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2- If you did not stop while on duty (the only exception is a truely life or limb patient in the back) and there was a death on scene you could be charged with criminal negligence .. period.

I totally disagree with that assumption. In fact, if there was a death on the scene, that would be the easiest of all scenarios to pass up. I don't carry dead bodies, nor do I treat them. This dead body of yours needs nothing that we can give it. My patient does need something I can provide, and I am already committed to providing it uninterrupted. Interruption = abandonment. Just because you come back and start again after playing with your dead body for awhile does not negate the fact that you abandoned your one and only patient before doing so. Think about it; if you rob a bank, then go back and return the money the next day, do you think you are no longer guilty of robbery? There ya go. Same applies to abandonment.

I think you are having trouble relating to your "reasonable man", because no reasonable man -- medical professional or not -- abandons care of a child to go poke at a dead body.

As for the "truly life or limb" scenario, I accept that you are probably better educated in paediatric illnesses than the average medic, for sure. However, neither you nor I are qualified to determine the stability of a post-seizure infant. Just because he is not actively seizing does not in any way reflect stability. All seizures eventually stop, but the underlying condition continues on. Unfortunately, EMS systems seriously fail our practitioners in paediatric education. There is a common tendency to ASSume all seizures are either "just febrile" or "just epileptic", and both are extremely dangerous ASSumptions. Imagine how stupid you will look on the stand when the plaintiff's attorney asks you how you knew their child was "stable". Trust me, unlike us, the attorney has done his homework and will blow you away like belly button lint. And that's before he even brings up the expert witness paediatricians to testify to the laundry list of seizure triggering pathologies that are not stable, as well as your inability to accurately diagnose them.

Remember, the jury is also bound by the "reasonable man" theory. And you would be very hard pressed to find 12 jurors who do not or have not had sick kids. Your chances of convincing them that a dead body, or even serious injuries, were more serious than their child, who just scared the shyte out of them with that seizure. Especially since, when you decided to ABANDON their child, you had no idea whatsoever if there were even any injuries at this incident. These FDNY guys didn't even stop for a patient. They didn't get a patient out of that fishing expedition until the guy was shot. By then, the abandonment was done. Those guys chose to take a gamble on a fender bender POSSIBLY having injuries more important than his current patient. No way can you defend that.

This is a prime example of what Dr. Bledsoe was talking about when he said it is no longer acceptable to operate blindly with no other understanding of what you are doing than a simple, "page 147 of Wanker EMS protocols says..." These guys thought they were following their protocols alright, but they farked it up. Their protocols say that they are to stop IF THEY ARE FLAGGED DOWN, and IF THEIR PATIENT IS STABLE. Unfortunately, they forgot everything beyond the "you are to stop" part. This is exactly like those people blindly applying medical therapeutics according to "protocol" without the slightest understanding of why they are doing it and the conditions that would override those protocols.

If you want to continue to "what if" this scenario with dead bodies and the like, try this "what if" on for size. What if the kid started seizing again in the back of that deli? And didn't stop? Or became apneic? Or exposed everybody in the deli to meningococcus? Or died? Remember, the "what if's" go both ways. And that is exactly why you have to act on behalf of the patient with which you already have established a duty to serve, not the one who might be behind door number 2.

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If I'm not mistaken, what tniuqs said was "if there was a death on scene" not a dead body. Of course you wouldn't know either way unless you stopped. He also said, in the same sentence that the only exception for not stopping being a truly life/limb patient in the back. I think we are all in agreeance that an actively seizing pt is a life threat. And that quote was not an assumption. If you are not running hot with your patient, and you pass up another scene, and someone dies at that scene as a direct result of a delay in care which you may have been able to provide, under our laws, if you are identified, you can be charged with criminal negligence.

On that note, if I'm not allowed to poke the dead bodies with a stick, noone else should be allowed to!! :lol:

Brat :angel8:

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Of course you wouldn't know either way unless you stopped.

Exactly. And, if you have no knowledge of a patient who is of higher priority than your own, then you have no justification for stopping. You're just fishing. Gambling. I have never seen a policy that justifies that.

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I never said anything about policy. I did say that if you do not have a legit life/limb in the back of your rig, here you are bound by the law to stop while on duty. Not policy. Law.

