In this episode of The Standard of Care podcast, hosts Samantha Johnson and Nick Adams delve into the complex legal framework of patient consent in EMS. What happens when a patient refuses care, even in life-threatening situations? How should EMS professionals navigate the fine line between consent, implied consent, and refusal, all while staying within the legal boundaries? Samantha quizzes Nick on real-world scenarios, offering practical insights on handling refusals, informed consent, and what EMS providers need to know about patient capacity.

Whether you're a seasoned paramedic, new to the field, or just brushing up for the National Registry exam, this episode offers valuable knowledge on critical issues you may face. Get actionable advice, hear relatable examples, and understand the nuances that could impact your next decision. Tune in now to explore this important topic—and remember, you can find The Standard of Care wherever you listen to podcasts or on our website at flightbridgeed.com/explore. While you’re there, check out our award-winning courses designed to enhance your professional skills and knowledge.

Key Takeaways:

• Understanding patient capacity is critical in determining whether you can proceed with care, even if consent is initially given. If a patient has capacity, their refusal must be respected, even in life-threatening situations.
• Implied consent allows EMS providers to intervene in emergencies when a patient is unconscious or unable to give explicit consent, but only within the necessary scope of care.
• Informed refusals are equally important as informed consent. EMS professionals must ensure patients fully understand the risks of refusing care and document everything thoroughly.

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In this episode of The Standard of Care Podcast, Samantha Johnson and Nick Adams recount their journey from attending conferences to becoming conference speakers on critical medical-legal topics in EMS. They reflect on how these pivotal experiences shaped their current work. The episode dives into highlights from recent EMS conferences, such as South Carolina EMS, Metro Atlanta EMS, and FAST24, where they engaged with street-level medics and addressed critical topics in the ever-evolving landscape of EMS law. Whether you're a seasoned provider or just starting, this episode offers valuable takeaways on the value of EMS conferences, the evolution of the Standard of Care Podcast, and the importance of staying informed and involved in industry developments.

Links:

National Association of EMS Physicians

https://naemsp.org/

2025 Annual Meeting
January 6-11, 2025
https://naemsp.org/annual-meeting/

South Carolina EMS Association

https://scemsa.org/

2025 SCEMSA Symposium
March 5-7, 2025
https://scemsa.org/ems-symposium

Metro Atlanta EMS Conference

2025 Metro Atlanta EMS Conference January 30-31, 2025

https://www.maemsc.org/

Prisma Health Swamp Rabbit Prehospital Medicine Conference

2025 Swamp Rabbit Conference June 17-19, 2025
https://www.facebook.com/ghsemsconference/

FAST25
(FlightBridgeED Air and Surface Transport Symposium 2025)

Lexington, KY | May 19-21, 2025
https://fbefast.com

FTFC/Gathering of Eagles
2025 FTFC/Gathering of Eagles June 9-13, 2025

https://firsttherefirstcare.com/

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It’s back-to-school time for the kids and for paramedics and EMTs, too!  Nick is planning to renew his certification.  But we know there will be a set of medical-legal questions on the National Registry exam, and he will be sure he’s prepared.  In this series, Nick and Samantha dive deeper into the medical-legal concepts commonly tested on the National Registry and help our listeners prepare to take on these questions.  Please like and subscribe! You can get this and other podcasts anywhere you get your podcasts or from the FlightBridgeED website at https://flightbridgeed.com/standard-of-care/

Key Takeaways
• Understand the Difference: Criminal actions are prosecuted by the state and aim to punish and deter, while torts are civil cases seeking compensation for wrongs.
• Evidentiary Standards Matter: The burden of proof is much higher in criminal cases (beyond a reasonable doubt) compared to civil cases (preponderance of the evidence).
• Negligence Requires Four Elements: To prove negligence, you must demonstrate duty, breach, causation, and damages. All four must be present for a successful claim.
• Know Your Legal Responsibilities: As an EMS provider, it’s crucial to act with due regard for public safety, especially in high-stakes situations like driving with lights and sirens.
• Be Prepared for Legal Complexity: Cases can involve both criminal and civil aspects, and understanding how these interact is vital for protecting yourself and your practice.

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Spencer and Chris bring in the big guns from the Standard of Care podcast, Samantha Johnson and Nick Adams! This episode is probably one of the most disturbing cases of neglect we've reviewed in a while, so you've been warned!

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On a hot Texas summer day, Dallas Fire responded to a grass fire on the side of the road.  Their subsequent encounter with a gentleman named Kyle Vess – all caught on surveillance camera - led to an ongoing lawsuit alleging “an abuse of power and a deliberate indifference to the life and welfare of the underprivileged in Dallas”.  What is the role of paramedics when confronted with a possible suspect?  Is it ever appropriate to fight a patient?  Are certain policies and practices of the department contributing to a perception (or a reality) that marginalized individuals are being treated differently?  Nick and Sam discuss all this and more.  Please like, comment, and subscribe!   

