Prehospital Resuscitation Decisions in Cases of Traumatic Cardiopulmonary Arrest: Assessing the Risk of Legal Liability & the Impact of TOR Guidelines
56 Pages Posted: 27 Aug 2014 Last revised: 8 Oct 2015
Date Written: August 1, 2014
Abstract
This article addresses the extent to which professional providers of emergency medical services (EMS providers) could be held liable for civil damages when, due to apparent futility, resuscitation efforts are withheld or terminated in the field for a person suffering traumatic cardiopulmonary arrest. The article is an important part of a larger effort to address concerns expressed by the community of EMS providers relating to termination or withholding of resuscitation efforts for persons suffering out-of-hospital traumatic cardiopulmonary arrest (TCPA).
Traumatic injury is the leading cause of death for persons ages 1-44, and the medical outcome for out-of-hospital TCPA is very poor. Medical researchers have thus formulated evidence-based termination of resuscitation (TOR) guidelines. Guidelines for adults were issued in 2003, and those for children in 2014. As part of the work leading to the 2014 pediatric guidelines, researchers surveyed EMS providers and state EMS medical directors and found that many EMS providers feel compelled to initiate and/or continue resuscitation efforts for a variety of non-medical reasons, even though they believe the efforts will provide no medical benefit. A concern frequently raised was legal liability.
The article is intended to address and temper that concern. The article includes an analysis of various state law immunities that will insulate many EMS providers from liability, deter lawsuits, and help to minimize expenses if a lawsuit is filed. For those that remain vulnerable to a negligence claim, the article presents an analysis of the challenges a plaintiff would face in proving negligence and that would tend to deter a lawsuit in a case arising from a resuscitation decision as to a victim of TCPA, including an analysis showing that the existence of and compliance with the 2003 and 2014 TOR guidelines should provide additional significant protection against liability. The article includes important legislative considerations relevant to successful implementation of the guidelines.
Keywords: Emergency medical services liability, EMS practice guidelines
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