That being said, isn't every call we stop at, that we haven't been dispatched to, considered a gamble?

Brat :angel8:

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That being said, isn't every call we stop at, that we haven't been dispatched to, considered a gamble?

Absolutely. And that is my point. You can gamble on your time. But when you are loaded, you are on your patient's time, not your own. Gambling on their time = abandonment.

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I can only speak with authority on the protocols I know......but it seems to me, that most protocols would address this issue speciffically.

The ONLY time I can stop for an accident that I drive up on is if the unit is EMPTY....no patients on board.

Once you make patient contact, you're committed to that patient. If you stop and 'check on ' another patient, you've just committed ABANDONMENT, no ifs, ands, or buts about it. Once you've abandoned your patient (even if its 'for just a moment', you can kiss your license and your career goodbye. There is no justification for abandonment, nor are there any 'degrees of abandonment'....kind of like being pregnant or married....either you are or you are not...end of story.

The flip side of this is, even if you stay with your stable patient while your driver/partner checks on the other patient....he/she has made patient contact, and even though the secondary patient is stable and has to wait for the next unit, once your partner leaves that scene to proceed with the original patient, your driver/partner has committed abandonment, and the cycle starts over again, except now its him/her that can kiss their license goobye.....

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tniuqs wrote:

If you did not stop while on duty (the only exception is a truly life or limb patient in the back) and there was a death on scene you could be charged with criminal negligence .. period.

I totally disagree with that assumption. In fact, if there was a death on the scene, that would be the easiest of all scenarios to pass up. I don't carry dead bodies, nor do I treat them. This dead body of yours needs nothing that we can give it. My patient does need something I can provide, and I am already committed to providing it uninterrupted. Interruption = abandonment. Just because you come back and start again after playing with your dead body for awhile does not negate the fact that you abandoned your one and only patient before doing so. Think about it; if you rob a bank, then go back and return the money the next day, do you think you are no longer guilty of robbery? There ya go. Same applies to abandonment.

Playing with a dead body ? just a hair condescending there dust, necrophilia is not in my make up ... tisk tisk.

just - 1 for well for now.

The point of abandonment is curious to me as there are 2 partners on a rig, one maintains the seamless continuity of care while the other provider's does a quick triage and intervenes with any life threatening injuries that could lead to a sudden death, hence the due diligence laws come rapidly into play leaving the scene of an accident.

Unfortunately not an assumption at all, as without due diligence to determine if there is a D.B. on scene one will never know, I don't carry a remote sensing tricorder on "well most days, on my bat belt" yet being aware of possible serious injury and not taking any immediate steps / action and in Kanukistan and you could be looking at very serious repercussions .... dustdevil the laws do actually change when one crosses even a poorly defended border.

I think you are having trouble relating to your "reasonable man", because no reasonable man -- medical professional or not -- abandons care of a child to go poke at a dead body.

As for the "truly life or limb" scenario, I accept that you are probably better educated in paediatric illnesses than the average medic, for sure. However, neither you nor I are qualified to determine the stability of a post-seizure infant. Just because he is not actively seizing does not in any way reflect stability. All seizures eventually stop, but the underlying condition continues on. Unfortunately, EMS systems seriously fail our practitioners in paediatric education. There is a common tendency to ASSume all seizures are either "just febrile" or "just epileptic", and both are extremely dangerous ASSumptions. Imagine how stupid you will look on the stand when the plaintiff's attorney asks you how you knew their child was "stable". Trust me, unlike us, the attorney has done his homework and will blow you away like belly button lint. And that's before he even brings up the expert witness paediatricians to testify to the laundry list of seizure triggering pathologies that are not stable, as well as your inability to accurately diagnose them.

- 5 off topic the thread is entitled "WOULD YOU STOP" not the what caused this Paediatric siezure, its root cause, prognosis or stability.

I will correct you here, it is called a barrister/solicitor not plaintiff , your comparing apples to frozen urine, if your following so far.

