This question comes from a NSW first aider who says:
I have a question regarding event first aid. It is common in this setting, especially within sport, for people to request ice for injuries. This is often wanted without a patient assessment conducted. I am often met with a negative response when I ask to have a look at the injury, as is often the case when the patient is some distance away from the medical centre.
On numerous occasions I have been asked for ice, but on patient assessment found that had I provided ice it would have been inappropriate treatment eg concussion. Also is a concern is returning to play immediately after a short ice application time, which risks further injury.
My question I guess comes down to what are the legal risks to provide ice without a patient assessment, and if ice is not given is that negligent?
Presumably your agency is contracted to provide professional first aid services, not to supply an esky. The old days of running onto the field with the magic sponge or trying to strap an injury are surely long past. If the team want a physiotherapist or sports specialist they should get one. If they want first aiders they need to allow first aiders to do their job.
You should not be issuing ice without doing a patient assessment because, as you have noted, ice may not be the appropriate treatment and you are there to give the appropriate treatment. If you simply handed over ice without doing a patient assessment and there was say a concussion or fracture then there could indeed be legal repercussions. Later the player may well allege that you were there to provide first aid, by issuing the ice you provided some care but clearly did not do what a reasonable first aider would do which is actually examine the patient. If the patient is some distance from the medical centre, your obligation may well be to go to them but I would not be handing out ice without seeing the patient.
As for players going on early, they are of course entitled to reject your treatment and your advice, but if that becomes a practice you should raise that with the team or organisers that engage you. If they don’t want your services then you don’t need to be there. If what they want is a sports physio to ‘strap the injury’ or do whatever they do, they should engage them.
Not giving out ice without assessing the patient could not be negligent.
If you are going to provide a professional service you have to act as a professional. That means expecting that you will be allowed to provide the service your agency has agreed to provide – ie a first aid service where first aid is given in accordance with best practice standards. If they want some other service, they should get another service provider. If they want to buy an esky and ice they can do that without your cooperation.
Australian Emergency Law 
Harsh.. but true! Michael Eburn has the ability to distill the problem down to its central issue and provide the solution which is blindingly obvious when all the camouflage is stripped away. Thank you once again
If by camouflage you mean things like paying a mortgage and surviving in business then sure – perfectly done. The reality of things however are somewhat different in the business world as compared to the academic world where presumably ones salary will be paid no matter what.
If the First Aider who asked the question addresses their concern with the organiser in the black & white manner prescribed above then the reality will be that they will lose the contract and another, perhaps more cooperative, competitor will be engaged.
With the industry being completely unregulated and first aiders being able to carry ‘the green whistle’ I do not see this changing in the near future either.
Let me strip the ‘camouflage’ away completely and tell me what IMHO is the one word it all comes down to:
MONEY.
In case you think that’s too simplistic and pessimistic, let me just put this in perspective and tell you what each of the players primary interest is underneath the camouflage that they call ‘patient care’ and ‘reputation’ …
St John: Money
Ambulance: Money
First Aider: Money
Hospitals: Money
Government: Money
Posts to this blog are ‘moderated’ that is they have to be approved by me before they appear. This is to ensure there is nothing inappropriate posted and to avoid the spam. I’m willing to ‘approve’ comments in order to foster debate but just because I have approved a comment it does not mean I endorse what has been said, that that is the case with the comment from “Me” (not Michael Eburn) above.
There is no doubt that money is important, people who have jobs as first aiders, paramedics, doctors and nurses no doubt need to earn their salary in order to pay the mortgage, send kids to school and put food on the table, but that does not mean it is their primary interest or motivator. Professionals and in particular health professionals, are driven by the higher ethics of their profession and that can, at times, mean putting those interests ahead of your own.
If the First Aider who posted the original question raised their concern they may well lose their contract; but if they are being expected to perform services that are inappropriate and not in the best interests of their patient they should be prepared to walk away from the contract. I’m sure they wouldn’t accept a condition that say, they are to run the canteen or clean the toilets as that is not their job. Neither is failing to provide proper care. The excuse, ‘but that is what the client wants’ is no justification for providing sub-standard care, nor is it an excuse for a builder, or electrician, or plumber or anyone else not to do a proper job, and if the client won’t let you do a proper job, find a different client.
I think the assertion that everyone’s ‘primary interest’ is money is ‘too simplistic and pessimistic’. It certainly does not honour the thousands of hours volunteers with St John have put in the 100+ years of that service or the work and time that nurses, paramedics, doctors and others put in over and above their contracted duties.
Even if it is all about the money, then understanding that providing less than adequate care is more likely to lead to liability will also encourage people not to bow to demands to provide sub-standard care.
It maybe that in “Me’s” ‘humble’ opinion that it’s only about the money, but I disagree. The very fact that this question was asked in the first place shows that my original correspondent was concerned about more than money. I allow this comment as everyone is entitled to an opinion and allowing opinions to be expressed reveals them and allows them to be debated. “Me” is entitled to his or her opinion but I disagree and find the comments sadly ‘simplistic and pessimistic’ and an insult to everyone who works in the public and health sectors.
Michael, my comment was in reply to Richard’s comment. I was certainly not trying to put words in your mouth.
As you mention several times in your reply, thankfully we live in a country and time where everyone is entitled to their opinion as opposed to having someone else’s rhetoric forced down our throats.
Let’s look at one of your examples.
Firstly, I certainly do not intend to dishonour the ‘thousands of hours volunteers with St John have put in the 100+ years of that service , yet the reality of things is Michael, like it or not, St John would not cover events for free or as a public benefit. Not do they provide cpr and first aid training to the community free of charge. In fact, since 2014 St John has started charging commercial rates, hiring paid First Responders and Paramedics to fulfil those services.
If money is not the primary driver for them as an organisation, then why would their courses be the most expensive in the state? As a supposed PBI, why then would they charge commercial rates and use paid staff to supplement the ‘thousands of hours volunteers with St John have put in’? Why as an organisation do they refuse or cancel attendance at events where “suggested donations” is too low for them?
Me, fair enough about the term camouflage, I’d missed that in the earlier comment.
Money is important, services cost money to provide and money is the medium of exchange – that still does not make it a primary driver and to reiterate, the fact that this question was posed in the first instance suggests my correspondent was concerned with good practice, not just money. I stand by the assertion too that where a contractor seeks to engage a first aid service provider but expects them to provide less than proper care, the agency should walk away from the contract. If one’s only concern is the money then sure one might take the view I’ll do whatever the client wants – but that is neither ethical nor professional. And the ‘I was only doing my job’ is not a defence so providing sub-standard care want be justified ‘because that is what the customer wanted’.