Links:

https://youtu.be/EGrlXDYzqqk

https://youtu.be/-IbjBf88gpo

https://www.dallasobserver.com/news/lawsuit-dallas-paramedic-kicked-man-in-face-while-in-police-custody-12235286

https://www.dallasobserver.com/news/dallas-tries-withholding-evidence-in-lawsuit-regarding-former-paramedic-brad-cox-who-kicked-man-in-face-12941255

https://www.dallasobserver.com/news/kyle-vess-court-rules-lawsuit-against-city-and-former-paramedic-can-move-forward-14303422

https://www.dallasobserver.com/news/video-dallas-fire-rescue-employee-kicks-man-in-face-12455856

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An employee commits a terrible crime – should the employer be liable?  In this episode, we explore the nuances of negligent hiring, retention, supervision, and training.  What does it mean for an employee to be “in the scope of employment” to allow their employer to be sued in the first place?  When is an EMS agency responsible for its own negligence in keeping a problematic employee on staff?  If an employee commits a terrible crime, is the agency automatically off the hook?  Please like, comment, and subscribe!   

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Season 3 is here!

The release of the police body camera footage in the cases of Earl Moore, Jr. in Springfield, Illinois and Tyre Nichols in Memphis, Tennessee show EMS personnel at their worst.  In both cases, the providers failed to assess their patients and render proper treatment.  In Illinois, these failures resulted in first degree murder charges; in Tennessee, the firings of the personnel involved.  The results of the cases may differ based upon whether the providers have qualified immunity.  In this episode, Nick and Samantha discuss the legal concept of qualified immunity and its application in the two cases.  We take a hard look at what these cases say about EMS as a profession, and what it means to have the worst of us on public display.  Please like, comment, and subscribe!   

The Standard of Care now has an email address!  Contact us directly at [email protected]!  We want to hear from you!  Tell us about the legal issues you’ve encountered, interesting cases you’d like us to discuss, and let us know what’s on your mind.

Links:

EMS 20/20 Show – Rapid Sequence Information. (2023, January 16). Reaction: Two EMS Workers CHARGED WITH FIRST DEGREE MURDER [Video]. YouTube. https://www.youtube.com/watch?v=HCqL3DF-apE

Finton, L. (2023, January 30). Three Memphis Fire Department Personnel Fired for Not Providing Aid to Tyre Nichols. The Commercial Appeal. Retrieved February 3, 2023, from https://www.commercialappeal.com/story/news/crime/2023/01/30/three-memphis-fire-department-personnel-fired-for-not-providing-aid-to-tyre-nichols/69855376007/

JEMS Staff (2023, January 31). Memphis Fire Department Fires Three in Connection to Tyre Nichols' Death. JEMS. Retrieved February 3, 2023, from https://www.jems.com/patient-care/report-tyre-nichols-may-have-survived/#:~:text=Memphis%20Fire%20Department%20Fires%20Three%20in%20Connection%20to%20Tyre%20Nichols'%20Death,-By&text=The%20Memphis%20Fire%20Department%20has,'%20death%2C%20the%20department%20announced

Olsen, D. (2023, February 3). New Details Emerge in Case Against EMS Workers Charged with Murder. Illinois Times. Retrieved February 3, 2023, from https://www.illinoistimes.com/springfield/new-details-emerge-in-case-against-ems-workers-charged-with-murder/Content?oid=16407188

WAND Staff (2023, January 16). Police Release Body Cam Footage from Fatal EMS Incident. WAND. Retrieved February 3, 2023, from https://www.wandtv.com/news/police-release-body-cam-footage-from-fatal-ems-incident/article_60ac0d16-9118-11ed-8a09-43e4be2bb405.html

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It’s the stuff of nightmares and horror stories: the dead rising from the grave.  On August 23, 2020, it happened in Michigan after a woman who was declared deceased by the responding EMS crew “woke up” in a funeral home.  Her case has been described as an instance of “Lazarus Syndrome”, or “autoresuscitation after failed cardiopulmonary resuscitation”, but was it this rare condition or negligence on the part of the providers?  Nick and Samantha discuss the family’s $50 million lawsuit against the City and the providers and examine the clinical and legal issues around patients presumed to be deceased.  Please like, comment, and subscribe!    

Links:  

Erika Lattimore, as Guardian of Timesha Beauchamp, An Incapacitated Person v. City of Southfield, Michael Storms, Scott Rickard, Phillip Mulligan, and Jake Kroll, In Their Individual Capacity, Jointly And Severally, United States District Court for the Eastern District of Michigan, Civil Action File No. 2:20-cv-12738, filed October 8, 2020.  Complaint available at: http://www.firelawblog.com/wp-content/uploads/sites/19/2020/10/US_DIS_MIED_2_20cv12738_COMPLAINT_filed_by_All_Plaintiffs_against_All_Defe.pdf

Michael Storms, Scott Rickard, Phillip Mulligan, and Jake Kroll v. Oakland County Medical Control Authority et al., United States District Court for the Eastern District of Michigan, Civil Action File No. 4:20-cv-12457, filed September 8, 2020.

