I have been addressing several questions regarding ethics and legalities behind providing care to someone who is having an emergency whether it be medical or non-medical related. I believe it is important to discuss “Barriers to Act” and how to overcome them during our classes. The most common barriers to act include:
- Presence of Other People – usually with the idea that someone else will respond making it so others do not have to.
- Being unsure of the ill or injured person’s condition
- The type of injury or illness – beyond what the responder thinks they can handle.
- Fear of catching a disease
- Fear of doing something wrong
- Fear of being sued
- Being unsure when to call 9-1-1
These are all valid reasons and can be overcome by getting the right training and informing yourself.
What is the right training?
Getting trained in First Aid and CPR/AED is invaluable. I recommend taking a comprehensive class that includes adults, children, and infants. I also recommend classes that include classroom time vs. the online only option. Hands on practice in CPR, AED, patient assessment, and other types of care (i.e. assisting with EPI Auto-Injectors) is the most important part of any class you can take. Practice scenarios are crucial.
Get training from reputable organizations and their licensed training providers. Some of these organizations have also gone through the accreditation process at the state and national level. A list of organizations BLE recognizes as reputable:
- American Red Cross
- American Heart Association
- Health and Safety Institute (includes ASHI and MEDIC First Aid)
- NOLS Wilderness Medicine Institute
- Wilderness Medical Associates
- National Ski Patrol Outdoor Emergency Care Program
- State Approved EMS Programs
- Programs accredited through Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS).
It is important to stay properly informed. There is a bunch of misinformation leading to erroneous misconceptions. Below is a list of answers to questions I often get asked. I have provided links to documentation that support many of these answers.
1) “Do I have a duty to respond if I am trained in first aid/CPR?” NO! Those that have a duty to respond include:
- Those that have been hired specifically for Emergency Medical Services (i.e. lifeguards, paramedics, ski patrol).
- Those, whose job, includes the duty to respond as part of the job requirement. For example, guides and outdoor educators have a duty to respond to a client or student emergency. However, they do not have a duty to respond to the general public.
All others fall under the Good Samaritan Law. In fact, even police officers, who are required to maintain an Emergency Medical Responder (EMR) level of certification, do NOT have the duty to respond to a citizen in distress that fall outside of California Penal Code 153.2. In the 1984 California Supreme Court Case Williams vs. State “the court concluded that a patrol officer who comes to the aid of an injured or stranded motorist is simply a Good Samaritan and should be held only to that minimal standard of care” (“Police Officers’ Duty to Rescue or Aid: Are They Only Good Samaritans?”). I have not found any cases since then refuting this ruling and welcome any literature that can shed more light on this topic as I find it an extremely intriguing one. Below are a couple papers discussing the “duty to rescue”.
- Understanding the Absence of a Duty to Reasonably Rescue in American Tort Law by Marin Roger Scordato (retrieved 12/12/2015 http://scholarship.law.edu/cgi/viewcontent.cgi?article=1045&context=scholar)
- Police Officers’ Duty to Rescue or Aid: Are They Only Good Samaritans? (retrieved 12/12/2015 http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=2094&context=californialawreview)
In addition, there are 10 states that have enacted duty to rescue statutes. California is one of them, but the statutes are limited to the duty to call the police if you witness a serious crime such as murder or rape, and can summon help without endangering yourself (California Penal Code 152.3).
2) “If I am trained am I still covered by the Good Samaritan Law? I thought that the Good Samaritan Law is only for those who are not trained.” This is not true. It is for anyone that acts in good faith and does not except compensation in return (see #3).
3) “What is the Good Samaritan Law?” This is a law that was enacted to encourage all of us to help a citizen in distress. It includes both medical and non-medical emergencies. It states that “No person who in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission.” It also states “An employer shall not adopt or enforce a policy prohibiting an employee from voluntarily providing emergency medical services, including, but not limited to, cardiopulmonary resuscitation, in response to a medical emergency, except as provided in subdivisions (b) and (c). (b) Notwithstanding subdivision (a), an employer may adopt and enforce a policy authorizing employees trained in emergency services to provide those services. However, in the event of an emergency, any available employee may voluntarily provide emergency medical services if a trained and authorized employee is not immediately available or is otherwise unable or unwilling to provide emergency medical services.” Subdivision (c) refers to Do Not Resuscitate Orders. We cannot provide care to anyone that has a DNR. Retrieved 12/12/2015 from California Health and Safety Code 1799.100-1799.112 (http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=hsc).
