Treatment off duty

[Dobo]

Okay I fear wading into this but since I started it I will just say a couple words, but I want everyone to recognize that they are said in all due respect and I am not trying to rock the boat here. My intention was never to cause a debate on forum regulations.

Yes a have made a hand full of posts where I should have searched first, but seeing as at the time of this post there are 9,809 threads on this forum I have a feeling almost every post is probably repetitive. Secondly I have been a member of these forums for but a few days and several members have joined up since, and I am sure there are plenty who have joined up before me that may want a say in the matter. Also it is difficult to keep up with every post on the forums so I may miss what other people have said and that should be taken into account, this is a very busy place.

That is all I really have to say,

Just to put everyone at ease a bit I will try to search out my topics a bit better, I never intended on subjecting everyone to a debate. However, I ask that should I start another thread that has been done before please just simply post the links and try to participate in the thread in a positive manner.

Sincerely,
Robert M Dobo

 

[KEVD18]

Section 14. No emergency medical technician certified under the provisions of this chapter and no police officer or firefighter, who in the performance of his duties and in good faith renders emergency first aid, including, but not limited to, the use of any semi-automatic or automatic external defibrillator or transportation to an injured person or to a person incapacitated by illness shall be personally in any way liable as a result of rendering such aid or as a result of transporting such person to a hospital or other safe place, nor shall he be liable to a hospital for its expenses if, under emergency conditions, he causes the admission of such person to said hospital.

Although there is always a risk of suit, they are rare and even more seldom do they ever get to court. In my state, Missouri, there has never been a successful suit brought on as a result of a Good Samaritan violation.

I have found that the fear of being sued while rendering aid off duty is more anecdotal EMS than reality.

you have to look at this section of mgl from the mass perspective, not just by reading the words. in this state, we have no duty to act off duty, only a duty to report. so "who in the performance of his duties" quite literally means a person who is on duty.


you reference that there has never been a sucessful suit in missouri. i reiterate, for at least the 10th time this year, even an "unsucessful" law suit can cost you everything. you actually have to make it into the courtroom to use the good samaritan defense. this means retaining a lawyer and paying him 200-400 or more an hour to prepare and argue your case. you're absolutely correct. your culpability will probably dismissed the first day. but how much did just getting to that first day in court cost you?

 

[Dobo]

Dobo, What an interesting question! You live in Canada, and I live in the United States, so I dont know much or anything about provincial or federal laws relating to liability.
Your choice to stop and care as opposed to calling it in, as opposed to the EMS Salute is going to be dependent on a few things:

1) Where you are. How far away is an ambulance? PD? FD? Urban? Suburban? Rural? There isnt much point to stopping if an ambulance is less than a few minutes away. Is PD already on scene? Why dont you call and make sure they are rolling?

2) Who you are. Are you a volunteer EMT/FF in the area? Are you on call? Are you going to be paged to this call within 2 minutes? Are you an EMT/PCP/ACP/XYZ? Do you have current certification? In the US, unless you are on a ambulance or fire truck, you have the SOP of a first responder.

3) What you have. Do you have a pair of gloves? A reflective vest (at night or on the highway)? Do you have some gauze or something to hold pressure? a c-collar? Mobile ICU in your trunk? If you cant do much to help, you arent much good on scene. Also beware where you park, if you decide to stop. Do you expect your supplies to be replenished?

4) How serious it is. Is the car smoking? Are there obvious immediate life threats? Think about scene safety for yourself.

Okay, lets review. In the US, whatever your training, you are a FR when alone/off-duty. Even if you think you are covered by Good Sam, you really aren't, and are opening yourself up to major litigation.

Towns/cities/counties keep minimum staffing levels for a reason-- they have enough people to handle any calls that come up-- they dont expect bystanders to stop, and can handle the call themselves.

My short answer, asses, make a decision, and in most cases, let the duty crew deal with it.

Am I making sense? Was this clear enough?
Trauma, can you comment on local laws and procedures?

DES

Thanks for the well explained response, it sounds like in a lot of ares if you decide to help off duty you do so at your own risk, I will be sure to search out and gain a proper understanding of the Alberta laws in this matter so that I do not overstep my bounds.

