Today’s question is described as being about “the extension of duty of care” but I’m not sure what that means. The scenario is:
In Tasmania, we regularly see ramped ambulance crews extending beyond their rostered finish time, and these crews are often sent to relieve the ramp at the commencement of their shift. On one recent occasion, a crew spent 13.5 hrs of their 14hr shift ramped, only to then have to remain at hospital for a further 2 hours beyond their rostered shift. My question is “if the hospital is not receiving your patient, at what point is it acceptable for the paramedic to relinquish their duty of care?” acknowledging that in this example, there was no foreseeable relief.
I don’t understand what my correspondent means by ‘relinquish their duty of care’ – a duty of care is a legal concept imposed by law, it is not someone that one can ‘relinquish’. I think what is meant is when can a paramedic relinquish the care of their patient.
I think I have largely answered this question before – see Paramedics leaving patients in casualty (January 24, 2015).
In that discussion the issue was about whether it was reasonable to wait with the patient for 45 minutes. It’s a much bigger issue if paramedics are waiting with patients for 15 hours! The question always has to be what are the paramedics doing for their patient. If they’re just sitting waiting and the patient could just as easily wait in the general area (and would have if they had made their own way to hospital) then one has to ask what value it is adding to have a paramedic staying with the patient. On the other hand, if they are providing care then they may need to wait but if the patient needs care and the hospital is taking that long, then effectively the hospital is closed and one would hope arrangements would be made to take the person to another centre or to some alternative care.
What we can say, as with the earlier post, there simply can’t be a rule that says for example, ‘at the end of the shift just leave the patient’ if that’s going to cause the patient to die or suffer extreme risk to their wellbeing. On the other hand the paramedics well-being also has to be considered so they can’t be expected to stay there for 24 hours, or perhaps 15 or even three. That’s not for me to say.
The legal answer is you can leave the patient when it’s reasonable to do so. The problem with that answer is that gives no specific guidance because every case is different.
If hospitals are unable to admit patients for 15 hours that is a political rather than a legal question and should be directed to the Minster rather than to this blog.
Further to this post – see this news story from the ABC:
Rhiana Whitson, ‘Ambulance ramping causing ‘undeniable psychological injury’ to Tasmanian paramedics’ ABC News (Online) 1 May 2019 (accessed 1 May 2019)<<https://www.abc.net.au/news/2019-05-01/tasmanian-paramedics-mental-health-hit-by-ambulance-ramping/11060410>>
If the hospital was required to pay for the time that the ambulance crew spent waiting at the hospital at the ambulance service rate it would soon change. The hospitals dont have to pay while patient is on a ambulance trolley and bejng cared for by an ambo
My Son is a Paramedic in Texas; he and his crew have 20 minutes to deliver the patient, clean the Ambulance and be ready for reassignment from arrival at a hospital – the Hospital must take delivery as they are recognised as being better able to care for the patient than when on a gurney or in the vehicle. Once at the Hospital the patient is no longer the Ambulance Officer’s responsibility but the Hospital’s, and they get back to doing what they are best at quickly.