A paramedic with NSW Ambulance says:

I recall seeing an article from you about the duty of care of Paramedics to complete Clinical Records and provide them to the hospital before departing on another case.  I can’t seem to find it though?

That post is Completing Paramedic Case Records (September 3, 2015).

The reason I ask is, NSW Ambulance has recently revised their clinical record policy which states:

“It is the responsibility of the paramedic to deliver and receive comprehensive clinical handovers wherever patient care changes from one clinician to another, this includes providing complete, legible and accurate documentation of the clinical observations, findings and management of the patient.”

But in another section states:

“Documentation of the clinical care is to occur at the time of, or as soon as practicable following the provision of professional advice, care, observation, assessment, management/treatment. It should include any other matter worthy of note.  However, response to a subsequent time critical incident should not be delayed in order to complete the CR. Records that are not completed contemporaneously with the treatment of the patient may lack in accuracy due to difficulty in recalling specifics of the incident. Where a CR is completed at a later time, a notation is to be made on the CR stating the reason for the delay and actual time the report was completed.”

To me this is a bit ambiguous because NSW Ambulance definition of “time critical incidents” may include someone with a simple cough “coded as Short Of Breath” or a caller with a cut finger who subjectively states the bleeding is “serious”.

That is a bit of a side issue.  Presumably NSW Ambulance define a time critical event as ‘short of breath’ or ‘severe bleeding’. The call taker and the paramedic don’t actually know what’s going on until they get there.  So the fact that it turns out the person had a simple cough or a cut finger, so their issue was not time critical, is not to the point.  The point is that, at the time, the case is prioritised as time critical.

Can I ask this… If a Paramedic delivers a patient to the hospital who has a complex medical condition/complex allergies/required significant active treatment, and that Paramedic was unable to provide a written copy of their clinical record because they were called away for a “time critical case” (as determined by NSW Ambulance), would that individual be liable for any mishaps that occur with the first patient as a result of the lack of documentation, or are they legally  “protected” by this policy which directs them to complete the written handover later?

The first rule is vicarious liability.  If the paramedic is negligent in the course of his or her employment, it is there employer that is liable.  So no, that individual WILL NOT be personally liable for any mishaps that occur with the first patient as a result of the lack of documentation, if there’s negligence it belongs to the ambulance service.  The other reason the ambulance service will be ‘at fault’ is that it’s the ambulance service’s duty to manage its resources and to give paramedics time to complete their tasks.

Managing resources will however always be a balancing act and a risk assessment.  There’s a risk to a patient if the handover isn’t completed with proper case sheet, but that person is already in hospital where others can provide care.  There is also a risk to the person who’s called triple zero and reported difficulty breathing or severe bleeding and the extent of that risk is not known.   The ambulance service has to manage both those risks with the limited resources that it has.

The ultimate issue is however for the paramedic who has to consider those risks. As I said in that earlier post:

… if there was no significant treatment to record on the eARF there may be little risk in leaving it if the paramedics are being asked to clear for an urgent task. On the other hand, if the patient has a life threatening condition and has received extensive treatment, including drug treatment from the paramedics, then ensuring that is recorded and handed over with the patient to allow their ongoing care is critical.   As noted above the ambulance service may owe a duty to get to other 000 callers as soon as possible, but the individual paramedic has a duty to continue to care for the person who is in their care.   Driving off without completing the eARF may be a remiss as simply dropping the patient at the door of A&E and driving away.

As employees’ paramedics are required to comply with the reasonable directions of their employer.  One can’t get into arguments on the spot about ‘what’s reasonable’ so if they are asked to clear for an urgent job but haven’t finished their paperwork and that does cause some problem, the paramedic won’t be liable, even if the ambulance service is.

When paramedics are registered health professionals the issue will change somewhat as the duty on paramedics to act as a responsible professional will be an independent and personal duty.  Liability will still belong to the Ambulance Service, but professional registration will enhance the paramedic’s capacity to say ‘I can’t clear as I need to complete this paperwork’.

Having said that I appreciate the dilemma both for paramedics and the ambulance service and it really does come down to a risk balance.  The problem for the paramedic is he or she knows what’s happening  with their current patient and can make a call on how important it is to their continued care that the documentation is completed.  What’s happening at the next call is at that stage unknown.