Remember, the jury is also bound by the "reasonable man" theory. And you would be very hard pressed to find 12 jurors who do not or have not had sick kids. Your chances of convincing them that a dead body, or even serious injuries, were more serious than their child, who just scared the shyte out of them with that seizure. Especially since, when you decided to ABANDON their child, you had no idea whatsoever if there were even any injuries at this incident. These FDNY guys didn't even stop for a patient. They didn't get a patient out of that fishing expedition until the guy was shot. By then, the abandonment was done. Those guys chose to take a gamble on a fender bender POSSIBLY having injuries more important than his current patient. No way can you defend that.

I am not having any difficulty understanding the "reasonable man" concept in Canadian law, it is a legal definition ... NOT a literal definition at all, one is judged on what a reasonable man/woman would do, in the event of any fatalities inquiry "firstly" and prior to any civil court action here, one would be judged by a peer group and experts sought (the run of the mill bus driver or ms minny mouse) this could be why we have far less litigation = less fear ?

We here in Canada generally speaking sue for vengeance not a monetary reward and it's a proven cultural fact, as for the heart break " I had a dtr that seized once, crowd " .... meh not going to cut in our court system, any empathy or pre-judgement towards that type of situation and the crown or defence attorney would violate that possible candidate in preliminary evaluation of jurors, have seen it, been there, have the T shirt.

The onus is to prove damages, unless there was a fatality either way, tis highly unlikely that this would ever make it to a courtroom, attempting to prove any damages from a delay in transport " for good reason " ...pftt aint going to trial.

I so like the innocent till proven guilty concept, it seams far more civilised than who has deep pockets .. but thats just me, I am just RED and WHITE but not BLEW (sp) ?

On the topic of assuming a lower priority and Fishing ? or just being duly diligent as a "PSO" aka Public Safety Officer, (here in assbackward snowshoe land) and there are benefits to that title here in Canada, but with that there comes responsibility for the public in general.

To impose ones Laws of THEIR land from one country to another is absolute folly/foolish EMT City is quite fortunate to have members other than in those lower provinces (please remember Canadians look DOWN on the US its a matter of geography ... te he !) AND very counterproductive in this thread, common sense should never be thwarted by ANY company policy ... PLEASE tell me it isn't so. Remember the TOPIC title again: I would not stop in NYC.

This is a prime example of what Dr. Bledsoe was talking about when he said it is no longer acceptable to operate blindly with no other understanding of what you are doing than a simple, "page 147 of Wanker EMS protocols says..." These guys thought they were following their protocols alright, but they farked it up. Their protocols say that they are to stop IF THEY ARE FLAGGED DOWN, and IF THEIR PATIENT IS STABLE. Unfortunately, they forgot everything beyond the "you are to stop" part. This is exactly like those people blindly applying medical therapeutics according to "protocol" without the slightest understanding of why they are doing it and the conditions that would override those protocols.

Out of Context.... period... again - 5 BLEDSOE is talking about medicine not law here and it is rote protocol vs. implementing standard cook book recipe books, funny but he has built a few of those to use as a model ... wierd aint it ?

(dust it is really not looking good for you, have you been wearing a hat in all that sun ?)

I did look up page 147 in MY wanker protocol book and a picture popped up (it is SO not my best side)

If you want to continue to "what if" this scenario with dead bodies and the like, try this "what if" on for size. What if the kid started seizing again in the back of that deli? And didn't stop? Or became apneic? Or exposed everybody in the deli to meningococcus? Or died? Remember, the "what if's" go both ways. And that is exactly why you have to act on behalf of the patient with which you already have established a duty to serve, not the one who might be behind door number 2.

In Conclusion: there are no what ifs, just the here and now.

NOW here is the very sad truth, EMS should not be practicing Law at all (or fear of the Law) or even some lay persons poor interpretation..... we should be practicing evidence based medicine and logic, I believe that is what Bledsoe is saying.

I often wonder what the Good Samaritan (it's in this big black book I read once) would think if he were to be reincarnated in today's day and age, somehow I think he would have found a way to help all.

cheers

edited for poor grammer

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The point of abandonment is curious to me as there are 2 partners on a rig, one maintains the seamless continuity of care...

Incorrect. It takes both partners to maintain seamless continuity of care. You see -- and I am amazed that I actually have to repeat this -- PROPER CARE INCLUDES TRANSPORTATION. IF YOU STOP TRANSPORTING, YOU STOP PROVIDING AT LEST HALF OF THE CARE THE PATIENT REQUIRES. Therefore, no, you are not maintaining the care you committed to in your relationship with this patient. Stopping transport = stopping care = abandonment. It is simple math.

