Re: Re: FRO Questiono

December 12, 2007

In a message dated 12/12/2007 9:51:19 A.M. Central Standard Time,

hbarber@... writes:

My issue is the ones that are irresponsible. No one controls them and they

answer to no one.

Sure they do and sure they are. If an FR is certified be it a person or an

organization by the TxDSHS then you and I and everyone else even john Q Public

has the complaint process to fall back upon if you feel that's the way to go.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Owner and President of LNM Emergency Services Consulting Services (LNMECS)

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

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December 12, 2007

In a message dated 12-Dec-07 15:16:00 Central Standard Time,

ExLngHrn@... writes:

I'm presuming that Henry, as the local EMS director, wants an organized EMS

system to respond to emergencies. Having a more or less non-regulated group

of first-aiders is much akin to our neighbors listening to a scanner and

showing up with a first aid kit, tank of oxygen, CPR and first aid card and

saying, " I can help. "

the funny part is that emergency oxygen (defined as a minimum of 6 liters

per minute delivered by a simple face mask) is specifically exempted from the

requirements under the USP for physician oversight. This is due to an agreement

between the US FDA, the Compressed Gas Association and the US National Fire

Protection Association that was renewed a couple of years ago.

Ergo, as long as the 'friendly neighbor' meets the standards mentioned above

(does not exceed his/her training), does not accept payment for his/her

actions (basic qualification for 'Good Sam' standard), keeps his/her mouth shut

about what went on (basic privacy standards), receives permission to provide

the help (or provides care to a person meeting 'implied consent' therefore

avoiding the tort of battery) and does not commit gross negligence in the

process, I'm not sure that there are any legal ramifications that can be brought

against the neighbor.

Solons, what say you?

ck

S. Krin, DO FAAFP

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December 12, 2007

I think this is what Henry is thinking:

I'm Bart P. Pharquahar, and I stayed at the Holiday Inn Express last night.

Today, I'm walking through the airport and I see a commotion in front of one

of the gates. I immediately run to the AED, retrieve it, take it to the

patient, who is blue on the floor with nobody doing CPR, attach the pads and let

it do its thing. I defibrillate the patient successfully. However, after he

regains ROSC he vomits and aspirates because my night at the Holiday Inn

didn't include post resuscitation care. Unfortunately, he dies later from

aspiration pneumonia.

I may be held liable to the patient's survivors (not likely), but the EMS

service is not liable for my actions because there is absolutely no relationship

between them and me.

Now, let's change the situation by adding one little fact. I am a FRO for

the EMS service in that area, and I have received permission from them to

perform BCLS. Now, are they responsible for my actions?

The answer depends upon the law of agency. Am I an agent of EMS? If I am,

then they may very well be liable for my actions according to the law of

respondeat superior. The situation will depend upon many facts. Some of

them

are: (1) the degree of control that EMS exercises over me and my

organization; (2) the amount of training I have had; (3) who provided the

training (was

it EMS or my organization?); (4) was the training adequate; (5) am I acting

under protocols of the EMS agency; (6) am I operating under delegated orders

from

their medical director; (7) does EMS oversee my service's actions in any way,

such as providing QA/QI for the FRO; (8) does EMS have actual knowledge or

constructive knowledge of my level of training and abilities; (9) does EMS

have actual or constructive knowledge that I have previously made mistakes that

were not remediated; (10) and the ultimate question: Does EMS have a close

enough relationship with the FRO that a reasonable and prudent person would

determine that they should be responsible for my actions?

These questions are difficult, and the answers will vary as widely as

services vary.

For the EMS service to be liable there must be a close enough relationship

that a jury could reasonably determine that they had the ability, through

control, to have anticipated the kind of problem that happened and failed to

take

reasonable actions to correct the deficiencies.

I submit that in order to find an EMS service liable for acts of an agent of

the FRO, there must be closer control than usually exists between EMS and FRO;

however, such a situation could exist.

