Today’s correspondent is hoping I:
… can shed some light on a discussion we have been having at work regarding the potential repercussions of failing to treat a patient to the standard expected of a paramedic (or registered health professional).
I accepted a job as a paramedic/emergency services officer at a site in the Hunter Valley, only to discover on arrival that the company did not have a contract to provide medical services on site, nor did they have CPG’s or a drug license. I was originally told to “work as a paramedic”, but wasn’t given an idea of what that was, or the scope of that “position”. I have therefore been working as a “first-aider” at the medical clinic on the days there is no occupational health nurse, as a favour to the contract manager, at the request of my boss, while they organise the return of the normally full-time nurse. My question has a few sides:
Would I be negligent in my provision of care should I not perform tests such as a fingerstick glucose, or ECG despite these things being available to me in the clinic? As these tests are far outside the scope of a “first-aider”. A few recent cases of chest pain I have investigated with chest inspection and auscultation, ECG and a full set of observations but have also called an ambulance. Both with the intention of providing high quality clinical care, and a good handover, and almost by reflex.
My initial thought is; if we are not contracted to provide this service, and are only attending on an as-needed basis, it could be considered a volunteer role, and therefore, the “Good Samaritan Act ” (I know you hate that phrase!) may apply. Could it then be argued that if I did not assess the patient appropriately, I was negligent?
Negligence requires proof of a duty of care, a breach of that duty and that the breach causes some damage. Let us consider those in turn.
Duty of care
A paramedic, a first aider or a nurse all owe a duty of care to their patient. That is axiomatic and will not be justified further.
Standard of care
The standard of care is problematic. There is no magic list that says ‘this is first aid but this is paramedic care’. The person providing care has the skills and knowledge that they have and are there to apply those skills for the benefit of the patient. The patient has no idea of the terms of any contract nor any control over that. They are seeking assistance from someone who is there to give it.
A registered paramedic has to deliver care that would be judged as appropriate care by their peers in all the circumstances. A paramedic employed by a jurisdictional ambulance service with a drug box may administer some treatment. A paramedic employed on a site with no drugs cannot administer those drugs and cannot be remiss for not administering treatment that they cannot administer.
The standard of care question can always be distilled down to ‘did you act reasonably and in the patient’s best interests, taking into account all the circumstances?’
The real answer to these questions is about damage. What difference does or would it make if you do, or do not, take blood sugar levels, an ECG or listen for breath sounds particularly if an ambulance has already been called. If it would make no difference to the treatment, then failure to do it won’t make a difference to the outcome. If it would make an immediate treatment difference then failure to take those observations if the means are available may be negligent. Take blood sugar levels as an example. If there is glucose paste (a non-scheduled item (see https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Glucose%20gel.pdf ) so it doesn’t need a drug licence) available and a blood sugar monitor, failure to take the blood sugar level, identify hypoglycaemia and get the patient to suck on the glucose syrup would be negligent if it can be shown that whilst waiting for the ambulance they fell into a coma and suffered permanent injuries that could have been avoided. But that’s true for anyone who knows how to use a blood glucose monitor whether they hold a first aid certificate or are a registered paramedic.
On the other hand, taking an ECG may reveal some heart condition but if the paramedic on scene has no means to treat it then failure to take the ECG can’t cause any damage. The jurisdictional crew may need to take an ECG if they have equipment or drugs that can make a difference.
If you are being paid to provide a health care service, even as a ‘first aider’ you are not a ‘good Samaritan’ for the purposes of the Civil Liability Act 2002 (NSW).
You are employed to provide some level of care. There is no magic line between first aid and other care. You use the skills and knowledge you have in the best interests of the patient. Not taking observations is not negligent unless it would make a difference to your treatment decisions and patient outcomes and that, in turn depends on what equipment you have at hand. You cannot be liable for not administering drugs or using equipment that you don’t have. If the outcome of the tests wouldn’t make a difference, then it’s not negligent not to do them. Equally there’s no negligence if you take the observations, identify the condition and even know the treatment (particularly drug treatment) but don’t administer that treatment as you do not have the means to do so. You wait like anyone else does, for the ambulance to arrive.