If its just me being overly cautious or thinking too much i'll leave it be but if its worth bringing up I will.

Thanks!
-Jessica
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Even though you're an EMT, if you are not working as one at the time of an incident, I would suggest to you that follow your employer's mandate that you pass the responsibility over to the lifeguards. EMT school does NOT train you for water rescues. Think about it like this: the Lifeguards are on-duty. Their employer (same as yours probably) is responsible for their actions and will provide for their legal defense if they follow their rules and regulations. You are NOT on duty as an EMT so your employer will not provide for your defense if you go beyond the scope of your employment.

I am a Paramedic. If I choose to assist at the scene of an emergency, it's not abandonment if I turn the patient over to the on-duty personnel, even if they're EMT-B. I'm mostly limited to the EMT-B scope anyway when not working for/employed by an ALS company/agency. One reason it's not abandonment is that I'm not leaving without providing for further care. I'm also not simply saying "Ok, the cavalry has arrived, bye!"
 
At the same time, you can be legally held to your highest certification, which ends up putting you in to a bind and can be civilially responsible.


Tis why you'll see many Paramedics refuse to work on a BLS truck.
 
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Thats great advice, thank you. Its what I was mainly thinking but there's always that grain of doubt that once its planted in your mind I just harp on possibilities.

I may not have made this clear earlier, but I was not referring to water rescue. Our pool is within a large public park and the children play and do their thing. My concerns are for the times a kid trips and hits face on the cement or bee stings, etc. Ive patched up split chins and sent them with their parents to the hospital, so its things like this but I do agree and appreciate the input. You helped to ease my mind some from all the 'what if's" I had.
 
...quite a predicament....

I do believe i'll just casually bring it up in conversation with the Aquatics director this week. Its worth her being aware of the concerns just in case she needs to back me in any way.

Thanks!
 
Basically, the most you can do in that situation is don't do something that a first aider is taught if your EMT tells you it will do harm.


Can't (legally) work to the full extent of your EMT, but alas doing something you know would cause harm just because you can only work at a lower level is a no-no.



Just make sure your employers policy is in writing, clearly defined, and you have a copy of it. C.Y.A.
 
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Linuss said:
At the same time, you can be legally held to your highest certification, which ends up putting you in to a bind and can be civilially responsible.


Tis why you'll see many Paramedics refuse to work on a BLS truck.
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Just curious, can you cite any cases where a lawsuit has been successful against an EMS provider at a non-EMS job?
 
JPINFV said:
Just curious, can you cite any cases where a lawsuit has been successful against an EMS provider at a non-EMS job?
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Never said I could, but again, look at how civil lawsuits are done, and the 'evidence' required (preponderance of evidence). Like I said, if the first aid level tells you to do one thing, but you know it would cause harm to the patient solely because of your EMT level, don't be surprised if you're held accountable for possible wrong-doing.

Even still, a case need not be successful to go to court or harm the provider. Better to just avoid the situation.




Just like an emergency medical provider is not covered by the good samaritan law in Texas, regardless of them being off-duty--- just better to avoid being in the situation in the first place.
 
Rearranged quotes to make this response flow better.

Just like an emergency medical provider is not covered by the good samaritan law in Texas, regardless of them being off-duty--- just better to avoid being in the situation in the first place.
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Err...

SUBCHAPTER D. EMERGENCY CARE


Sec. 74.151. LIABILITY FOR EMERGENCY CARE. (a) A person who in good faith administers emergency care is not liable in civil damages for an act performed during the emergency unless the act is wilfully or wantonly negligent, including a person who:
(1) administers emergency care using an automated external defibrillator; or
(2) administers emergency care as a volunteer who is a first responder as the term is defined under Section 421.095, Government Code.
(b) This section does not apply to care administered:
(1) for or in expectation of remuneration, provided that being legally entitled to receive remuneration for the emergency care rendered shall not determine whether or not the care was administered for or in anticipation of remuneration; or
(2) by a person who was at the scene of the emergency because he or a person he represents as an agent was soliciting business or seeking to perform a service for remuneration.
(c), (d) Deleted by Acts 2003, 78th Leg., ch. 204, Sec. 10.01.
(e) This section does not apply to a person whose negligent act or omission was a producing cause of the emergency for which care is being administered.
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http://www.statutes.legis.state.tx.us/Docs/CP/htm/CP.74.htm#74.151

Who ever told you that obviously has no clue what Texas state law is. A quick Google search brought me to the Texas Medical Association's page on Good Samaritan laws, which provided the proper legal reference. If you aren't expecting pay for that specific incident, then you have an affirmative defense. 74.152(b)(1) specifically lays out that being legally entitled to reimbursement is not the same as providing care with the expectation of reimbursement.


Linuss said:
Never said I could, but again, look at how civil lawsuits are done, and the 'evidence' required (preponderance of evidence). Like I said, if the first aid level tells you to do one thing, but you know it would cause harm to the patient solely because of your EMT level, don't be surprised if you're held accountable for possible wrong-doing.
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Sure, but that falls under the standard willful or wanton exception to the law. Even if you couldn't be held liable, why would you willfully provide care that you knew was wrong? "Befehl ist Befehl" went out of style sometime around 1945.

Even still, a case need not be successful to go to court or harm the provider. Better to just avoid the situation.
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...then why do anything at all? Driving down the road could lead to a lawsuit, so why drive? There was a kid on Friday who took a baseball to the chest while trying to bunt at a Little League game and went into cardiac arrest. Are you saying that if you were in the stands, trained in CPR, you wouldn't provide compressions because of liability concerns?
 
JPINFV said:
Err...


http://www.statutes.legis.state.tx.us/Docs/CP/htm/CP.74.htm#74.151
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On one hand, apparently the law I read was the older law, as it stated:



(3) by a person who regularly administers emergency care in a hospital or emergency room; or
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But looking at your link, it was amended in 2003 to remove that point.



