It will be a sad day indeed if fear of litigation keeps you, an emergency physician, from providing aid in an out-of-hospital emergency situation. This is, after all, what we were taught to do, and why society helped subsidize your medical training. Many emergency physicians practice in hospitals where they are the only physicians in the hospital a significant number of hours per year. In the vast majority of hospitals, the emergency physician is the most skilled in resuscitation, crisis airway management and approach to emergency situations (a person “down” in the hospital lobby) in the entire building. Make no mistake. You make a difference! Step up in an emergency and people won’t want to sue you. They’ll want to thank you!
I have been a firefighter and run with EMS for almost 30 years, and I still spend a lot of time in the field. There is nothing better at a bad emergency medical scene then a helpful Good Samaritan physician, one that walks up, quickly gives his/her credentials and then offers to assist. It’s important that the physician work within the existing system, not extending the EMTs or Paramedics beyond their capabilities or standing orders. The best physicians participate in what they are good at and don’t insist on commanding the scene. Those physicians then are ready to manage a difficult airway, assist in the care of the badly injured child or triage. Usually at the end of the incident, that physician feels like a team player, has a new respect for what the EMTs do and wants any available follow-up on the patient he/she helped care for. I haven’t been involved in any cases in the field where a Good Samaritan physician was sued, and I have been involved in a lot of those cases.
I also served as medical director for Atlanta’s Airport Fire Department, and again, there was nothing better then to have a talented physician, particularly an emergency physician, caring for a patient when the plane arrived at the airport. Not one of these thousands of cases ever progressed into a lawsuit. In a commercial airplane, the intervening physician, nurse or paramedic is often all that stands between a medical emergency and an untimely death. The flight attendants are generally completely unprepared, wanting only to know whether they need to divert the flight to a closer airport. When I have dealt with emergencies in the air, there has been no reward, barely a thank you from the flight crew, only some paperwork to fill out.
I had the experience of helping defend a case where an emergency physician went to L&D to assist in a precipitant delivery, that unfortunately ended with a bad outcome for the baby. As in many small community hospitals, there was a contractual requirement for the emergency physician to respond to in-house emergencies. In the lawsuit that followed, the Good Samaritan defense was completely respected because the emergency physician was clearly contributing outside his area of usual patient management, was the only in-house resource and assisted the L&D nurses who were working within their day-to-day environment. The judge was completely supportive of the concept that physicians have areas of expertise, and that performance of emergency aid outside the typical practice duties is honorable and should not be discouraged by alleging negligence.
Dear colleagues, please continue to provide aid in out-of-hospital emergency situations. Provide the skills your community needs in times of crisis. Don’t pretend to know something you don’t to know, like how to perform auto extrication or put out the fire. If you have the time, go talk to the local fire/EMS Chief and learn some more skills that will better prepare you for responding appropriately to out-of-hospital emergencies.
If you work in a hospital where skilled response teams are not available for medical emergencies, be ready to go and assess, assist when they call for help. However, if you find yourself the only physician in-house for a significant number of hours per year, work with the lawyers and hospital administration to establish appropriate boundaries and expectations.
Let’s provide medical aid and be the positive role models that we envisioned when we chose this field. Be a good Samaritan, and you will make a difference.
James Augustine, MD, is the Director of Clinical Operations for Emergency Medicine Physicians (EMP)
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