EMS providers often express concern about the meaning of the term abandonment. In EMS, it can happen in a number of ways. It is important for field providers to know what abandonment is and what it isn t.
Abandonment is sometimes defined as the unilateral termination of the provider/patient relationship at a time when continuing care is still needed. It is a form of negligence that involves termination of care without the patient s consent. To prove abandonment, a plaintiff must show that a patient needs care that a medical provider has entered into a relationship to provide care to that patient, and then either stops providing care or transfers care to a person of lesser training when the patient needs the higher level of training.
Abandonment can occur if EMTs drop a patient at the ED without giving a report or otherwise transferring care of the patient to a responsible party. It s always good form to have the nurse or physician who is taking over patient care sign the run form acknowledging the transfer of care. Simply putting the patient on the ED stretcher and walking out does not constitute an appropriate transfer of care.
However, EMTs often think that a paramedic can never turn over care to an intermediate or basic EMT in the prehospital setting, and that simply isn t the case. For example, if a volunteer rescue unit responds to a patient with a sprained ankle, the paramedic on that unit may stay in the district while the basic EMTs transport the patient. This is not abandonment if the paramedic has not initiated any advanced life support care that cannot be monitored by basic EMTs. This transfer of care should be done under your EMS medical director s orders, and with protocols to cover the situation. If in doubt, contact on-line medical control.
Abandonment can also occur when the EMS system as a whole fails to respond to a patient s call for help. This can occur if dispatch refuses to send a unit, or when units from the local service are not available and no mutual aid is sought. Another way that abandonment might occur is if a responding EMS unit comes upon an accident en route to the call, or is diverted to a higher priority call by dispatch. If nothing is done for the initial caller, abandonment may occur. Appropriate use of priority dispatching systems and the development of mutual aid agreements will go a long way towards limiting liability for abandonment. Abandonment may occur in systems that do not have adequate mutual aid agreements, or priority dispatch systems, and instead stack calls in the order they come in, without regard to severity, until an EMS unit becomes available.
Another area of confusion over the concept of abandonment is when EMS responders face an unsecured scene, or when a scene deteriorates and becomes dangerous for the providers. EMTs are never required to risk their own safety. When responding to a call that involves violence, such as a shooting, stabbing or domestic violence situation, be sure that law enforcement also responds. If law enforcement is not on scene when you arrive, it s appropriate to stage close by the scene to await them. This is not patient abandonment. Should EMTs be on a scene caring for a patient, and suddenly find themselves facing a loaded gun, they should escape by any means possible, even if that means leaving the patient behind. This does not constitute patient abandonment, because the EMTs are faced with a situation that does not allow them to provide continued care.
Understanding exactly what constitutes patient abandonment will go a long way toward providing both responsible care and limiting liability.
JEMS.com Editor’s Note: Want to know more about the legalities of patient abandonment? Check out W. Ann Maggiore’s follow-up article, “Patient Abandonment Part Two.”