Funny thing is, I continued on in the law to look at Texas' legislation on the matter, and in House Bill 215, they define volunteers to add Physicians / RNs/ PAs, even dental hygienist of all people... but specifically left out Emergency Medical Technicians / Paramedics. Now granted, the 76th sessions was in 1999, but I have found no ademendment of the law since then and the most recent posting of the law was in 2007.

http://www.legis.state.tx.us/tlodocs/76R/billtext/html/SB00215I.htm







Are you saying that if you were in the stands, trained in CPR, you wouldn't provide compressions because of liability concerns?
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If liability concerned me, JPIN, I am in the wrong profession, aren't I? ;)
 
obviously I would not go beyond my scope of practice, likely not even beyond basic first aide/cpr practice... I guess its a matter of being trained to do things more efficiently or effectively...

my main concern with all of this was the possibility of losing all progress of what i've accomplished so far and having the potential to negatively affect my chances in the nurse Practitioner program i'd like to get into after some field experience as an EMT...

we are across the street from a hospital so my concerns were never with the care i'd need to give or to stabilize... it was purely logistics and based on the conversation there are A LOT of logistics! Thanks for all the great information, its a lot to think about.
 
Linuss said:
On one hand, apparently the law I read was the older law, as it stated:





But looking at your link, it was amended in 2003 to remove that point.
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Ah, gotcha.

Funny thing is, I continued on in the law to look at Texas' legislation on the matter, and in House Bill 215, they define volunteers to add Physicians / RNs/ PAs, even dental hygienist of all people... but specifically left out Emergency Medical Technicians / Paramedics. Now granted, the 76th sessions was in 1999, but I have found no ademendment of the law since then and the most recent posting of the law was in 2007.

http://www.legis.state.tx.us/tlodocs/76R/billtext/html/SB00215I.htm
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If I was a lawyer, I would argue that the use of the word "includes" indicates that the list is not all inclusive of protected individuals.







If liability concerned me, JPIN, I am in the wrong profession, aren't I? ;)[/QUOTE]
 
Linuss, at OC they told us that TX EMTs were included if they were not being compensated. For instance, if I rolled up on an accident somewhere in my county when I worked in TX, since I had a duty to act per my SOPs, I would not be covered, but if I was in the next county over I would be fine to stop and be covered as a Good Samaritan
 
'Leading from behind'

Jessica,
You should not hesitate to brnig this up to your supervisor. The policies as you outline them place the responsibility for the patient management on the lifeguard but that probably does not preclude you from 'assisting'. Any lifeguard worth his / her salt is probably good at recognizing the need to work with the responders / employees to insure the best outcome for the patient. Your best bet is to develop a great set of communication skills that allow the lifeguard to see that you are an asset. Along the lines of "I am an EMT, how can I help"? Learn to be the 'tale wagging the dog' and you will find that there will be many opportunities to manage an event through someone elses authority and with their blessing..It's all in how you approach it and your communication styles......


jessicaj said:
obviously I would not go beyond my scope of practice, likely not even beyond basic first aide/cpr practice... I guess its a matter of being trained to do things more efficiently or effectively...

my main concern with all of this was the possibility of losing all progress of what i've accomplished so far and having the potential to negatively affect my chances in the nurse Practitioner program i'd like to get into after some field experience as an EMT... .
Click to expand...
 
3 words: Good Samaritan Law

From Wikipedia:

Good Samaritan laws are laws or acts protecting those who choose to serve and tend to others who are injured or ill. They are intended to reduce bystanders' hesitation to assist, for fear of being sued or prosecuted for unintentional injury or wrongful death. In Canada, a good Samaritan doctrine is a legal principle that prevents a rescuer who has voluntarily helped a victim in distress from being successfully sued for 'wrongdoing'. Its purpose is to keep people from being reluctant to help a stranger in need for fear of legal repercussions should they make some mistake in treatment.[1] Good Samaritan laws vary from jurisdiction to jurisdiction, as do their interactions with various other legal principles, such as consent, parental rights and the right to refuse treatment. Such laws generally do not apply to medical professionals' or career emergency responders' on-the-job conduct, but some extend protection to professional rescuers when they are acting in a volunteer capacity.

From me: Look up the Good Smaritan Law for your state - it should provide you with actual truth in response to your question.
 
Three more words: On The Job

I'm enjoying the Good Sam discussion, learning, but this post is about employment scope.

Hypothetical: I'm a RN, and if McKinley pool or SplashZone or whoever hires me to do first aid, I do first aid. Danged GOOD first aid, but first aid nonetheless. If something worse happens, I call the other guys who are supposed to do it, then help. (My license would be jeopardized if I saw poor care and did not intervene, but as an EMT, I do not believe you are in jeopardy; maybe if it is a kid, check your legal status and certifications*).
As an EMT-B, work the job description, and ask if you can help or make suggestions.

*Health care, teaching, law enforcement, social work and some other licensed professions in Calif have a duty to report child abuse, neglect or endangerment. I almost shut down a baseball game that way.
 
In the final analysis it will boil down to how you choose to react when faced with an emergrncy with one of your kids IN THE MOMENT.

If you see where you can really help oe where you must really intervene in order to prevent further trauma I hope you'd just do what needs to be done.

All of the legal information in the world does not make it easier to live with yourself if you stand by when you believe you should have acted.
 
Still just a student, but it seems to me that in some cases the duty to act when not on duty would have to be clearly defined. The thing to me is that in the OP capacity they are not serving as an EMT, and that further they may only legally render care under direct or standing orders of a physician, in so far as meeting the full scope of practice.
 
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