Ethics/Liability in EMS

[rugrat]

Hey guys,

So I am in college, and for my rhetoric and research class I am writing a 12pg persuasive essay on "ethics and liability in EMS."

More to the point as I am an EMT now (well somewhat... still need a job... :sad: ) I see stories and occurrences differently. For instance when a friend is reading a story about "x ems person does this" and they can't believe it. I know the other side and the legal ramifications of actions, laws involved, and protocol (plus we are all humans!).

I feel like (which means you guys must feel more so!) that most people don't realize the daily stresses, factors, protocols, laws etc. that go into play on scene. Mostly obviously because they are not in EMS (this goes with any field or specialty I suppose). So my aim is to show this perspective. To show that EMS work hard and have a lot of challenges that they face.

Now I know most likely only a few classmates, my professor, and possibly some others will read this, but I am also writing it for myself. I am researching and pondering these issues, because I know I will soon be on the field (looking for a job currently) and will be dealing with these things.

Anyways so far I have been able to find TONS of "academic" sources (My university has an awesome database available for use) but I also think it would be awesome to put in some real stories, thoughts, and experiences from the men and women who are out working in it everyday. I have been privileged to be able to read your guys posts for a long time now and I have enjoyed the learning (and the fun!). I know a lot o you guys were the pioneers of this field, many of you have decades (or many years) of experience, and with all of that I know you guys have some thoughts.

So what are your experiences with unexpected patient outcomes, what you do for a living, the ethics of situations you have been in (good or bad), your thoughts on policy's (good or bad), the risk you are at for liability (if anyone has any stories on that).. etc etc.. This is really opened ended. I am basically just wanting to pick your guy's brains. So anything you deem applicable you can reply. Also for credibility's sake (it is a rhetoric class after all) if I could maybe have your experience, nickname (vs fullname), and possibly who you work for?

Thanks guys! Looking forward to hearing your guys wisdom and good stories (I have been enjoying both for quite some time!)

Shalom,
matthias

 

[mycrofft]

1. Define the Universe.
a. Give three examples


Most often as an EMT you don't learn the outcome if you don't have sort of relationship with the receiving facility or family. That means a lack of feedback unless something goes really wrong, then you are in trouble.

Fear of liability is like fear of the freeways; if you can't tuck it back behind paying attention to the job, stay home. Know what you are doing, do what you know, follow the protocols, and stay away from shady or sloppy companies and co-workers.

And were I still active, no way I'd post my name, nickname, or employer!

 

[akflightmedic]

Ethics and liability....wow, what a topic but definitely an interesting one.

I responded to a cardiac arrest in the patient's home. Turns out he was end stage cancer patient. DNR is NOT on site for whatever reason. His family is there, they actually thought they had waited long enough before calling EMS.

Upon arrival, the patient still has a treatable cardiac rhythm. Many family members in attendance and their concern/despair/emotions are seemingly genuine. It looked as if they all came to say goodbye while he died.

No one wanted him to be worked. No one had a DNR readily available. This man was emaciated, a bag of bones, looked like a skeleton covered in leather.

Per protocol, I was to "work" this guy. I was the Lt. on scene, I had a fairly new medic with me who did not yet see the rhythm, and I had fire department back up walking in any second.

Decisions, decisions...

I acted quickly and decisively based on everything I observed. I turned the gain on the monitor all the way down. The patient now appeared to be in asystole. I printed a strip of it. I then cancelled the fire department on radio. I sent my partner to the truck for a clipboard. I then turned to the family and "again confirmed" they had last seen the patient alive well over an hour ago. I then rolled the patient and observed some lividity.

My notes were well documented. The wife of 40+ years hugged me and said thank you. The other family shook hands and expressed great appreciation.

That decision...was it right or wrong...depends on who you ask. It was mine to make and I own it, I do not regret it.

I did consult my Battalion Chief later that day. We went for an "ice cream". He was a cool guy. Going for an ice cream was code for his shift staff...it meant an off the record chat. Sometimes it involved real ice cream, other times it was us leaning on the hood of the BC's truck in the garage. It was our safe area. I presented the hypothetical to him...we talked about the possible ramifications if this ever came to light. While not voicing any direct right or wrong statements, I walked away from that meeting feeling ok.

What I did...people can quarterback it all day long...but until you are in those shoes, you truly do not know what you will or will not do. This was not something I preplanned, this was not something I was trained for. It was simply me being human and reacting in the moment.

 

[mycrofft]

Sorry duplicate

 

[mycrofft]

Ethics and liability....wow, what a topic but definitely an interesting one.

I responded to a cardiac arrest in the patient's home. Turns out he was end stage cancer patient. DNR is NOT on site for whatever reason. His family is there, they actually thought they had waited long enough before calling EMS.

Upon arrival, the patient still has a treatable cardiac rhythm. Many family members in attendance and their concern/despair/emotions are seemingly genuine. It looked as if they all came to say goodbye while he died.

No one wanted him to be worked. No one had a DNR readily available. This man was emaciated, a bag of bones, looked like a skeleton covered in leather.

