FEW doctors are trained to care for critically ill or injured people in uncontrolled environments outside hospital or clinics.
When doctors do volunteer to help in an emergency that is outside their scope of practice and skills, their responsibilities and the medicolegal implications can be unclear.
Many doctors have been asked to respond to first aid calls on planes
and other public transport, usually for self-limiting symptoms such as fainting, vomiting, diarrhoea, dehydration and anxiety. Rarely is a plane diverted for a passenger suffering life- and limb-threatening illness that requires urgent treatment.
Most clinicians can function to acceptable standards only within their scope of training and familiar practice settings. It is difficult to deliver equivalent care in a non-medical setting in the midst of noise, chaos and the discomfort of open conditions.
The Good Samaritan impulse compels health care workers to at least consider helping in acute emergencies outside work when requested over a public address system. However, concerns about issues such as infection control and lack of clinical competencies can dissuade participation.
Medicolegal exposure is another niggling concern for Good Samaritans. So what are the doctor’s obligations, and are there legal consequences for not volunteering to help a person in need of urgent care?
Australian states and territories consistently support anyone who comes forward to render assistance in a medical emergency
without expectation of being paid. The Good Samaritan is not liable for any damage caused by their well intentioned actions if they act in good faith, without recklessness and exercise reasonable care and skill in the circumstances.
Although doctors are not legally obliged to provide care in a medical emergency, one notable case
involved a doctor who, when approached for help while consulting at his surgery, refused assistance to a boy nearby having an epileptic seizure. The court found the doctor had a duty to render emergency medical care, as he was at work as a doctor and the patient was close by.
In 2013, the Medical Board of Australia
found a doctor’s failure to check if help was needed at the scene of a serious car accident constituted unsatisfactory professional conduct. In 2012, a doctor who denied being a doctor when approached by a mother seeking medical care for her child outside a medical clinic was cautioned and fined by the board
The Code of Conduct
for Doctors in Australia supports offering assistance in an emergency that takes into account the clinician’s safety, skills and the availability of other options.
Although the doctor doesn’t have to help in an emergency, there is an expectation that health professionals will render assistance when they are made aware that assistance is required. Doctors do need to consider not making the situation worse. It’s a hard judgement to make without having carefully considered your clinical skills, training, competence and comfort level for delivering care out of hospital.
There is no justification for getting involved when more appropriate staff or volunteers are available and willing to act in an emergency. It goes without saying that a paramedic is better suited to trauma care at an accident scene than a GP.
Medical care delivered in good faith and not incurring gross negligence or misconduct is likely to pass muster even if the patient outcome is poor. If you are called to attend a seriously ill or injured patient in the community, the following list will assist both the doctor and others at the scene:
1. Identify yourself
2. State your medical training
3. Briefly describe your current clinical skills
4. Ask if help is required
5. If so, ask how you can assist
6. Think about whether you can provide the assistance needed.
Most importantly, be guided and directed by experienced prehospital practitioners in maximising your Good Samaritan contribution. This helps ensure the doctor volunteer is being deployed for medical tasks that offer the best care for the patient, and offers protection if legal issues arise later.
Dr Joseph Ting has worked as a prehospital and retrieval physician in Australia and the UK, and is adjunct associate professor for clinical research methods and prehospital care at the Queensland University of Technology School of Public Health and Social Work and clinical senior lecturer in the Division of Anaesthesiology and Critical Care at the University of Queensland. He is the coauthor of several publications on ambulance use and is a member of the Emergency Health Services Queensland Group.
Acknowledgement: The author thanks Professor John Devereux, professor of law at the University of Queensland, for his help with this article.