Ian's recent postings to the list have proved most useful. I hope Neil will
not object too much to some further legal observations ....
As I understand it, health professionals owe a duty of care to those whom
they undertake to treat, either as a normal part of their professional
duties or in the course of an emergency.
Doctors / nurses / paramedics must reach the standard of care of a
reasonably competent professional holding himself out as having those
special skills; as we know, this is the 'Bolam' test and applies in all
areas of diagnosis and treatment, with the plaintiff having to prove
causation (clearly presenting problems in the case of the patient who is
already ill or injured) and that the injury is not too remote. Of course,
the definition of the word 'reasonable' is the stuff that court cases are
made of.
Additionally, I can see no reason why the 'Bolam' test would not apply to
the application of treatment by volunteers (say, members of St. John
Ambulance or the British Red Cross Society). It is certainly clear that
where a volunteer goes to the aid of a victim, the law will expect him to
act in such a way as not to leave the victim in a worse position than he
would have been in, had that volunteer not intervened. He will be expected
to have the same degree of skill and care that a reasonably competent
volunteer would display given all the circumstances.
In a more general case, we know that all rescuers must act with the standard
of skill and care expected of someone having that special calling (eg
firefighter, police officer, nurse etc.). If a rescuer embarks upon a
rescue and then abandons the attempt he may be liable either:
(1) to the original victim if he leaves him in a worse situation than
before, eg deters other rescuers from assisting [Horsley v McLaren];
or
(2) to a subsequent rescuer who is injured through an increased level of
risk caused by the first rescuer.
Finally, the recent legal discussions provide an opportunity to present the
list with a medico-legal problem that has bugged me for some time - it
relates to the application of triage in the context of the medical response
to major incidents.
Let us assume that there has been a major incident (for sake of argument,
let's say a Ramstein-type incident but it doesn't really matter) and that a
qualified medical practitioner is undertaking the primary triage sieve using
the 'P' (as opposed to 'T') system. He is moving round the 'field',
examining casualties as he finds them, and comes across a patient who is not
walking. He therefore moves on to assess the airway and finds that the
casualty does not breath in spite of a simple airway-opening manoeuvre (eg
jaw-thrust or chin lift); the patient is therefore categorised and labelled
as 'dead' and the doctor moves on to the next patient.
So far so good - the triage sieve has been performed on this patient 'by the
book'. Now assume that the unfortunate victim's spouse was looking over the
shoulder of the triage doctor whilst the sieve was performed. In normal
circumstances, aggressive resuscitation would have been attempted and
possibly the life could have been saved. In performing the triage
assessment, has the doctor officially commenced treatment? By labelling the
patient 'dead' as the book requires and then moving on without any further
treatment, has the doctor legally abandoned the patient? Assuming the
spouse survived, would he/she have any grounds to stand on in bringing a
courst case against the triage doctor post-incident?
I fully acknowledge that the case is perhaps academic as in the case of a
major incident, demand outstrips available resources and we have to do 'the
most for the most' (can you hear MIMMS talking?), but it seems to me to be
at least a grey area of law, if not a medico-legal minefield.
I'd be interested in the list's comments. Cheers.
Pete.
Peter J. Davis, MSc, MIEM, BEng(Hons), GIFireE.
E-mail: [log in to unmask]
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