 

[medicdan]

What do you base this on? I did some research on this topic a little while ago and found the opposite. Many states do include EMS, Fire, Police, etc. as part of their good Sam law. Massachusetts is specific about this in their doctrine:

Section 14. No emergency medical technician certified under the provisions of this chapter and no police officer or firefighter, who in the performance of his duties and in good faith renders emergency first aid, including, but not limited to, the use of any semi-automatic or automatic external defibrillator or transportation to an injured person or to a person incapacitated by illness shall be personally in any way liable as a result of rendering such aid or as a result of transporting such person to a hospital or other safe place, nor shall he be liable to a hospital for its expenses if, under emergency conditions, he causes the admission of such person to said hospital.

Although there is always a risk of suit, they are rare and even more seldom do they ever get to court. In my state, Missouri, there has never been a successful suit brought on as a result of a Good Samaritan violation.

I have found that the fear of being sued while rendering aid off duty is more anecdotal EMS than reality.

Thank you for challenging me, I realize I didnt make sense. I am describing what I understand to be the legal implications.
My understanding of this, and feel free to correct me, is that the skills and protocols allowed to EMTs and Paramedics are performed under the indirect supervision and license of a MD. No ambulance or service with a Medical Director= skills at FR level.

The mass law says, independent of malpractice, abandonment, etc. that EMS is not liable for the underlying injuries that patients have suffered. That is, we are not responsible for the skull fracture you sustained in the MVA, so as long as we do our job properly, we cant be sued for bringing you to the hospital.
I also understand that if you are in a position of duty-to-act, that is, your ambulance has coverage for an accident in a response area, and you respond, render aid, transport, etc, that is NOT Good Samaritan-- because it's your job.

Quick side-story:
What I am coming from personal experience. A good friend of mine (who is also an EMT) was in a MVA in his POV last year (coming back, incidentally from taking his NREMT written exam). On scene, he was fine, but asked the other driver repeadly if she was okay. Three times she refused an ambulance-- denied all injuries/abn. Denied H/N/B pain. 12 months later, he was dropped with a lawsuit for pain and suffering. She claimed she injured her neck and pelvis, and required $100,000s of treatment, and held him responsible.
She claimed that because he was an EMT (he never told her, she looked it up on the internet), he had a responsibility to asses/treat her. This was not considered to be a failure of Good Sam laws-- because he had the training (EMT-B)... She hasn't received a penny yet, but the legal fees are growing.

Back to the topic at hand. Am I grossly wrong with any of these assertions?

 

[BossyCow]

DoBo, I think part of the animosity stems from the size and controversy regarding the post. There are large contingencies of members firmly entrenched in their positions on this issue. Many of the previous posts have been closely monitored by Admin here because they can get pretty emotional. There are a bunch of people here who believe that stopping at a roadside MVA while off duty makes you a whacker who is ruining all chances of EMS being taken seriously as a profession. There is another equally vocal group who believes that to not stop is a gross derliction of your moral obligation to support your fellow human being. These groups weigh in with much vehemence every time this topic is brought up.

Much of this topic will be made clearer to you with time and research into your own state laws, practice and the SOGs and Protocols of the region/agency where you end up working. The problem is mostly associated with Liability. MVA fatalities are generally emotionally charged incidents for the families of the victims. A natural part of the grief process is the blame phase, where the grieving look around for someone who is responsible for the tragic, untimely death of their loved one. When they cast the eyes of their lawyers into the crowd at the scene, the responder who is associated with a deep pocketed, heavily insured agency is often a tasty target.

The Good Samaritan Laws vary wildly from state to state. Most liability insurance policies for EMS Agencies will wash their hands of anything you do while not on their watch. You are liable yourself for anything you do that is outside of the established SOGs/Protocols/Procedures of your agency. If the agency trained you to do something a certain way, and you do it differently, again you are on your own liability-wise. The knowledge that you can lose your house or your kids college fund to some sue-happy estranged former son in law of an MVA victim with a shyster on speed dial is enough to make you think very carefully about what you are risking and what you stand to gain.

There is also the issues of scene safety. Making sure a scene is safe is Job #1 on all incidents. Stopping at the roadside of an MVA with lookyloos zooming by 4" from your backside, without the big flashy lights, OSHA vest with reflective material, flares and others to help watch out for your behind while you help the pt is a recipe for disaster.

Then, what exactly are you going to do for this pt? If its a life threatening emergency, the pt needs an ambulance. Trauma codes do not have a high survivability rate. Probably the only incident where you might be able to make a difference is in the case of an arterial bleed. If you could get to the pt safely, if you could find the bleed and put proper pressure on it without putting yourself in danger, you may up the chances of this pt surviving the MVA.

