Re: Hypothermia and medical-legal aspects of first aid/consent
Amick Robert (amick@SPOT.COLORADO.EDU)
Mon, 1 Apr 1996 18:47:23 -0700
(Caution: Long Post, sorry about that, but I hope it contains useful info)
Rex brings up an interesting point about field care for hypothermia. A
later post expresses concern about "good samaritan laws," and the legal*
ramifications for rendering care. Perhaps the following will clarify
some of the concerns. (*-Please note that I am not an attorney and the
following information is not to be construed as legal advice. It is
primarily information which I have gathered as an EMT and Red Cross
Emergency response Instructor over about 25 years, and working on
National Scout Jamboree Medical Centers and many high adventure
Scout/Explorer trips and events. The information discussed here was
derived in consultation with physician/attorneys and other
knowledgeable individuals.)
If you need specific legal advice on these matters it is recommended that you
consult with your local council risk manager/attorney or other qualified
professional.
First, as a Scout leader, by virtue of assuming the role of a person
entrusted to care for youth on Scouting activities, you also assume a
"duty to act." That is, if a Scout is ill or injured, you are legally
responsible for providing emergency medical care (i.e., first aid) for that
the best of your training and ability, and to ensure that the Scout is
promptly given more "definitive care" (i.e., notifying emergency medical
services, responding an ambulance, and/or hospitalization/emergency room
care) if the injury or illness warrant such care.
To fail to provide such care especially if it can be shown that you
have been trained in appropriate procedures would legally be considered
"abandonment" of the victim and would constitute negligence on your part.
You may only relinquish care of the victim to a person with equal or
greater qualifications than yours (e.g., an EMT, Paramedic, nurse, or
physician) and you must be able to verify that the person is qualified.
As far as "permission to treat" goes, any Scout trip must have a parental
consent and medical treatment consent/waiver filled out and signed by the
Scout's parent or legal guardian. This gives the leader blanket
permission to treat or arrange for treatment of emergent AND non-emergent
medical/trauma problems while the Scout is under the care of the leader. I
posted a copy of our permission slip in January, and would be happy to
send another copy to anyone interested. As noted in another post, anyone
with life threatening illness or injury who is mentally incapable of
refusing or consenting to treatment, gives "implied" consent for
treatment under the law. This applies to minors (under age 18 in most
states) and to adults. It also applies to those who object to any medical
treatment on religious grounds, if the injury/illness is immediately life
threatening, and/or the individual is under the age of majority (18)or is
not an "emancipated minor." (check with your legal/medical advisor in
your area to clarify these issues for your situation).
It is always essential and appropriate to get verbal consent from anyone
you treat, even if you have written permission, and as noted this should
be done in the presence of a witness. Nontheless if you have a "standing
written consent" from parents, there is no question, and it may save you a
lot of time and frustration in an emergency room if you are far away from
home.
Hypothermia treatment utilizing heat transfer by body contact in a field
setting when other options are not immediately available is
uniformly defined in wilderness medical treatment protocols and literature,
and considerable evidence has shown this method to have saved lives. It
is defined as a "standard of care" for hypothermia which any "reasonable
and prudent" person with appropriate knowledge and training would
administer given the circumstances and lack of other options.
Certainly,if you are in "civilized" surroundings where sources of external
heat such as vehicles, warm water, warmed beverages, etc., are available,
and the patient is still capable of ingesting warmed beverages, those are
appropriate. The body heat transfer is usually a "last resort" effort
for severe hypothermia in remote settings. It has frequently been used
in wilderness mountain climbing or other expeditions as a lifesaving measure.
Nontheless, it is always appropriate when other techniques are
unavailable or ineffective. So long as the treatment is conducted
appropriately (as noted in another post) in the presence of of other
adults/scouts, and the treatment is obviously necessary, there is
little cause for concern. Most of all it may save someone's life.
It is somewhat frightening to realize that many (especially new) Scout
leaders, and particularly parents of Scouts are extremely uninformed about
the life threatening dangers of hypothermia (and other facets of trauma and
illness recognition and treatment), and would tend to err on the
side of "avoiding" treatment for fear of legal entanglements. In point
of fact, they would place themselves in much greater legal peril by
witholding treatment, and subsequently causing the serious injury or
death of a Scout.
