A paramedic with 18+ years of experience has

… a question regarding responsibility / accountability.  Statements by team members have included “if it all goes to bad, it will be his fault as the senior clinician”.  In hearing these statements, I have often taken the lead in treating patients (well within my partners scope of practice) and resulted in complaints about me ‘taking over patient care’.

In light of registration, in the case of an adverse patient event will the highest level clinician be the one held responsible for the actions, or lack thereof, of clinicians they are working with?

The answer to that question is ‘no’.  If the answer were not ‘no’ it would deny everyone any chance to learn or practice their profession.  You may as well put each intensive care paramedic with a ‘driver’ as no-one else but the senior clinician could provide care.

You are responsible for that which you are responsible for.  Let me explore that to give it meaning.  If there is some skill set that is within the partner’s scope of practice you could trust them to perform that skill whilst for example you go and get the stretcher and set up the ambulance.  They are responsible for their own performance and their own practice.

But if, you are formally appointed as a training officer, then that may mean you do not have the liberty to leave them to their own devices and need to supervise them.

And everyone has a duty to supervise each other.  If you see your partner is about to make a mistake you have an obligation to say something but not because you are the senior practitioner but because that is professional practice in the patient’s best interest.  Equally your partner has an obligation to, and hopefully is in a culture that supports him or her, question you and point out that you’ve missed a step or picked up the wrong drug or are going to do anything that is not appropriate.   And in the event of an adverse outcome that is subject to a learning review everyone is going to be asked what did you do and see and what could you have done differently to prevent this outcome.

In terms of professional discipline the question is ‘did the paramedic engage in conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience conduct?’  Not was there an adverse outcome.  As argued above I think a registered paramedic will pull up any colleague if they see a mistake or error is about to be made.  Equally a senior clinician may intervene if they think the patient’s condition warrants the use of their further skills or experience.  But a registered paramedic may also allow their colleagues to practice their profession within their scope of practice.

Conclusion

The Senior practitioner will be responsible if he or she knows that his or her advanced skills are called for but doesn’t provide them so as not to offend the more junior partner.  But short of that, what the consequences of actions that lead to adverse patient outcomes will be will depend on all the circumstances. There is no rule that says ‘the senior practitioner on scene is responsible for everyone’s behaviour and the patient’s outcome’.