The EMS legal conundrum of a 'still alarm'

An EMS lawyer replies to a California reader's question about a duty to respond to a still alarm while en route to the hospital for a non-emergency discharge

David Givot, an EMS1 columnist and editorial advisor, occasionally receives questions from EMS providers who find themselves in the kinds of situations about which he writes. The following is a question Givot received from a reader and is happy to answer. 

Question: "If a [BLS] unit [in California] is on duty on their way to a BLS discharge from a hospital and they run on an accident on the road en route (no patient on board yet), do we have a duty to act at that point, or do we have to continue on to the discharge?"

Answer: Yes. And Yes. [1]

It’s somewhat complicated and you are probably going to hate my non-answer.

It is my opinion that, regardless of agency or assignment type, an emergency vehicle is exactly that: an emergency vehicle, with all of the duties and responsibilities that go with it. Thus, the general public can reasonably expect that an emergency resource, in the presence of an emergency, has a duty to act. I believe that, where the expectation is reasonable, the duty exists unless otherwise codified.

It is also my opinion, and the law, that the execution of that duty must be reasonable. Reasonable is generally understood, in the law, to mean "that which a reasonable, prudent provider with the same level of training and experience, in the same locale, would do under similar circumstances."

However, the California Health and Safety Code sections relating to the local EMS Authority do not specifically address the issue of so-called "still alarms," which is happening upon an emergency rather than being called to it. Instead, the code mostly addresses when, if at all, liability attaches for grossly negligent acts or omissions committed in bad faith.

The general rule for emergency responses is that you keep going to the original call — unless another unit could take over your call in a reasonably close amount of time — and you call for additional resources to respond to the still-alarm incident.

Dynamics of non-emergency BLS responses

Non-emergency BLS calls create a different dynamic. In the context of this discussion, we can look at the scenario in one of two ways.

First, where a BLS unit is assigned to a BLS discharge from a facility to a residence, it can be presumed that the subject of the call, in this case a patient in the hospital, is in no distress, is in a controlled environment and that the need for transportation is non-emergent. When the BLS unit happens upon an emergency that requires or may require immediate attention, even if only in anticipation of arriving assigned units, it would appear reasonable for the crew of that unit to stop and render whatever aid they can until the assigned units arrive; doing so does not jeopardize the patient awaiting discharge from the hospital. Furthermore, it could be argued in this scenario that failing to stop and assess might constitute an actionable omission.

However, you have probably already spotted the slippery slope. Units in the field don't know what the dispatch center knows; a call received in the field as simple and non-emergent may, in fact, involve secondary or even tertiary elements that may be or may become urgent, but those are factors about which the field unit is unaware.

Extrapolated further, apply the same scenario to a BLS call for service from one hospital to another or from a nursing home to a hospital, as opposed to a discharge. While the initial level of urgency may appear low, everyone in EMS knows that nursing home calls are frequently different upon arrival than dispatch.

Extrapolated out the rest of the way, since an EMS provider cannot be sure what awaits them on the other end of the original call, stopping along the way could constitute a breach of duty to the original caller. Yes, it's a mess!

Respond reasonably

You will quickly see that the infinite number of variables makes it virtually impossible to create an effective policy regarding still-alarms on the way to non-emergency calls. Which means we are back to providers responding reasonably when confronted with the dynamics of EMS; we are back to the actual duty being unclear.

Ultimately, in the moment, armed only with what the provider knows at the time, decisions in EMS are almost always made on the fly. As I wrote a few years ago, EMS providers are frequently confronted with the choice of doing what’s right versus doing what’s allowed where the determining factor is usually one’s willingness to accept the consequences of the decision.

Still alarm response policy

The second way at which to look at this scenario is this: for private, non-emergency, BLS transport provider agencies, still-alarms are bad for business.

The question also described the provider’s company policy against stopping for still-alarms. It has been my experience that most private, non-emergency BLS transport companies have such a policy.

Private, non-emergency BLS transport companies operate much like airlines. Planes don’t make money on the ground and empty ambulances don’t make money either. Like flights making it gate-to-gate in the allotted time, ambulance companies depend on assigned units to meet the ETAs quoted to the clients for myriad reasons; contract requirements for which monetary penalties may be assessed, allocating resources to stacked calls and system status resource management. Much like emergency landings at unscheduled airports, still-alarms cost company's time … and money.

However, while I understand and even sympathize with the system demands private, non-emergency BLS provider agencies face, they knew the risks when they opened and one of the risks of putting an ambulance on the road — even for non-emergency purposes — is that the ambulance crew may have to spring into action and put the assigned task on hold.

As does everything else in modern times, it boils down, in my opinion, to these questions:

  • What will the decision look like in court?
  • What will the policy look like in court?
  • Will the response to the situation be considered reasonable in court?

One last bit of bad news for my California peeps. California is an at-will state, private ambulance companies are ubiquitous and EMTs are fungible. So it is not uncommon for providers who willfully violate no-still-alarms policies to be fired.

Yes, I believe there is a duty to stop for still-alarms.

Yes, sometimes you cannot stop for still-alarms.

Welcome to EMS.

Author's note:
1. It is important to note that the question comes from California, so the answer and analysis are as to California law. If you are outside California, consult your local policies and regulations as they may differ.

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