Then factor in the response time of the agency responding to this incident. If this is an urban area with response times of 10 minutes or less, you are really not helping anyone much. You are merely cluttering the scene with your car and your gianormous Whacker/Trauma/Response Bag.

I've been doing this for a long time. I am with a volly agency in a highly rural area. I have stopped in my career twice for MVAs. Both times the calls happened right in front of me, and it was far enough off the beaten track where I knew the response to the scene was going to be more than 20 minutes. I stopped, checked for life threatening injuries, set some flares, called dispatch with a short report for the responding agency and in one case, used a blanket from my car to put a horse collar type c-spine immobilization on an unconscious victim. ( I never got that blanket back too and it was a nice one dammit). And once you start to give aid, you can't leave or it can be considered abandonment.

Much of what we do involves the equation of risk vs gain. We do not engage in high risk behavior for low gain. MVAs especially are high risk incidents. After you've been to a few funerals, or seen some co-workers on permanent disability due to the idiocy of a passerby on one of these, your attitude does undergo some adjustment.

 

[Dobo]

Thanks BossyCow,

I am most interested because I am going to be moving to a remote area in Northern Canada, and to be honest I have no idea what response times are, I guess I can see why there is two sides to the coin and I will be honest in saying I feel with my training and abilities to assist it would be immoral to pass by a MVA without at least assessing the situation to ensure no one has life threatening injuries. But I will be sure to research Alberta law and do my very best to abide by it.

 

[karaya]

you have to look at this section of mgl from the mass perspective, not just by reading the words. in this state, we have no duty to act off duty, only a duty to report. so "who in the performance of his duties" quite literally means a person who is on duty.

You're being too simplistic. This was added to the Massachusetts Good Samaritan Law. The performance of duties is not limited to being on duty, but is a more general statement of what one is trained to do as part of their duty as an EMT, firefighter, police, etc. This addition to the doctrine came about as AEDs started to become common in public areas. Concerns were raised that off duty personnel trained to use AEDs would be in fear of suit if an AED was available for him or her to use. That is why there is the specific inclusion of AEDs in the doctrine.

I understand that you do not have a duty to act, but the doctrine states that if you decide to act, you will be umbrellaed within the State's Good Samaritan law.

I ask you this question. You're in a shopping mall (off duty) and someone collapses into cardiac arrest. On the wall there is an AED. Would you stop and render aid and use the AED to possibly save this person's life? Or would you just call it in and continue with your shopping?

 

[bstone]

My rule: if I am in the middle of nowhere- i mean nowhere- i will stop. if i see CPR being done i will likely stop. if i am in a suburb or metropolitan area i will call 911. i will also call 911 when i am nowhere, assuming i have cell coverage.

 

[KEVD18]

You're being too simplistic. This was added to the Massachusetts Good Samaritan Law. The performance of duties is not limited to being on duty, but is a more general statement of what one is trained to do as part of their duty as an EMT, firefighter, police, etc. This addition to the doctrine came about as AEDs started to become common in public areas. Concerns were raised that off duty personnel trained to use AEDs would be in fear of suit if an AED was available for him or her to use. That is why there is the specific inclusion of AEDs in the doctrine.

I understand that you do not have a duty to act, but the doctrine states that if you decide to act, you will be umbrellaed within the State's Good Samaritan law.

I ask you this question. You're in a shopping mall (off duty) and someone collapses into cardiac arrest. On the wall there is an AED. Would you stop and render aid and use the AED to possibly save this person's life? Or would you just call it in and continue with your shopping?

depends. have i been drinking? have i had a momentary lapse in judgement and imbibed another substance that would alter my ability to do my job? if so then i'll be up in the food court having a cinnabon before they hit the floor. stone sober, yes i would work a code(cfr level only please) off duty. that sort of the whole point of public access defib. also, a person in arrest cant physically be made any more dead. dead is dead. mva's on the highway are a whole nother ball game. you have traffic, no resources, the possibility of paralyzing them etc etc etc. theres logic and theres insanity.

as far as off duty practice and inherent liability in the state of massachusetts, feel free to interpret out laws any way you see fit. i on the other hand live here, schooled here, and practice here. i'll be taking a more first hand approach to understanding the potential pitfalls to off duty medical practice in the most screwed up legal state in the union.

 

[karaya]

as far as off duty practice and inherent liability in the state of massachusetts, feel free to interpret out laws any way you see fit. i on the other hand live here, schooled here, and practice here. i'll be taking a more first hand approach to understanding the potential pitfalls to off duty medical practice in the most screwed up legal state in the union.

