Liability - Part II

Hidden in the controversy that surrounds "customer service" in Fire and EMS, I reminded you of the two distinct definitions of the word liability and how 99% of people in this line of work misuse it.

Much like patient has two completely different definitions, liability has always been explained to young EMTs as something pertaining to them defending their license or certificate in court for doing something wrong.

But when we transport Bubba Fishbiscuit because he's out of Xanax at 11pm, driving past 2 24 hour pharmacies, we are ignoring the real liability, the next person who might actually need us.

In my rose colored world of a successful EMS 2.0 launch, the Paramedic at the scene directs Bubba to the pharmacy, cancels the ambulance and makes a note to follow up by phone in the morning to make sure Bubba gets his meds refilled on his own without activating 911.  That releases the service from the perceived liability that Bubba *might* get angry, *might* complain, and *might* make noise at the next City Council meeting.

I say let him.

Let's start to hear these folks explain their actions at a City Council, shareholder, union meeting or court room.

Let them describe the inconvenience of having to wait a whole 6 minutes for a lights and sirens response for a prescription refill they have known will be gone since the moment it was filled.

Cry about not having a car, bus fare or a friend to drive them.  Do it.  Then let them describe the treatment given to them by the EMS crews.  Every detail of the extensive advanced life support service rendered since the 911 call was placed.

Not going to happen?  I know.  Your Chiefs and managers are too worried about a perceived wrong doing that is actually a response to a wrong doing.  Following me?

I can go on and on for weeks about persons abusing 911 as their personal taxi service, but today let's discuss the stranded.

I define a stranded patient as one who has been passed over by the "system," both private and public and is now 100% dependent upon EMS to get them to appointments, refills, dialysis, etc.

These folks need a service that exists in only a few communities.  A van.

"No!" the bean counters are screaming, "That's a huge liability!"

He means the part of the definition of liability that pertains to a responsibility or duty.  But he is actually referring to the second, more accurate, definition of liability, a hindrance.

Persons who call 911 and demand a level of service below the standard of care are a hindrance to the efficient running of an emergency service, not a responsibility of emergency workers.

But this is where that other question pops up, isn't it?

Is EMS a public safety agency or a public health agency?

Really depends on your system and how you handle calls for service that have no medical component.

If you will take anyone for any reason, I say you fall into the public health model.

If your service focuses on lights and sirens emergencies, take a seat in the public safety model.

But in every system there are persons creating actual liability by draining highly trained, not to mention expensive, resources to do the job of a clerk, aide or driver.

Putting a van on the street that can be called and arranged for these kinds of folks can not only save money, but lives.

I can hear some of you now, "Vans save lives? Prove it!"

I can't, but I can make the inference that more ambulances available for emergencies means a shorter response time and early intervention is key in survivability in the one case we can trend with certainty: SCA.

Let me give you a situation and let's see what you would do.

You are dispatched to a street corner in your ALS ambulance for a reported asthma attack.  When you arrive, a group of young women, in their twenties, are all texting away on the newest of phones.  As you approach, one of them produces an albuterol inhaler and, without a hint of respiratory trouble, tells you she is out and wants to goto the hospital to get more.

If your answer is "Get in, let's get this over with" you are accepting the perceived liability and putting your community at risk.

If your answer is "Can one of them take you to the pharmacy?" you are leaning in the needed direction, but unless you can arrange something, you're about to start a losing fight and will, in the end, be taking her.

If, in the off chance you are lucky enough, you respond by telling her your service does not give rides to refills, then arrange for her to seek out the proper assistance, I want to know about your system.

As you load the girl into the back of the ambulance and begin your assessment, the next person who may actually need you is now at an increased risk of poorer outcome.

Unless, of course, one of her friends decides she wants a ride too.

Ask your Medical Director the definition of liability and why we assign it to the least of our worries and roll the dice on the rest.

And, again, follow your local protocols.  Which likely means you'll answer "get in."