Prehospital Care: Clinical Negligence in Ambulance Service Practice - - PowerPoint PPT Presentation

Prehospital Care: Clinical Negligence in Ambulance Service Practice

Dr Tim Kilner

Senior Lecturer in Paramedic Science Expert Witness in Ambulance and Paramedic Practice

Medico-Legal Issues in Emergency Medicine Conference | Dublin | 15 May 2019

When is a paramedic not a paramedic?

• RoI
• Intermediate Care Operative
• Emergency Medical Technician
• Student Paramedic
• Observer
• Internship
• Paramedic
• Advanced Paramedic
• ESW
• Emergency Care Assistant
• Student Paramedic
• Autonomous EMT at threshold
• Emergency Medical Technician
• Registered Paramedic
• Critical Care Paramedic
• Community Paramedic
• Advanced Paramedic
• Specialist Paramedic
• Consultant Paramedic

Guidelines

Shared accountability

• Shared accountability … or

finding someone else to blame.

• Duty does not transfer, it

duplicates

Patient refusal

‘The patient declined/refused treatment and/or transportation’ ‘The patient took their own discharge’ ‘The patient or their relative signed the disclaimer form’

Disposition decisions

• Discharging patients on scene

is ‘easy’, doing it safely is infinitely more difficult.

• Informed choice
• Duty to provide adequate

information

• Montgomery v Lanarkshire Health Board

[2015] SC 11 [2015] 1 AC 1430.

• Persuasion
• Disclaimer
• Adequately informed?
• Capacity
• Safety net
• ‘If worried call back’
• Who?
• In what circumstances?
• What should they do?

Diagnosis by inclusion

• Formulating a diagnosis
• Sticking with it at the expense of

alternative explanations

• Constructing the history and

assessment around an assumed diagnosis or explanation

• Not excluding or being unable to

exclude important alternative explanations

• Some themes;
• Alcohol and alcohol dependence
• Age eg. ‘not old enough to have

heart disease/stroke’

• D&V ‘is gastroenteritis’
• Reported pain intensity is not actual

pain intensity

History & examination

• Narrow focus (assumed

diagnosis)

• Incomplete
• Omission of pertinent negatives
• Lack of reasoning
• Conflation of history and

examination

Clinical records

• Sequence of events & timing
• Multiple clinicians
• Mismatch between clinical

record and statements

• Proximity to events
• Unqualified statements
• ‘FROM’
• ‘Has capacity’
• ‘PEEFR within normal limits’
• ‘NAD’
• ‘If it isn’t written down it didn’t

happen’

• Not necessarily ... but may be

difficult to mount a defense.

Are delays or long response times a breach of duty?

‘… once there are available, both in the form of an ambulance and in the form of manpower, the resources to provide an ambulance on which there are no alternative demands, the ambulance service would be acting perversely ... if it did not make those resources available.’

Lord Woolfe

Kent v Griffiths and Others [2000] 2 WLR 1158

Questions

Dr Tim Kilner | expert@tmkconsultancy.co.uk