It is not reassuring that the more control the EMS service has over FROs in

an attempt to improve quality, the more likely it is to be liable for the

actions of the FRO.

I haven't addressed the other problems of sovereign immunity, practical

aspects of suing a FRO (what's its corporate structure, if any; is it an agency

of

a municipality? a county? a volunteer agency? and so on).

One suggestion I will make to all EMS organizations who have relationships

with FROS is to discuss liability matters with their insurers. Does the EMS

organization's liability insurance extend to the actions of a FRO? Most

insurers have risk management folks who will gladly discuss risk management with

the

insured, and often some answers can be elicited from those discussions.

This is not meant to be a treatise on the subject upon which whole books have

been written. All I have attempted to do is highlight some of the

considerations.

Gene G.

>

> I think Henry's concern is with NON-certified first responders.Â Â There's no

> real complaint process for them.

>

> Sure, the local county attorney could file charges for impersonating an EMS

> provider, but charges are unlikely if the first responder isn't exceeding a

> layperson's first aid efforts. (Which is probably why Henry and others keep

> discussing emergency oxygen.)

>

> I'm presuming that Henry, as the local EMS director, wants an organized EMS

> system to respond to emergencies.Â Having a more or less non-regulated group

> of first-aiders is much akin to our neighbors listening to a scanner and

> showing up with a first aid kit, tank of oxygen, CPR and first aid card and

> saying, " I can help. "

>

> While such help is welcome in some cases, we owe it to our public who we

> serve to ensure standards for quality and safety are met.

>

> -Wes Ogilvie, MPA, JD, LP

>

> -Attorney/Licensed Paramedic

>

> Re: Re: FRO Questiono

>

> In a message dated 12/12/2007 9:51:19 A.M. Central Standard Time,

> hbarber@... writes:

>

> My issue is the ones that are irresponsible. No one controls them and they

> answer to no one.

> Sure they do and sure they are. If an FR is certified be it a person or an

> organization by the TxDSHS then you and I and everyone else even john Q

> Public

> has the complaint process to fall back upon if you feel that's the way to

> go.

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/ FF/

> Owner and President of LNM Emergency Services Consulting Services (LNMECS)

> Freelance Consultant/Trainer/ Freelance Consu Freelance Consultant/Traine

>

> LNMolino@...

>

> (Cell Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> The comments contained in this E-mail are the opinions of the author and the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated with

> unless I

> specifically state that I am doing so. Further this E-mail is intended only

> for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public domain by

> the

> original author.

>

> ************ ******** ******** ************<wbr>*********<wbr>****

> (http://food.http://food.http://food.<whttp://food.<wbrhttp://fo)

>

December 12, 2007

In a message dated 12-Dec-07 15:42:18 Central Standard Time,

ExLngHrn@... writes:

Doc Krin --

I'm inclined to agree with you.?? Shall I send your application to law

school to you?

will the Texas bar accept home study/apprentiship to sit for the Bar exam?

and if so, will any other state (or

the federal court system accept those results?

ck

S. Krin, DO FAAFP

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December 12, 2007

Doc Krin --

I'm inclined to agree with you.?? Shall I send your application to law school to

you?

I definitely agree that is probably legal, albeit with very strictly defined

parameters.?? I could also see an issue where in Texas, the voluntary training

standards for volunteer firefighters, as promulgated by the State Firefighters &

Fire Marshal's Association, specifically include first aid training.

So, in the instance of a volunteer fire department being dispatched along with

the ambulance, and the volunteer firefighters providing only that level of

traning (IE first aid), I think it would be hard to stop through DSHS.? The

local political process may or may not be a different animal.? (STANDARD

DISCLAIMER ABOUT THIS NOT BEING LEGAL ADVICE, NOR AM I PROVIDING LEGAL

REPRESENTATION)

Regardless, it's no way to design or run an EMS system.

-Wes Ogilvie, MPA, JD, LP