Issue 27 / 20 July 2015

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.
 

Poll

Should doctors always offer assistance in an emergency?
  • Yes – it’s an ethical duty (48%, 73 Votes)
  • Maybe – depends on circumstances (47%, 72 Votes)
  • No – only if asked (5%, 7 Votes)

Total Voters: 152

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9 thoughts on “Joseph Ting: In an emergency

  1. University of Queensland - Central Library says:

    This sounds like an important gap in medical (and nursing) training.  It would be a pity if we can’t think on the spot how to manage an emergency without the comfort of an emergency call bell and emergency trolley/equipment.  If we feel uncomfortable without them, how much more uncomfortable must non-health professionals feel in the same situation.  We can at least bring some informed planning skills into a frightening situation.  Situational honesty is sensible, thanks Joseph, and perhaps we could complement that with some self-directed learning to expand our skills to cope better (not perfectly) outside the clinical environment, should the need arise.

  2. q402681@amamember says:

    I fully agree with Letitia and Joseph but I would add a note of caution. The ”Good Samaritan” is a Christian concept only. When thinking of offering assistance overseas, even on non-Australian airlines, please be aware that doing so may well render you legally responsible for any untoward patient outcome irrespective of any culpability. For example, no rational person should consider stopping and rendering assistance at the scene of an accident in Saudi Arabia. Any untoward outcome would inevitably lead to a loss of your passport and the pursuit of “blood money” by famiy members through the sharia court system. This may well occur without your presence or even knowledge. Just such an episode happened to a Nigerian colleague of mine (an orthopaedic surgeon) who was trapped for two years in the country.

  3. Ramsay Health Care Library says:

    I have been involved in ’emergencies’ many times on aeroplanes and have on just as many occasions given feedback about the contents of the emergency bags…no injectable analgesics, minimal IV fluids and nothing to help a mother delivering a baby or having a miscarriage ..eg ergometrine.The lack of IV anticonvulsants is inexplicable. 

    I have not once received feedback from the company or from their doctors.

    It is surely not too difficult to get uniform agreement across the industry as what each emergency bag should contain?

     

     

  4. Tim Leeuwenburg says:

    Thanks Dr Ting for this overview; it does however raise several issues, not least :

    (i) the need for a consistent standard for medical equipment on air carriers – standardisation of packs and ensuring minimal supplies available would be useful

    (ii) the potential to ensure identity of responders (too often doctors state that their offer of assistance is declined unless can establish bona fides) and the link with reliance on ‘good samaritan’ responders – would it not be sensible for doctors prepared to offer assistance to identify themselves when booking…and not in expectation of payment for services rendered per se, but perhaps be offered a ‘frequent flier’ card or similar perk in recognition of availability and sobriety (I am told Lufthansa already offer this)

    (iii) the nature of ‘good samaritan’ responses in law – on a related note, there are moves afoot to crowdsource community lay responders for out-of-hospital cardiac arrest via smartphone apps such as GoodSAMapp.org – ensuring both bona fides and ‘good samaritan’ nature of responders for medicolegal purposes can only enhance community benefits and needs clrification in the wake of the WA case
     

  5. Tim Leeuwenburg says:

    Ting highlights the need for responders to be adequately trained, not “enthusiastic amateurs” in the prehospital environment

    Ting makes note that “it goes without saying that a paramedic is better suited to trauma care at an accident scene than a GP”.  This is a provocative statement.

    In rural Australia, many ambulance responders are volunteers…and many rural doctors have significant experience in emergency medicine via their oncall committments to local country hospitals – and of these, a subset maintain advanced skills in resuscitation (not least airway management inc RSI)

    In the instance of the Kerang train crash, no local doctors were called to the scene.  And yet a 2012 survey showed that 58% of GP-anaesthetists had been called to attend a prehosptial incident in their locality at request of ambulance in previous 2 months.  A 2014 survey (EMA, In Press) shows overwhelmning support for rural doctors to be tasked to prehospital incidents in their community ONLY in instances where can ‘value add’, and contingent on appropriate trainign and equipment.

    South Austraia has such as shceme – the Rural Emeregncy Responder Network – utilising experienced rural doctors to assit in emergencies, akin to UK BASICS and NZ PRIME systems.

    In short, the rural GP is a potential asset in the prehospital environment, not a liability!

    Ref:

    Leeuwenburg T (2012) Access to difficutl airway equipemnt for rural GP-anaesthetists: results of 2012 survey Rural & Remote Health 12 : 2127

    Leeuwenburg T & Hall J (2015) Tyranny of distance: is there potential for a national rural responder network? EMA In Press

  6. stephen lionel betheras says:

    Again the insulting” just a GP” view. I currently work with Paramedics in an isolated Island setting. They in fact respect my resus skills and look to me to manage major trauma difficulties in cannulation and airway management when they have problems. I respect their skills and they certainly respect mine. It is Team managment where there is no ladder of arrogance. I have seen this sort of condascending attitude at it’s worst recently in the N.T. where as a result of an Alice Springs ED Doctor’s meddling all of the advanced airway management equipment was removed from the Clinic Ambulance. Only problem was this was at a Clinic with experienced Rural and Remote GPs 1200 km from the nearest Hospital.  This only came to my attention after a particularly bad 5 person road smash attended to by a particularly Cowboy RN who didn’t bother informing myself at the time. Result a 27yo single Mother hypoxic paraplegic luckily only an Aboriginal. In my curious state I enquired as to the airway management and what she would have done in an complete airway obstruction given the removal of any advanced airway equipment from the Ambulance. Answer ” Oh you know the old biro trick!” In reality it goes without saying that well trained Rural and Remote GP’s are bettersuited with their knowledge of local conditions and logistics at a Rural Accident scene than many Hospital based Specialists.

  7. Vivian john Affleck says:

    If “just a GP” is insulting just how low and insulting does it get to describe a serious adverse outcome subject as “luckily only an aboriginal”.  Shame on you. Where is the moderator? MJA should apologise to aboriginal people.

  8. Sue Ieraci says:

    I may have misunderstood, anonymous person, but I had assumed “just a GP” was being ironic. It would certainly be good if that were clarified.

  9. randal williams says:

    I don’t stop at accidents where an ambulance and paramedics are already in attendance–there is little extra you can offer . If you do stop, I agree with identifying yourself and ASK if you can help. Always acknowledge your training limitations, and stay within them. Beware the ‘good samaritan’ legislation or philosophy may not apply in some countries.

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