Katherine Mims Crocker, Qualified Immunity, Sovereign Immunity, and Systemic Reform, 71 Duke L.J. 1701-1780 (2022), available at: https://scholarship.law.duke.edu/dlj/vol71/iss8/1

Hutchinson, D. and MacDonald, M., (2020, September 16, updated 2020, October 19), “She’s Still Breathing”: Hear 911 Call From Moment Workers Realized Southfield Woman Declared Dead Was Alive, ClickOnDetroit https://www.clickondetroit.com/news/local/2020/09/16/shes-still-breathing-hear-911-call-from-workers-realized-southfield-woman-declared-dead-was-alive/

Kaur, H. et al., (2020, October 20), Family of Woman Who Died Weeks After She Was Found Alive at a Funeral Home Sues Paramedics For $50 Million, CNN, https://www.cnn.com/2020/10/20/us/timesha-beauchamp-dies-lawsuit-trnd

McEvoy, M., (2019, June 21), “Dead Wrong”, EMS1.com https://www.ems1.com/ems-products/medical-monitoring/articles/dead-wrong-RXW3893p2D3u8R3T/

Varone, K. (host). (2020, September 13).  Interview With Attorney For Disciplined Michigan Firefighters In Mistaken Death Pronouncement (No. 35) [Audio podcast episode]. Fire Law Blog. https://podcasts.apple.com/us/podcast/podcast-episode-35-interview-with-attorney-for/id876773998?i=1000491102861

White, E., (2020, December 10), Paramedics Who Wrongly Pronounced Timesha Beauchamp 'Dead' Can Regain Licenses, Detroit Free Press https://www.freep.com/story/news/local/michigan/2020/12/10/timesha-beauchamp-paramedics-regain-licenses/3883480001/

WXYZ Detroit, (2020, October 8), Fieger Files $50 Million Lawsuit in Case of Woman Found Alive After Being Pronounced Dead, https://www.wxyz.com/news/fieger-files-50-million-lawsuit-in-case-of-woman-found-alive-after-being-pronounced-dead

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Dispatchers, call-takers, emergency communications officers – our 911 communications staff are our first first responders.  They work to ensure that patients receive the right resources for their emergencies.  But sometimes, it goes wrong.  According to a recently filed lawsuit, a Pennsylvania dispatcher refused to send an ambulance to a patient, resulting in the patient’s death.  The incident was allegedly so egregious that the local district attorney filed criminal charges against the dispatcher and his leadership.  In this episode, Nick and Samantha discuss the case of Titchennell v. Greene County, Pennsylvania, and explore the liability issues for 911 centers.  Please like, comment, and subscribe!    

Links:  

Kelly D. Titchenell, Administratrix of the Estate of Diania L. Kronk, deceased v. Greene County and Robert J. “Jeff Rhodes”, individually and as an employee of Greene County Emergency Management/911 Communications Center; and Leon Price, individually and as an employee of Greene County Emergency

Management/911 Communications Center, Individually and Severally, United States District Court, Western District of Pennsylvania, No. 2:22-CV-890.

CBS Interactive. (2022, July 22). 3 More Charged After 911 Operator Accused of Not Sending Help. CBS News. Retrieved September 1, 2022, from https://www.cbsnews.com/news/911-operator-accused-of-not-sending-help-three-more-charged/

Mark Scolforo | The Associated Press. (2022, July 8). Pa. 911 Dispatcher Charged with Manslaughter After Failing to Send Ambulance. Pennlive. Retrieved September 1, 2022, from https://www.pennlive.com/news/2022/07/pa-911-dispatcher-charged-with-manslaughter-after-failing-to-send-ambulance.html

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In April 2022, 81-year old Celeste Salanitri died twelve days after being resuscitated by paramedics.  Unfortunately, she never wanted to be resuscitated in the first place.  Do Not Resuscitate (DNR) laws – and the accompanying forms and rules – can be confusing.  In this episode, Nick and Samantha explain what DNR is – and is not – and explore the legal, ethical and clinical implications of DNRs for EMS providers.  Please like, comment, and subscribe!    

Links:  

Walser, A. (2022, May 9).  “She Didn’t Want to Be Resuscitated”: Family Says Paramedics Ignoring DNR Order Led to Suffering, ABC Action News/WFTS Tampa Bay https://www.abcactionnews.com/news/local-news/i-team-investigates/she-didnt-want-to-be-resuscitated-family-says-paramedics-ignoring-dnr-order-led-to-suffering

State of Florida Do Not Resuscitate Order: https://www.floridahealth.gov/licensing-and-regulation/trauma-system/_documents/dnro-form-multi-lingual2004bwyw.pdf

State of Florida Frequently Asked Questions About a Do Not Resuscitate Order (DNRO): https://www.floridahealth.gov/licensing-and-regulation/trauma-system/_documents/dnro-faq.pdf

Pope, T., Unwanted Medical Treatment, https://www.thaddeuspope.com/unwantedtreatment.html

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