Generally speaking, EMS liability is a hard hurdle to reach. In Texas, EMS is actually covered under our version of the Good Samaritan law. The appellate courts here have held that EMS is not a licensed health care profession, so we're covered under the statute. (The one time that low EMS standards are helping us!)
hmm, I have been told that because we receive a paycheck, the good sam law doesn't apply to us in NJ. so while volunteers might be covered, those of us who are paid are not.
So, under Texas law, you have to prove a willful act or gross negligence to prove a medic liable. Hard hurdle to overcome. To prove negligence, you have to prove the medic had a duty to act, that they breached the duty (IE, violating the standard of care), that the breach caused harm, and that the harm created damage. So, you'd have to prove all of those things. And for it to be gross negligence (the standard for EMS liabilty here in the Lone Star State), it's got to be pretty egregious. So, I'd tend to lean against liability for the medic.
gross negligence, probably not. what about simple negligence?
A slightly better bet would be a claim against the EMS medical director for not approving RSI. But your chances on that are a crapshoot too. Both sides will pull up every expert witness they can find. Six or half a dozen there, especially since you never know what a jury would do. My personal supposition is that RSI does not represent the standard of care.
if, as an agency, the medical director doesn't approve RSI, so be it. but if he only approves certain people? and on a patient that could have benefited form RSI, and a non-RSI unit was sent, with negative consequences? You don't think you could argue that simple negligence did occur?
In fact, a few years ago, there was a discussion about this very issue here in Austin. Austin/Travis County EMS medics don't RSI, but the STAR Flight flight medics do. There was a great deal of discussion as to whether the STAR Flight medics could carry RSI drugs if they were working overtime on a ground unit. The decision was to not authorize them to carry RSI meds for the exact reason of liability and a uniform standard systemwide.
that's system wide, which isn't what I am talking about. it's not like half the Austin county Medics can't RSI, and the other half can. System wide is system wide.
Final thought -- given the crappy state of airway education in general for EMS, I think there's a lot more potential for liability over failed RSI than there is for failure to authorize and allow RSI.
wait until intubation is taken out of the paramedic skill set at a result of this
I want a truck with 2 Paramedics but get one with just 1 and an EMT because of staffing issues. Can I sue? Probably not.
depends: if I need a paramedic unit, can the single person paramedic unit do less than a dual paramedic? and is there any damages that result of being unable to do those procedures that having 2 medics would have permitted?
I want to go to the cath lab at the hospital 2 blocks further when I have chest pain but your protocol says "closest facility" which is where you take me. Can I sue? I could but you did what your protocols said. Your medical director probably had a reason for writing them.
where is the group that say "following orders isn't a justification for bad medicine? Just look at the nuremburg war trials". Actually, you probably could sue the agency, might even win. probably wouldn't get anything from the paramedic.
I work for an EMS agency across town which allows me to RSI or do pericardiocentesis but moonlight at another which does not. Can I do my advanced skills "to save a life" when at the other agency? No. This has already be challenged in many cases.
the agency sets the standard. if your agency won't allow you, than they won't allow you. but the agency sets the standard agency wide, so no matter who shows up, it's a paramedic who can do all the skills that any paramedic can do. essentially a paramedic is a paramedic is a paramedic, regardless of which paramedic unit for your agency shows up.
By your argument every doctor in a hospital should be neurosurgeons if the patient needed neurosurgery.
no: but every neurosurgeon should be able to do the same neurosurgery stuff, so if I call the on call Neuro, I don't need to worry about him or her not being able to do that procedure, and has to call someone else.
First of all, you are comparing apples and oranges. Pushing D50 or obtaining a 12-lead has very little in comparison to RSI, in terms of the training needed and the risk to the patient. If you can't see the difference between the gravity of RSI vs. that of obtaining a 12-lead, then I'm at a loss.
The important point you are missing is that all paramedics are simply not all the same in terms of training and experience and competency. If you haven't learned that reality yet, you will when you are more experienced.
they are both procedures, so yes, they are not apples and oranges. has RSI saved people? or benefited people? are paramedics trained in performing RSI?
I know that no all paramedics were trained equally, or as experienced, and some are incompetent. But a paramedic should be able to do paramedic skills, especially if that is the standard of care of a paramedic. no matter which unit shows us, the interventions should be the same. If you don't understand that, than I'm at a loss.
If a medical director wanted to require his paramedics to have a certain number of year's experience before they could RSI, and a certain amount of time with the agency, and to complete a time-consuming training program first, I think that'd be pretty responsible and reasonable, and probably well in line with what the literature indicates is necessary for a successful RSI program. If he wanted to suspend RSI from individuals who don't meet certain continuing training or competency criteria, I think that's quite reasonable, too. These requirements would probably result in not all the paramedics at a given agency being able to RSI, but I don't know how you'd argue it's not a reasonable process or that it's not in the best interest of patients, or that it puts the agency at legal risk somehow.
Based on your logic, he should be able to suspend D50 administration, or 12 lead transmissions, or needle decompressions, or intubation, on a per person basis, based on his beliefs that " don't meet certain continuing training or competency criteria." although you can see the potential problems of having them still be a paramedic if they can't function 100% as a paramedic right?
I'd like to see Wes weigh in on this, but I think there'd be a very slim chance you could successfully sue. If you could, it would set a precedent that every EMS agency and every hospital would essentially be responsible for following the same protocols and offering the same services, procedures, and interventions, because anyone who didn't do something that someone else did could be sued.
not at all, but if damages were caused...
Go to a hospital that doesn't offer the same procedure as another one? Sue 'em. Call EMS and they don't have the same drugs that another agency does? Sue 'em. Think that is good for patients? Or for the EMS profession?
huh? each hospital can decide what it does; but if I call for an OB doc, they should be able to do OB doc stuff, not just 90% of what an OB doc can do.
Most importantly, order to successfully sue, you'd have to show damages resulting from the paramedic's action or inaction. I suppose it is plausible you could argue that damages resulted from the paramedic's inability to RSI - rather than from the disease process - but that would be an uphill battle, I think. The EMS agency's lawyers would counter-argue that much of the literature shows that prehospital RSI is unsafe and doesn't improve outcomes (it is, in reality, inconclusive at best), and therefore having it in the protocols does more harm than good and this patient would very possibly have been even more seriously injured by it. Expert witnesses will explain that paramedics in general aren't good at RSI and even when they do it right, it doesn't improve outcomes.
So maybe no one should be RSIing, since it's so bad, it's unsafe and doesn't improve patient outcomes? and if it's so bad, why do we even do it?