Unfortunately not an assumption at all, as without due diligence to determine if there is a D.B. on scene one will never know, I don't carry a remote sensing tricorder on "well most days, on my bat belt" yet being aware of possible serious injury and not taking any immediate steps / action and in Kanukistan and you could be looking at very serious repercussions .... dustdevil the laws do actually change when one crosses even a poorly defended border.

You're the one getting all legal on the matter, not me. My discussion is not about the law. It is about what is right. Regardless, I have fifty bucks that says no Canadian court would convict you for failing to stop and explore a fender bender with no obvious injuries while you were loaded with a sick and potentially unstable kid. Matter of fact, I'd bet the same thing for U.S. courts. Show me the evidence. Show me an adjudicated case of any such thing ever happening in the U.S. or Canadia.

- 5 off topic the thread is entitled "WOULD YOU STOP" not the what caused this Paediatric siezure, its root cause, prognosis or stability.

Minus 5 for forgetting what the thread is about. Titles do not always fully reflect content here. The thread was started in response to a particular incident, and then the question asked in relation to that incident. If you forgot all that last July, that's understandable. But the condition of the patient you are loaded with is indeed relevant. In fact, it is the most relevant information in the entire thread.

I am not having any difficulty understanding the "reasonable man" concept in Canadian law, it is a legal definition ... NOT a literal definition at all, one is judged on what a reasonable man/woman would do, in the event of any fatalities inquiry "firstly" and prior to any civil court action here, one would be judged by a peer group and experts sought (the run of the mill bus driver or ms minny mouse) this could be why we have far less litigation = less fear ?

Remind me again who is too concerned about the legal and litigious ramifications here?

We here in Canada generally speaking sue for vengeance not a monetary reward and it's a proven cultural fact, as for the heart break " I had a dtr that seized once, crowd " .... meh not going to cut in our court system, any empathy or pre-judgement towards that type of situation and the crown or defence attorney would violate that possible candidate in preliminary evaluation of jurors, have seen it, been there, have the T shirt.

So, Canadia excludes all parents from serving on a jury? Suuuuure!

T

he onus is to prove damages, unless there was a fatality either way, tis highly unlikely that this would ever make it to a courtroom, attempting to prove any damages from a delay in transport " for good reason " ...pftt aint going to trial.

Well, at least you came back to the point of the thread, even if you did attempt to nonchalant it. Good reason? That is the point we are debating. Is the mere possibility that somebody in that car on the side of the road might possibly be injured -- and if he is, be injured more seriously than your current patient -- a "good reason" in the eyes of society or the legal eagles? What percentage of MVAs result in any injuries whatsoever? Damn few. Now, what percentage result in injuries that would be a higher priority than a kid sick enough to seize in the last few minutes? Get out your microscope, because you're going to need it to see that number. It's not going to take a medical or legal expert to make you look stupid on this one. All it's going to take is a statistician. As always, do the math. You lose.

To impose ones Laws of THEIR land from one country to another is absolute folly/foolish EMT City is quite fortunate to have members other than in those lower provinces (please remember Canadians look DOWN on the US its a matter of geography ... te he !) AND very counterproductive in this thread, common sense should never be thwarted by ANY company policy ... PLEASE tell me it isn't so. Remember the TOPIC title again: I would not stop in NYC.

Agreed. And again, this is not about laws. This is about doing what is ethically right for your patient, regardless of what country you are in.

Out of Context.... period... again - 5 BLEDSOE is talking about medicine not law here and it is rote protocol vs. implementing standard cook book recipe books

That's what I've been saying all along. But cooking by the book is cooking by the book, whether it be medically or operationally speaking. And this scenario is a great illustration of what you get when your people know just enough to read the cookbook, but not enough to comprehend it.

In Conclusion: there are no what ifs, just the here and now.

Exactly. And that is the beauty of the NYC scenario. We don't even have to what-if it. Regardless of how anybody tries to spin it, they were wrong, and it damn near cost them their lives. If we just blow a bunch of "hero" smoke up everybody's arse over it, the opportunity for people to learn a valuable lesson is lost.

