Can We Leave the Scene?
Attack One responds to a motor vehicle accident with several persons injured. The caller who reported the accident, a resident of the street on which it occurred, related hearing the screech of tires, then glass breaking. On arrival, the crew finds two cars involved. One vehicle contains an adult who has no injuries. The other vehicle’s windows were blown out by the collision. Its four occupants are standing in the caller’s yard.
The occupants of this second, smaller vehicle were all restrained when their car struck the back of a stopped vehicle at a traffic light. It was a minor impact, they report, and the front vehicle sustained no visible damage. There is only a small dent in the front bumper of the rear vehicle, but the impact caused both of the car’s air bags to deploy, which in turn caused all the windows to shatter and the windshield to crack. The four occupants, ages 16 and 17, incurred minor injuries related to the air bag deployment and shattered glass. The 17-year-old driver has a 3mm superficial laceration to the forehead, with about three drops of blood. The 16-year-old front passenger has a small contusion to the knee from the plastic panel over the passenger air bag. One 16-year-old rear-seat passenger has a similar small laceration to the forehead from broken glass. The 17-year-old rear-seat passenger denies any injury.
EMS personnel conduct physical examinations on and obtain complete vital signs for all occupants of the car (and the driver of the other vehicle). None of these individuals request further treatment or transportation to the hospital. One of the passengers had contacted a parent, who was en route to pick up all four occupants. Law enforcement is on the scene.
The Attack One crew then asks each of the occupants to read and sign a form indicating that they do not desire further service. Due to the need for equipment at another critical call, the Attack One crew leaves the minors with law enforcement personnel to await the arrival of the adult and a wrecker to tow the disabled car.
Case Discussion
As providers of public-safety services, we have a duty to respond and evaluate when we are activated as part of an emergency response system. We have a duty to arrive at the scene in a safe manner, in an appropriate amount of time. We have a duty to treat emergency conditions within the capabilities of our training and equipment, then to provide safe transportation to an appropriate receiving facility. Most of us are not law enforcement personnel and do not have law enforcement responsibilities.
Within the field of healthcare, our responsibility is to assist those with medical needs, and to “do no harm.” Our duty to provide emergency evaluation and treatment does not give us the right to assault individuals, and this includes competent persons who do not wish to have our services performed.
An undesired touching of an individual can result in a charge of battery. EMS providers who restrain a person against his or her will may also face a claim of false imprisonment or kidnapping.
A minor who claims no injury and, upon EMS assessment, does not have any signs or symptoms of a serious injury or illness can make a definitive statement that he or she does not want EMS services. A minor cannot refuse emergency services if the EMS crew believes an emergency condition exists. It is sound EMS practice to provide a complete evaluation of a minor when that individual has been involved in any incident where injury or illness may have occurred. This would include a complete history, evaluation of vital signs, an appropriate physical examination and an interaction with a responsible adult, if one is available. For minors and other persons compromised by an emergency situation, it is important that EMS ensure that safe disposition will occur. It is never prudent to leave a person, especially a minor, in a situation where further harm could result.
Persons who are under the legal age of majority are frequently out of the physical presence of a parent or legal guardian, including situations where they are driving motor vehicles, in public transportation or at the site of school or other recreational activities. An emergency call requesting response and evaluation for a scene where unaccompanied minors are present requires EMS personnel to understand their duties to evaluate and treat. A minor cannot refuse care in a situation where EMS evaluation indicates an emergency condition is present. A minor cannot sign a form refusing medical care (an AMA form), because a minor cannot bind himself into a contract. But a minor can say that he or she is not ill or injured. If, upon appropriate evaluation by an EMS provider, this is found to be the case, what remains is the EMS providers’ responsibility to make sure that the minor can make it home or to another safe destination without harm. Parents, coaches, teachers, law enforcement personnel and others can assist in that duty. Finally, good documentation of these incidents will allow the parents or guardian to understand that a thoughtful evaluation of their child was performed.
This is an excellent case to discuss with your medical director and the legal counsel for your agency.
