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EMS News in Focus
by Arthur Hsieh

Legal vs. ethical expectations

By Arthur Hsieh

Editor's note: An asthmatic English student lay dying feet away from an emergency room after a hospital receptionist told her friend she must call an ambulance for treatment. Editorial Advisor Art Hsieh says incidents like these are complex and full of legal and ethical land mines.

This tragic story happened just a few days after a similar case in which an Oregon man died outside an ER after he crashed his car trying to get to the hospital. In both cases there are questions whether hospital staff should have provided care to patients that collapsed outside of the facility but still on hospital property.

These situations speak to the issues of legal versus ethical versus realistic expectations. I can't speak to the UK situation — I'm not clear whether there are laws in place that compels hospital personnel to provide essentially first responder care in an out-of-hospital environment.

Even in the U.S., the Emergency Medical Treatment and Active Labor Act refers primarily to the point that a patient within 250 yards of an emergency department, with an emergency condition, must be screened and treated in the department. It does not comment on whether the staff has a responsibility to respond to an incident on hospital grounds. And yes, it's confusing.

My question is, what should hospital staff do? Is it reasonable to expect that some trained personnel should provide first aid while EMS providers respond? As one reader noted, hospital staff may not be trained or equipped to handle extrication and overall scene management, especially for a trauma patient.

It may be better to wait for trained personnel with proficiency in those skills. Of course none of this hypothetical musings take into account staffing levels, patient census and other factors that play into any formulated response.

The bottom line is, the incidents can be complex and full of legal and ethical land mines. It'll be interesting to see how they play out, and without the dramatic reporting.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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