Download • - Paramedic EMS Zone

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Ambulance personnel operate in an environment that exposes them to legal
liability. Failing to perform their role and failure to deliver care to the required
standard could expose them to civil and/or criminal liability.
Three branches of government, the executive, judiciary, and legislative branches
form the framework within which the law works.
There are two types of law: civil and criminal.
o Civil cases result in financial compensation.
o Criminal cases result in some form of punishment.
Ambulance personnel are vulnerable to allegations of assault and battery. Assault
is said to occur when the fear of bodily harm is instilled in another. Battery occurs
when one person unlawfully touches another without his or her consent.
False imprisonment can occur when ambulance personnel restrain patients against
their will. Accurate, detailed, and comprehensive documentation can help protect
against this allegation.
Defamation, slander, and libel present risks to ambulance personnel when they
make statements, whether verbal, written or in some other permanent form, which
injure a person’s reputation. Care should be taken to document objectively all
clinical findings and the concerns that ambulance personnel may have.
Claims follow a general process that involves the lodging of a complaint, a
response or answer by the defendant, a discovery period, settlement discussions,
and trial process.
Ambulance personnel are subject to multiple jurisdictions including the law of the
land, professional regulations, national guidelines and local policy.
Ambulance personnel must ensure that all actions are aimed at doing what is in
the best interests of their patients and doing them no further harm.
Paramedics must ensure that they act within their scope of professional practice at
all times. All other ambulance personnel must ensure that they act in accordance
with guidelines and protocols.
The Data Protection Act 1998 and Freedom of Information Act 2000 govern the
management of patient identifiable information and access to information by
professionals and the public alike.
Emergency vehicles must always be operated in a safe and courteous manner in
order to protect the public from further injury. There is no excuse for reckless or
careless driving or for driving without due care or attention.
Ambulance personnel may provide care when they are off duty. However, they
must remember that in so doing they are not covered by their employer and must
take out some form of personal insurance to protect themselves in such situations.
This particularly applies to paramedics who should obtain individual membership
of organisations such as the British Paramedic Association or the Medical
Defence Union.
Ambulance personnel are no longer protected from liability by Crown immunity.
Where complaints suggesting allegations of negligence are made, such personnel
may be covered vicariously by their employers through vicarious liability if it can
be shown that they were acting within the scope of their employment at the time
the alleged negligence occurred.
Negligence can only be said to occur when four elements are present:
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o Duty of care. The ambulance service provider must have owed a duty to
care to the patient.
o Breach of duty of care. This duty of care was breached in some way, for
example by acting in a way that could not be said to be reasonable by the
standard of the ordinary ambulance person skilled in that particular art.
o Causation. This breach of duty caused or materially contributed to the
claimant’s injury.
o Harm, injury or loss resulted as a consequence of the above.
Patients have the right to determine their own care. Ambulance personnel must
understand their responsibilities when faced with advance directives issued by
patients.
Do not attempt resuscitation (DNAR) orders are a specific type of advance
directives that generally define those lifesaving procedures that patients are
consenting to. This does not represent a signal to avoid caring for patients or to
avoid administering other
forms of treatment.
Ambulance personnel must respect the fact that all adult patients with capacity
have the right to consent to treatment and to refuse it.
Patients must be provided with all relevant information regarding any proposed
examination, treatment or intervention to enable them to make an informed
decision regarding giving their consent.
When faced with unconscious patients or those incapacitated by virtue of injury or
illness from whom it is not possible to obtain consent, ambulance personnel may
administer that life-saving treatment that would be considered reasonable in the
circumstances under the doctrine of necessity.
For the purposes of consenting to treatment minors aged 16 and 17 are treated as
adults. Where children aged less than 16 are deemed to have sufficient
understanding and intelligence to enable them to fully comprehend the treatment
proposed, ie, they have capacity, and they are permitted to consent to treatment.
This is referred to as “Gillick competence”.
Minors aged under 18 years are not permitted to refuse treatment. In these
circumstances consultation must be made with those who have parental
responsibility for them. Where those with parental responsibility refuse treatment
that clinicians deem to be in the best interests of patients, a court order may be
sought to determine the way forward.
A detailed and comprehensive clinical record must be made of all calls attended
by ambulance crews. This documentation should include demographic
information, the date and time of events, the history of events including
mechanism of injury, details of the physical examination, treatment given
including medications administered and vital signs, noting any changes in the
patient’s condition and response to interventions.
Accurate, detailed and comprehensive clinical records that are completed as soon
as possible after the event will prove invaluable in defending claims of alleged
negligence.
Violence is prevalent in today’s society. Ambulance personnel must be vigilant to
ensure their safety and that of their team members. Joint guidelines and protocols
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must be devised by ambulance, police and other emergency services for the
management of such situations.
Ambulance personnel have a key role to play in preserving evidence at incident
sites or scenes of crime. Effective communication between ambulance, police and
other emergency services is essential to managing such situations, and to ensuring
a collaborative approach in investigations. Concise and accurate documentation
may prove invaluable in these instances.