This from a paramedic trainee in NSW (and I assume I’m not answering their assignment question):
I was talking with a friend the other day, who met another friend at hospital after he called 000. Basically, he called an ambulance after (what he suspected was) breaking his foot. The ambulance officers arrived, assessed him, splinted his foot and told him that he had probably broken it and should got to hospital to have it x-rayed and attended to by a physician. He asked to be transported to hospital as he couldn’t drive (obviously) and didn’t have anyone around to take him. They told him they couldn’t take him because they had a small vehicle and there was a new policy being introduced to free up emergency rooms from ‘non-emergency’ patients. It’s my understanding that these paramedics, upon providing assistance, and after the man told them he had no way of getting to a hospital or doctor, had a duty of care to the man. They refused to take him, or to call another ambulance to take him, and left. He ended up having to take public transport to hospital, and was met there by my friend.
It has been reported that NSW Ambulance is trialling a scheme to divert patients from emergency departments (see Denice Barnes, ‘Paramedics to decide if patients need GP or hospital during Central Coast trial’ ; Alicia Wood ‘Paramedics will get power to refuse to take people to hospital in a bid to crack down on ambulances being used as taxis’) but that would not appear to apply here as I take it this did not occur on the Central Coast.
I have argued, earlier, that the law does not require paramedics to transport everyone but the particular service may require that of its staff (see ‘Do paramedics have to transport everyone?’ and ‘Transport everyone or act as a professional? A question for paramedics’).
The legal issue, as always, is ‘what is reasonable in the circumstances?’ The paramedics attending upon a person owe that person a duty of care (see Neal v Ambulance Service  NSWCA 346; Kent v Griffiths  EWCA Civ 25) but that is not a duty to everything they want, but a duty to do what is ‘reasonable’. Now what is (or was) reasonable in this case could, presumably, be a matter of debate. The real issue is what is an ‘emergency’ and who gets to decide? A broken leg may not be an emergency for advanced life support paramedics but it would be for the person who’s leg is broken, particularly if they don’t have private means to get to hospital. If the paramedics suspected that the person’s leg was broken and they needed to go to hospital, and I assume your average GP does not have either an x-ray machine or the capacity to properly manage a fractured leg, so hospital does seem appropriate, then this would warrant transport unlike, say, ‘sore throats, boils, sunburn and even a broken nail’ (http://www.ambulance.nsw.gov.au/Calling-an-Ambulance/When-to-call-Triple-Zero-000.html).
Was the conduct of the paramedics ‘reasonable’? That can’t be definitively answered here. If the person’s condition was worse off because he was not transported by ambulance he could sue and a judge would be the final arbiter of what was ‘reasonable’ in the circumstances. Short of that there could be a complaint to the ambulance service and they could determine what was appropriate (see ‘Failure to attend by NSW Police and Ambulance’).
What it does mean is that the services have to decide and make clear what in their mind constitutes an ‘emergency’ and remember that the modern trend is to see the ambulance services as aprt of the health services, not an emergency service. Health services treat all manner of cases, not just emergencies. If the reports on the central coast trials are correct the aim is not to have the ambulance service leave people to their own devices but to ensure that they are directed to appropriate care, such as a GP. Refusing to transport a person with a suspected broken leg anywhere at all would not seem to equate with any ‘reasonable’ policy but more than that we cannot say without all the facts to hand.
Whilst not being there I can’t comment with any certainty, but for background a typical case like this should go like this:
In NSW ankle injuries are assessed using the Ottowa Ankle assessment which is an evidence based physical examination of the foot. If the assessment is negative, there is a 99.5% certainty that there is no fracture and the ankle will heal within a few days. If the patient can hobble to the toilet and has access to life sustaining amenities such as food and water etc, they can be left at home to recover. Oral pain relief is offered and left with the patient. The patient is also told that if it is not improving in a couple of days they will need to arrange further consultation and referral to x-ray examination. Whilst painful and inconvenient, ankle injuries are not life threatening, nor time critical.
Peter, thanks for the clinical update and it may be that the treatment in question was quite reasonable in the circumstances. It does beg the question of whether an ambulance service is a health service, or an emergency service and are only events that are time critical or life threatening “emergencies”, what of events that will have significant impact on a person’s mobility or emotional state? These are issues that paramedics and ambulance services will need to grapple with in their move to professionalism.