Negligence, confidentiality and crime scenes

1. You findYou are on duty and dispatched to a patient.You doYou have a duty to act. Provide care that meets the standard of care, because failing to do so is a breach of that duty.
2. You findYou need to end your care of a patient.You doHand over to a provider of equal or higher level, and make sure they have accepted the patient. Ending care without that, and without the patient's consent, is abandonment.
3. You findA competent patient says no to a procedure or to being touched.You doDo not do it. Unwanted physical contact, or care performed without consent, is battery. Putting a patient in fear of that contact is assault.
4. You findSomeone asks you about a patient: a bystander, a reporter, a friend at dinner.You doDo not share it. Patient information may be shared for treatment, payment and healthcare operations, such as your handoff to hospital staff, but not for unrelated purposes without authorization.
5. You findYou are sent to a patient at a crime scene.You doDo not enter until law enforcement confirms the scene is safe. Then care for the patient first; patient care always comes before preserving evidence.
6. You findYou are treating the patient at the crime scene.You doDisturb as little as you can without compromising care: do not move items unnecessarily, cut around bullet or knife holes in clothing and not through them, and document what you see and hear, including what patients and bystanders say.

• A tort is a civil wrong, settled by a lawsuit, as opposed to a crime.
• Negligence needs all four elements: duty to act, breach of duty, damages (actual harm to the patient), and causation (your breach directly caused the harm).
• Duty to act exists once you are on duty and dispatched; in some places also once you begin patient contact while off duty. It varies by state.
• Res ipsa loquitur ("the thing speaks for itself") presumes negligence from the nature of the injury, such as a surgical instrument left inside a patient.
• Good Samaritan laws protect people who give emergency care voluntarily, in good faith and without expecting payment, from liability for ordinary negligence. They do not cover gross negligence or willful misconduct.
• Confidentiality is usually broken by carelessness: talking about patients in elevators, restaurants or on social media, telling bystanders or the media, or leaving reports where others can see them. HIPAA is the federal law that governs sharing of health information.
• Slander is a spoken false statement that damages a reputation; libel is the same in writing.
• Special situations: use medical identification devices when present; organ donor status does not change resuscitation of a living patient; safe haven laws let a parent surrender an unharmed newborn anonymously at a designated place without prosecution.

The wrong idea: If I make any mistake on a call, I am negligent and can be successfully sued.

What is actually true: Negligence needs all four elements together: a duty to act, a breach of that duty, actual harm to the patient, and proof that the breach caused the harm. A mistake that caused no harm, or harm that your care did not cause, does not make a negligence claim.

A tort is a civil wrong, and negligence is the one EMTs most often face. It needs four elements together: duty to act, breach of duty, damages and causation. Abandonment is ending care without an equal or higher level of care taking over; assault is putting a patient in fear of unwanted contact, and battery is the contact itself or care without consent. Good Samaritan laws protect good-faith volunteers from ordinary negligence, not gross negligence. Patient information is shared only for treatment, payment and healthcare operations. At a crime scene, wait until police say it is safe, put patient care before evidence, disturb as little as possible, cut around holes in clothing, and document what you see and hear.

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