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Pro Bono: When Patients Won't Stay Put

We’ve seen some tragic headlines recently that should be a cause for concern: 

>>  Aug. 19, 2012: “Woman Dies After Jumping from Ambulance” (Calif.)
>> March 12, 2012: “Patient Jumps from Ambulance Only to be Struck by Truck” (Nev.)
>> Dec. 23, 2011: “Naked Man Jumps from Ambulance, Dies on Freeway” (Calif.)
>> Oct. 13, 2011: “Patient Jumps Out of Ambulance and Into River” (Okla.)

Is this a trend? How can these incidents happen in the first place? We don’t know the statistics, but we do know that patients who unexpectedly leap from your ambulance—while you’re with them in the patient compartment—not only can get injured or killed, but can also present huge liability issues for you and your EMS agency.

Dealing with patients with psychological issues is a big challenge. They may appear “fine” and “calm” one moment and then they snap into another person the next second. They often don’t have any outward physical injury, so they almost appear “normal.” This is when we may let our guard down ever so slightly, and bang: The next thing you see is the rear door flapping open and no patient in your vehicle. Not a good scenario.

We need to always remember to strive to never let something bad happen to a patient while they’re under our care. We don’t want them to be worse off than when we first found them, because if they are, then the obvious question from a “fact-finder” will be: “Did the EMS crew do enough to prevent this unfortunate incident?” And if the answer is no, then you may be looking at a negligence or wrongful death action against your agency.

Follow these tips for reducing your risk when transporting patients who have a “questionable” mental state:

>> Always be attentive: Keep your eye on the patient at all times in a face-to-face position. The first sign that the patient is about to escape may be a change in their facial expression. You can’t see that sitting in the captain’s chair texting a friend, staring out the side window, or chatting with the driver. We must be totally attentive to the patient every second they’re with us. Being complacent or distracted leads to dead patients in these situations.

>> Follow your protocols: Most systems have a protocol for dealing with a patient who may have psychological issues or has exhibited signs they may hurt themselves. Make sure you review that protocol and follow it. Your protocol will usually be the patient care standard by which you will be judged in a negligence lawsuit.

>> Get good Information at the scene: Ask lots of questions of the facility staff or family members concerning mental stability, suicidal ideations, and so forth. Document exactly what the patient, nursing staff and bystanders tell you. Never accept a patient who looks “fine” without a good explanation as to why you’re taking them.

>> Don’t hesitate to call law enforcement: True, police officers are not always helpful, but it’s best to err on the side of calling them, and then keep them there for the remainder of the transport or ask an officer to ride in the back if possible. Always consider the option of an involuntary mental health commitment in accordance with your state law, if you’re concerned.

>> Use two people in the back: If you question the mental stability of a patient, it’s always best to have two providers in the patient compartment—positioned strategically so that the patient can’t escape easily. Someone should definitely be between the patient and the rear door of the ambulance. Don’t make it easy for them to escape.

>> Use restraints when needed: We’re not talking about the cot straps, which by the way, should always be in your complete view so that you can see them if a patient is trying to get unbuckled; never cover buckles under a blanket. Chemical restraints may be the safer way to go and can reduce patient anxiety. Don’t hesitate to use them or ask your medical command physician.

Keep in mind from a risk management standpoint, it’s far better to get sued for false imprisonment for excessively restraining a patient, than to get sued for wrongful death if the patient jumps from your ambulance as you look up and it’s too late.  There are only a few lawsuits where EMS providers were sued for taking a patient involuntarily, but there have been hundreds of lawsuits against EMS for negligence when the patient is left worse off than when you found them —regardless of your defense.

The authors are all attorneys with Page, Wolfberg & Wirth, a national EMS law firm. Visit the firm’s website at www.pwwemslaw.com for more information on a variety of EMS law issues.

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