Good Samaritan laws (for the most part, the language varies from State to
State) only protect those individuals who render care voluntarily,
without an expectation or "duty to act" as a part of their job or volunteer
position. For example, if you are driving down the road and stop at the
scene of an accident, voluntarily, to assist, AND if you render care
according to the "standard of care" under which you are
trained/experienced without negligent acts or omissions, you are given
immunity from litigation should the person you assisted choose to file
suit against you.
Although anyone may file a lawsuit against you for nearly any reason, the
probability of the suit being successful is negligible if you have acted
in "good faith, and in a reasonable and prudent manner" to assist someone
to the "best of your training and ability." On the other hand, if you are
a Scout leader,(or volunteer firefighter, volunteer ambulance
technician, or Scout camp staff member et al, whether you get paid or not),
and if you are acting in an "official capacity" at the time,
you still have a "duty to act" and (unless your state laws are written
differently than most) are NOT protected by "good Samaritan laws."
The good news, however, is that there are virtually NO successful
lawsuits against anyone in these categories who provide care
appropriately according to the "standard of care" under which they have
been trained.
In point of fact, far more successful lawsuits have been filed against
those persons who knowingly withheld care of a victim, without a
legitimate reason. You are much better off trying to do something you
are trained and/or qualified to do to the best of your knowledge and
ability. Conversely if you try to do something you are not qualified to
do, you may also be at risk, so just maintain your efforts to the
"standard of care" that you have been trained in..no more and no less.
The legal system is very understanding of those who make a good faith
effort even if unsuccesful.
Conversely it is very unforgiving of those who fail to act without good
cause, or of those who act recklessly and negligently.
I would especially say AMEN to the post saying that hypothermia is
largely preventable!. It is important to remember that little folks
(i.e. young Scouts/children) are far more susceptible to hypothermia
than older Scouts or adults. There have been cases in which leaders have
dismissed or ignored initial complaints of being "cold" or chilled by
Scouts as "whining." In fact, some of those cases resulted in Scouts
suffering mild hypothermia, and had action not been quickly taken, could
have been tragic. Simple precautions such as not wearing cotton clothing
for any reason, and using adequate synthetic underwear and outer
garments, as well as proper hydration and nutrition go a long way it
preventing a problem.
Sometimes, it is necessary to just inform a Scout that he needs to "put
on his hat" to forestall chilling.. Many times they just miss little things
that can save them from a lot of discomfort.
The other factors are just recognizing when wind-chill is
serious and taking prompt action to remove the source of heat loss.
Most Scouters know, if you become hypothermic yourself, your brain tends not
to function very well, and you make bad decisions, which may be tragic.
Someone who is still in control needs to take control and remove the
person or group from any further exposure, and to reverse the effects of
the wind chill.
Finally, I would strongly encourage anyone who is in a Scout leadership
position, as well as the Scouts themselves, to take a Red Cross or
equivalent training class in first aid and CPR. If you can get an
experienced instructor, (i.e. someone who has actually worked in the
emergency medical services field as an EMT, Paramedic, Rescue squad,
firefighter, outdoor guide, etc., and has first hand experience, your
class will be greatly enhanced). The Red Cross has a new class called
"emergency response" and "CPR for the Professional Rescuer" which is
designed for volunteer and professional "first responders." It is
extremely well designed, and well suited to Scout leaders and older Scouts.
I currently teach this class to Explorers in my high adventure and
emergency management posts, and to Venture crews and Scout leaders in my
district. They find the training extremely useful, and sufficiently
thorough that they often assist in teaching future classes. A
few have also become instructors when they turn 17 and are quite good at
teaching their fellow Scouts! Most of all they are much more aware of the
dangers of a variety of outdoor risk factors and know not only how to treat
them, but more importantly how to avoid them in the first place!
Good Scouting!
Bob Amick, EMT-B, Exploring Training Chair, Longs Peak Council, Boulder, CO
Terry Howerton Sakima Group, Inc. SCOUTER Magazine Kansas City |