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Incorrect. It takes both partners to maintain seamless continuity of care. You see -- and I am amazed that I actually have to repeat this -- PROPER CARE INCLUDES TRANSPORTATION. IF YOU STOP TRANSPORTING, YOU STOP PROVIDING AT LEST HALF OF THE CARE THE PATIENT REQUIRES. Therefore, no, you are not maintaining the care you committed to in your relationship with this patient. Stopping transport = stopping care = abandonment. It is simple math.

Maybe incorrect in your world, I am presently in remote depolyment right now, and following this rationalizing by yourself ... so therfore without a partner and your "new math" ... I am impudent ? MEH.

You're the one getting all legal on the matter, not me. My discussion is not about the law. It is about what is right. Regardless, I have fifty bucks that says no Canadian court would convict you for failing to stop and explore a fender bender with no obvious injuries while you were loaded with a sick and potentially unstable kid. Matter of fact, I'd bet the same thing for U.S. courts. Show me the evidence. Show me an adjudicated case of any such thing ever happening in the U.S. or Canada.

Legal not really, I am a lay person just attempting to point out some the differences between 2 countries, cultural, moral, and ethical perspectives.

I will take that $50.00 and please read vs ehs post I think about page 5 ... very few indeed in fact, and I can't find an issue/ precedent setting ruling anywhere in my searches regarding abandonment, possibly its just a yall thang ?

Factually in 25 years of Paramedicine in Alberta only 3 cases have ever gone to the courts, that I am aware 2 out of 3 the Paramedics admitted errors and were forced to be re evaluated, no monitary reward, one did use his position of Authority to spread his gene pool with a 16 year old ... resulted in a jail term for statutory rape, hence no more ride alongs unless your Legal....

That said I suspect that cases that are settled out of court in mutual "i.e. shut the hell up agreements" are not published.

Minus 5 for forgetting what the thread is about.

Perhaps look to your score, still ahead in my old math books ...

Remind me again who is too concerned about the legal and litigious ramifications here?

Again the point you missed point is the differences, only trying to point that out, the major point is not being restricted by the law to do the right thing... in this semi populated land driving away from a scene could take an moose age for a response, and leaving the scene of an accident (that may or may not) require medical care and here you could be hanging your arse in da breeze: MY WHOLE POINT !

So, Canadia excludes all parents from serving on a jury? Suuuuure!

No comment just sarcasm here, if this hypothetical abandonment case EVER got to a court room, I would hope that any juror that would believe a childs life is more important than a parent, a sibling a grandmother ... dust a life is a life this an ethical question with no answer.

Well, at least you came back to the point of the thread, even if you did attempt to nonchalant it. Good reason? That is the point we are debating. Is the mere possibility that somebody in that car on the side of the road might possibly be injured -- and if he is, be injured more seriously than your current patient -- a "good reason" in the eyes of society or the legal eagles? What percentage of MVAs result in any injuries whatsoever? Damn few. Now, what percentage result in injuries that would be a higher priority than a kid sick enough to seize in the last few minutes? Get out your microscope, because you're going to need it to see that number. It's not going to take a medical or legal expert to make you look stupid on this one. All it's going to take is a statistician. As always, do the math. You lose.

No your statement (s) is supposition only.

Not only could it be fender bender , and not trauma at all, it could be a medical call as I eluded to prior.

Agreed. And again, this is not about laws. This is about doing what is ethically right for your patient, regardless of what country you are in.

Your ethics are influnced by your culture as are my views influnced by my culture, there IS a difference.

That's what I've been saying all along. But cooking by the book is cooking by the book, whether it be medically or operationally speaking. And this scenario is a great illustration of what you get when your people know just enough to read the cookbook, but not enough to comprehend it.

You missed the edit.... mr. quickdraw.

In Conclusion: there are no what ifs, just the here and now.

Exactly. And that is the beauty of the NYC scenario. We don't even have to what-if it. Regardless of how anybody tries to spin it, they were wrong, and it damn near cost them their lives. If we just blow a bunch of "hero" smoke up everybody's arse over it, the opportunity for people to learn a valuable lesson is lost.

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