I didn't interpret this law. Keep in mind I'm a journalist so I need to keep my facts accurate; I used a well known EMS attorney for clarification.

 

[Dobo]

Is there a nationwide body in the US that helps lobby and or regulate EMS? Or is it all just state run programs with no unity? From what I am understanding the answer is no but I thought I would clarify it rather than assume it.

I know in Canada the regulations are Province by Province, That is why I am doing my training in Alberta because that is where I wish to practise.

 

[bstone]

Is there a nationwide body in the US that helps lobby and or regulate EMS? Or is it all just state run programs with no unity? From what I am understanding the answer is no but I thought I would clarify it rather than assume it.

I know in Canada the regulations are Province by Province, That is why I am doing my training in Alberta because that is where I wish to practise.

The NREMT supposedly is our testing body. The federal gov't supposedly sets standards. There is no good lobbying body. The NAEMT tries but many EMTs don't even know of their existance.

 

[medicdan]

The NREMT is the supposed national testing body, the NAEMT the supposed lobbying body, but for the most part, each state sets their own educational standards and writes their own protocols/SOP. Each state has slightly different laws, giving each level of training different skills and tools. Its confusing.

 

[Dobo]

Okay lets try flipping this scenario. If you are witness to a MVA, or some other emergency where people may be injured and you are off duty and choose not to lend aid, can you be held liable for not providing your trained abilities?

 

[BossyCow]

Okay lets try flipping this scenario. If you are witness to a MVA, or some other emergency where people may be injured and you are off duty and choose not to lend aid, can you be held liable for not providing your trained abilities?

Again,depends on the circumstances, the state, the region, the scene, and what did you do or not do?

In my state I must at a minimum call 911 when I see an accident or its a crime.

 

[Dobo]

LOL I am sorry for laughing but I cannot believe neither the US or Canada can nationally regulate the actions and SOP of EMT's and Paramedics. To me it seems like a national issue that requires clear wording and honestly I think at least with the high price of registration fees we have to pay to our certifying bodies they cannot provide some liability support. Reason I think it should be nation wide is because you should be able to assist if you choose to help a person in need and not have to carry along legal text books for each state to see what you can do if you were on a vacation.

 

[BossyCow]

LOL I am sorry for laughing but I cannot believe neither the US or Canada can nationally regulate the actions and SOP of EMT's and Paramedics. To me it seems like a national issue that requires clear wording and honestly I think at least with the high price of registration fees we have to pay to our certifying bodies they cannot provide some liability support. Reason I think it should be nation wide is because you should be able to assist if you choose to help a person in need and not have to carry along legal text books for each state to see what you can do if you were on a vacation.

Really.. so do you think that the powers that be in Toronto are going to be able to set a policy that works in Saskatchewan? The response areas are very different, so are the circumstances.

 

[BEorP]

To me it seems like a national issue that requires clear wording and honestly I think at least with the high price of registration fees we have to pay to our certifying bodies they cannot provide some liability support.

Why should it be a national issue when in Canada healthcare is a provincial responsibility? As well, I'm not quite sure what you're referring to about registration fees at least in Ontario. I paid to write my AEMCA but after that I haven't paid anyone registration fees.

 

[BEorP]

Thanks BossyCow,

I am most interested because I am going to be moving to a remote area in Northern Canada, and to be honest I have no idea what response times are, I guess I can see why there is two sides to the coin and I will be honest in saying I feel with my training and abilities to assist it would be immoral to pass by a MVA without at least assessing the situation to ensure no one has life threatening injuries. But I will be sure to research Alberta law and do my very best to abide by it.

Other than helping to control a major bleed, what life saving interventions will you be performing while off duty? Please enlighten me.

 

[Dobo]

Well we are getting into politics here a bit but I believe that the healthcare should be a national thing not a provincial thing as well. But beyond that what do I expect to do except stop excessive bleeding? I have no idea, it would depend on the scenario, it could be something as simple as helping an elderly lady in the hot summer sun to some shade while waiting for the ambulance to arrive, to stopping excessive bleeding. You can say the only scenario that could possibly pop up is a bleeder case. It is not just MVA but could be a seizure or something else in a public place. I had to deal with that before with my ex fiancee she had a seizure and lost consciousness in a theatre while we were out, I helped her the best I could and later while explaining to the doctor what I tried to do to help her, he informed me that I should have actually done the exact opposite.