On another note, California changed the Good Samaritan Law to include non-medical care after a lay responder got sued for pulling a woman from a vehicle that was thought to have caught fire in the engine compartment (Alexandra Van Horn v. Anthony Glen Watson and Lisa Torti). The victim sued the rescuer claiming that the act of pulling her from the car caused her further injury. While it was argued that the rescuer acted in good faith and should fall under the Good Samaritan Law, the court ruled in favor of the victim because the act of pulling the victim from the car was a non-medical emergency. This led to much heated public debate. California has since then changed the law (not sure of exact year or date) to include the verbage “medical and nonmedical emergencies” and to stress that “the intent of the Legislature to encourage other individuals to volunteer…to assist others in need during an emergency… ”
- Alexandra Van Horn v. Anthony Glen Watson and Lisa Torti (retreived 12/12/2015 http://www.courts.ca.gov/documents/vanhorn7.pdf)
- “Good Samaritan Immunity Limited to Medical Assistance” (retrieved 12/12/2015 http://www.emsworld.com/article/10320650/good-samaritan-immunity-limited-to-medical-assistance)
Overall, anyone can get sued. I can get sued if someone walks across my property, falls, and hurts themselves. Unfortunately, we live in a litigious society. To help counteract this and encourage people to be Good Samaritans, California has the Good Samaritan Program, which helps people with legal counsel fees if they are sued.
4) “What if I mess up and don’t do something exactly as I was trained? Will I still be covered under the Good Samaritan Law?” Yes. Let’s say you are giving CPR and forget that the ratio of compressions to breaths is 30:2 and you do 15:2 like you learned way back in the day. You acted in good faith and did the best you could…you should be fine. Now, if you stopped CPR because you realized that the person you were administering CPR to is a criminal, then you could be held liable for gross negligence. Another more extreme example would be performing a surgical procedure, which would be considered reckless in nature. Both are prosecutable. Understand the difference?
5) “Teachers, coaches, daycare personnel, and athletic trainers are required to have training. I work in the ski industry. Why does my employer not make it a requirement to be trained as a condition of employment?” OSHA requires that employers only train a certain number of employees if response from professional care is greater than 5 minutes or if there is not an infirmary on the worksite. Daycare personnel must be trained to meet California state mandates. Daycare facilities are only required to have one trained staff member on duty while children are present. If the day care goes on a “field trip” then they must have a trained staff member both at the daycare facility and one on the “field trip”. In California, teachers’ first aid training is tied to the teaching credential. They are expected to maintain certification and may be asked to provide proof during the credential renewal process. Some coach and athletic training certifications require it as well. While I think it should be, it is not a standard that all employees that work in higher risk industries and/or with children be required to have training according to OSHA.
6) “Why do some organizations require all their employees to have FA/CPR training if it is not required by OSHA?” Some organizations wish to exceed both state and federal OSHA standards in order to improve the health and safety of both their employees and clients. These organizations, in my opinion, lead the way when it comes to health and safety.
7) “Is my employer required to pay for my first aid/CPR training if being certified is a condition of employment?” I have found no documentation that states companies are required to pay for training. Most employers including EMS agencies do not pay for training. If they do, it is a voluntary benefit provided by that particular employer. For example, I am required to have a Wilderness First Responder/CPR certification (minimum) to work for National Outdoor Leadership School (NOLS) as well as the guiding company I work for in Alaska, basic FA/CPR to maintain my California teaching credential, and a minimum of EMR for lifeguarding (LACOFD). I personally pay for training and recertification fees for my certs. NOLS and LACOFD happen to provide training in some way. NOLS offers their employees who work a certain number of field weeks a subsidy for courses taken through NOLS Wilderness Medicine Institute. If I attend a class through another organization I do not get a subsidy. LACOFD provides CPR and EMR training at no cost and lifeguards get paid during training. They also provide EMT refreshers for a minimal fee that covers the filing fees with the county. We are not paid to attend EMT training. Either way they are not required to offer or pay for training, but simply are offering it as a nice gesture.
8) “Am I allowed to do all the things I was trained to do in my first aid/CPR class (i.e. administer EPI Auto-Injectors to someone in need)?”
Many organizations (i.e. American Red Cross, American Heart Association, American Health and Safety Institute) teach to the National Emergency Medical Services Education Standards. However, each state has their own guidelines in what responders are allowed and not allowed to perform. This is called the “scope of practice”. It is important to stay informed as to what the scope of practice entails in your local area. For example, laypersons may have received anaphylaxis/EPI Auto-Injector training in their basic first aid class. As such, in the state of California they are permitted to assist any patient with their prescribed EPI Auto-Injector and are covered under the good Samaritan law. This includes minors who are placed under the care of another adult (i.e. daycare, youth programs, etc) and given an EPI Auto-Injector by the parent, who gives permission to the adult to use (verbal or written). In addition, there is new legislation that allows the general public and off-duty EMS personnel to obtain a prescription from their physician and administer that EPI Auto-Injector if trained by a CAEMSA authorized training provider. For more detailed information on California’s “scope of practice” visit California Emergency Medical Services Agency’s website at the following links:
I hope this helps answers questions about the legal aspect of rendering aid to someone in an emergency. Please keep the questions coming. I will do my best to provide evidence based answers. I also welcome any resources that have to do with this topic.