Administration and Leadership, Columns

Pro Bono: Stay Current on EMS Standards of Care to Avoid Liability Risk

Issue 1 and Volume 42.

Medical care is advancing at a very rapid pace. New technologies, new medications, and new or modified patient care procedures affect our practice of EMS as well as our potential liability.

We must keep up with what’s happening in the world of evidence-based healthcare. The public expects us to drive the standard of care forward and provide the best possible healthcare with the latest technologies and procedures.

EMS agencies that don’t keep up with current research and improvements in patient care procedures will not only be left in the dust, but could also end up under a pile of litigation.

It’s not just new technologies that we need to be aware of. A back-to-basics perspective can be just as important.

Many providers minimize the importance of taking a patient’s temperature with the thermometer even though we were taught how to do that in EMT and paramedic school. We may think, “What difference will that make in how we’ll treat the patient?” But now, research suggests many patients die needlessly from septic shock as a result of systemic inflammatory response syndrome (SIRS) and that thoroughly measuring a patient’s temperature (with more than just the back of a hand) can help detect SIRS earlier, and save lives through prehospital alerts. (For more, see the September 2016 issue.)

So, could you or your agency be found negligent for not taking a patient’s temperature with a thermometer? Likely not, but if taking an oral temperature is part of the protocol for the assessment and treatment of SIRS in the field, it’s certainly within the realm of possibility. Potential liability would focus on the standard of care for the treatment of that type of patient—and standards of care are constantly evolving.

So, what’s the standard of care by which you’ll be judged in the event of potential litigation for negligence? First it starts with the “scope of practice” as identified under state law. EMS professionals must be familiar with the specific skills and procedures that they’re permitted (and not permitted) to perform within their certification level.

Unfortunately, state law scope of practice often doesn’t keep up with the rapidly evolving medical advancements. That’s why in recent years more states have amended their EMS laws and regulations to allow greater flexibility for medical directors to implement new procedures, medications and techniques. This places a higher burden on local medical directors to stay in touch with the evolving realm of prehospital medicine.

We’ve found that local and regional EMS treatment protocols are becoming the standard of care by which you’ll be judged in the event of a negligence lawsuit. That’s why these protocols must be kept up to date. And if you deviate from your medical director-approved protocols, then the savvy plaintiff’s lawyer can seize on that and attempt to show that your assessment and/or treatment of the patient wasn’t consistent with the standard of care, and thus negligent.

Staying in Sync

Here are four things EMS personnel should do to ensure they’re practicing EMS in sync with the current state of the science:

1. Read, read and read! Stay on top of these changes by reading journals and publications that present the latest clinical advancements and the impact on EMS care. Share this information and talk to your medical director and others in your system about it. Thoughtful and meaningful discussions lead to positive change in the way we treat patients in the field.

2. Don’t overreact to what you read. There’s sometimes a tendency to read one or two clinical studies and then rush to change what we’ve been doing to be in line with the “latest” study that everyone’s talking about. For example, throwing away all the backboards because one or two studies show that most patients don’t benefit from their use may be premature, especially if your state law and treatment protocols haven’t been changed.

3. Have an active and engaged medical director. Your medical director needs to stay on top of the latest advancements in emergency medicine, working closely with operational leadership to implement changes to protocols, equipment and medications as necessary and within the confines of state law.

Any changes to EMS protocols must be made only after careful deliberation of all the available research and should be consistent with what other EMS agencies are doing. Keep in mind that we’ll always be judged in a negligence case based on how a similarly situated EMS agency or EMS provider would perform given the same or similar circumstances. If treatment protocols are out of line with other systems, there’s a greater likelihood they can be challenged as to their efficacy
and “reasonableness.”

4. Review treatment protocols regularly. Far too many EMS treatment protocols are simply out of date. A multidisciplinary approach to protocol review is essential to have as much breadth and diversity of opinion before making changes to already established treatment procedures. Effective and respected medical directors know that they don’t have all the answers—collaboration is what good medicine is all about. Medical direction committees can be helpful for reasoned debate so that a proper consensus is reached before implementing protocol changes.

Conclusion

Looking outside our own systems, visiting other EMS agencies and keeping up with what the rest of the world is doing can go a long way toward ensuring that your community is receiving the highest possible level of emergency care. It will also help reduce the likelihood of lawsuits based on alleged negligent care and treatment.