Per protocol, I was to "work" this guy. I was the Lt. on scene, I had a fairly new medic with me who did not yet see the rhythm, and I had fire department back up walking in any second.

Decisions, decisions...

I acted quickly and decisively based on everything I observed. I turned the gain on the monitor all the way down. The patient now appeared to be in asystole. I printed a strip of it. I then cancelled the fire department on radio. I sent my partner to the truck for a clipboard. I then turned to the family and "again confirmed" they had last seen the patient alive well over an hour ago. I then rolled the patient and observed some lividity.

My notes were well documented. The wife of 40+ years hugged me and said thank you. The other family shook hands and expressed great appreciation.

That decision...was it right or wrong...depends on who you ask. It was mine to make and I own it, I do not regret it.

I did consult my Battalion Chief later that day. We went for an "ice cream". He was a cool guy. Going for an ice cream was code for his shift staff...it meant an off the record chat. Sometimes it involved real ice cream, other times it was us leaning on the hood of the BC's truck in the garage. It was our safe area. I presented the hypothetical to him...we talked about the possible ramifications if this ever came to light. While not voicing any direct right or wrong statements, I walked away from that meeting feeling ok.

What I did...people can quarterback it all day long...but until you are in those shoes, you truly do not know what you will or will not do. This was not something I preplanned, this was not something I was trained for. It was simply me being human and reacting in the moment.

I called a private MD once on a Sunday and he read me the DNR verbatim over the phone. A second provider heard it also, and it was done.
No idea if it was actually on the chart, but we made sure it was the MD when we spoke.

What we need to remember is that the fear of being sued or getting into trouble is intentional. Punishment is levied for acts which either foreseeably or in the past have done bad things to patients. The thing to do is not find a way to do what we want and escape punishment, but decide what is right based on our training and experience (and hopefully protocols) and act in the patient's best interest.

 

[NBFFD2433]

Ethics and liability....wow, what a topic but definitely an interesting one.

I responded to a cardiac arrest in the patient's home. Turns out he was end stage cancer patient. DNR is NOT on site for whatever reason. His family is there, they actually thought they had waited long enough before calling EMS.

Upon arrival, the patient still has a treatable cardiac rhythm. Many family members in attendance and their concern/despair/emotions are seemingly genuine. It looked as if they all came to say goodbye while he died.

No one wanted him to be worked. No one had a DNR readily available. This man was emaciated, a bag of bones, looked like a skeleton covered in leather.

Per protocol, I was to "work" this guy. I was the Lt. on scene, I had a fairly new medic with me who did not yet see the rhythm, and I had fire department back up walking in any second.

Decisions, decisions...

I acted quickly and decisively based on everything I observed. I turned the gain on the monitor all the way down. The patient now appeared to be in asystole. I printed a strip of it. I then cancelled the fire department on radio. I sent my partner to the truck for a clipboard. I then turned to the family and "again confirmed" they had last seen the patient alive well over an hour ago. I then rolled the patient and observed some lividity.

My notes were well documented. The wife of 40+ years hugged me and said thank you. The other family shook hands and expressed great appreciation.

That decision...was it right or wrong...depends on who you ask. It was mine to make and I own it, I do not regret it.

I did consult my Battalion Chief later that day. We went for an "ice cream". He was a cool guy. Going for an ice cream was code for his shift staff...it meant an off the record chat. Sometimes it involved real ice cream, other times it was us leaning on the hood of the BC's truck in the garage. It was our safe area. I presented the hypothetical to him...we talked about the possible ramifications if this ever came to light. While not voicing any direct right or wrong statements, I walked away from that meeting feeling ok.

What I did...people can quarterback it all day long...but until you are in those shoes, you truly do not know what you will or will not do. This was not something I preplanned, this was not something I was trained for. It was simply me being human and reacting in the moment.

This stuff seems to happen all the time in my county. It is pretty hard to deal with. About the DNR.

 

[ExpatMedic0]

Which University/Program if you don't mind me asking?

 

[rugrat]

@mycrofft

Good points...

And yes good you give you please define the universe..
Also I will need your address and SSN too... :lol::lol:

@Flightmedic very interesting story. Thanks for sharing.

--

And no I am not worried so much about being sued in the futture, but rather it is a thought provoking and intriguing topic to me. I am more go with the flow guy.

Also a good point about not being able to plan. One of the main reasons I took EMT training (had no idea if I wanted a career in it... suppose I still don't haha) is I have been in a few situations doing mission work where something goes wrong, and it sure would be nice to have someone who knew what the heck they were doing!

@ExpatMedic0

I am at North Central University majoring in Inter-Cultural Studies. It is a university in downtown Minneapolis. Actually HCMC (a hospital with one of the top 10 EMS systems in the US from what I hear) is literally right behind my dorm. They only accept Paramedics (for work).. They do have a good paramedic program from what I hear. So I am hoping to get some EMT experience and maybe in a year or two I will go to school there too... (its actually not farther than any of my other classes!) Not sure what I want to do yet, but figuring that out