Today’s correspondent asks:
Do First Aiders have a Duty or Care to inform First Responders of all serious hazards? For example, should first aiders ask a casualty if they have any blood borne diseases or have they taken any illegal drugs, and then pass that information confidentially to paramedics? Are First Aiders justified in asking a casualty for this information as part of their hazard assessment when an incident has occurred?
I’ll take those questions in reverse order, so I’ll start with “Are First Aiders justified in asking a casualty for this information as part of their hazard assessment when an incident has occurred?” For the sake of this question I assume, without confirming it, that the Australian privacy principles apply to the first aider ie they are part of an agency collecting personal information rather than just a good Samaritan.
Because my correspondent has not nominated a jurisdiction, I’ll refer to the Privacy Act 1988 (Cth). Australian Privacy Principle 3.3 says:
An APP entity must not collect sensitive information about an individual unless:
… the individual consents to the collection of the information and … the information is reasonably necessary for, or directly related to, one or more of the entity’s functions or activities…
How is the information necessary? I would suggest that there can be no doubt that a patient’s drug use is relevant in first aid. Determining what if any drugs a patient has taken will make a relevant difference to the diagnosis and the patient’s treatment. The issue of blood borne disease is more difficult. As I understand it, one should take universal precautions to prevent contamination from the patient’s blood whether they tell you they have a blood borne disease or not. If the information is not going to make a difference to how you treat the patient, why do you need it?
Resolving that issue is not however important to a final answer. Let me assume that all the information is clinically relevant in which case first aiders are justified in asking the questions but for the purposes of providing patient care rather than as their risk assessment.
An agency that has collected personal information may use it for the purpose for which it was collected. Why do first aiders collect personal information – see First aid patient records – who and what are they for? (January 31, 2015). A reason to collect sensitive medical information is to provide appropriate care and to ensure continuity of care. First aiders who hand-over a patient to a paramedic, and a paramedic who gives a hand-over to nursing staff are all sharing sensitive information in order to ensure appropriate patient care.
If one is asking the question because of personal security concerns rather than for clinical reasons, then the issue is a bit more complex. If you really think that asking a patient if they have a blood borne disease is about your security then do you have a ‘duty’ to tell someone else? It’s unlikely that you do as there is generally no duty to prevent harm. As Crennan and Kiefel JJ said in Stuart v Kirkland-Veenstra  HCA 15, at  ‘The common law generally does not impose a duty upon a person to take affirmative action to protect another from harm’.
Even if there was a duty, telling the paramedics shouldn’t make a difference. A paramedic should treat the patient the same either way. If the paramedic contacts the blood borne disease, then it will be the failure to use appropriate safeguards rather than the knowledge that could have been passed to them.
As for drug use again if you ask for security reasons then passing on the information would be reasonable but again, if you don’t, the paramedics are going to make their own patient assessment. Whether there’s a duty to share that information or not is again unlikely to make much of a difference as paramedics will no doubt make their own assessment both of the patient and the risk.
It is appropriate to ask a patient clinically relevant information and pass that onto the next level of care.