Today’s question comes from a person who works:
… in an Ambulance Service that due to a Rural Volunteer shortage is often undertaking the interhospital transfer of patients as single officer. This is currently done by putting patient on monitor and turning it to face the rear vision mirror and driving the patient to either a RV point or the hospital. Some operators choose to give narcotic pain relief on way and monitor via rear vision mirror and some choose not to give narcotics to patient with pain due to the risks.
When we transfer a patient, should they be treated or not, are we providing a level of care that could be seen a decrease in the level that they were already receiving and what would be the legal ramifications of this?
This question is simply about risk management. Presumably there is a risk to the patient if they are not transferred to the other hospital, that is there has to be some reason to send them. Then there is the risk to them along the route. Of course that risk might be reduced if there two ambulance officers, or two paramedics, or a medical retrieval team. I imagine a single operator is not tasked to transfer a patient from one ICU to another. But not everyone gets a medical retrieval team to deal with unlikely risks. Presumably then someone has considered the patient’s condition, the need for the transfer, the alternative transfer options etc.
The test is always what is reasonable in all the circumstances. If someone has not considered the patient’s condition eg the doctor who books the transfer or the single operator who turns up and says ‘that’s not safe’ then that may be negligent. But if everyone has and has made a decision that is reasonable in all the circumstances, including the ambulance officer who considers whether they can observe the patient and whatever the indications and contraindications for any drug treatment are, then that is all that can be expected. Even if something goes wrong en route.
I cannot say whether a person should be ‘treated’ or not. One has to weigh up the risks and benefits. If you’re talking narcotic pain relief you have to consider the risk to the patient and their well being if they are not provided adequate pain relief, and the risk to them if they are and cannot be monitored. I would think that if you believe they need pain relief but they also need monitoring then you need to raise that with the medical team so that the situation can be considered. This is a clinical question. The legal question is ‘were the actions reasonable in all the circumstances?’ that is not a question that can be answered in the abstract.
This blog is made possible with generous financial support from (in alphabetical order) the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), the Australian Paramedics Association (Qld), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
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Australian Emergency Law 
Irregardless of the legalities, this just sounds like an adverse event waiting to happen.
As a Paramedic, I would not leave a pt who has had narcotics administered alone in the back of an ambulance unattended over a distance.
The fact volunteer Ambulance Officers could be doing this horrifies me.
Not To be rude, but a lot of them simply do not have the training or experience to be doing something so risky. I’m glad this person has recognised the risk, hence their question to you Michael.
I would strongly be suggesting at the very least, if the Pt needs any sort of medication or monitoring, at the very they wait for another volunteer or contact their communications to send another car.
A pt deteriorating or suffering an adverse reaction is simply not going to be recognised in the rear view mirror in a timely fashion.
Id hope if their Clinical Support Officers were aware of this practice they would be advising them not to do it in no uncertain terms. If there shortages of Volunteers, it’s up to the Service to address them, either by recruiting more Volunteers, or placing paid staff into more of these Rural areas
I think the volunteer attendant’s role would be to drive allowing the paramedic to treat the patient.