Assisting at Accidents
A physician has no duty to help an injured or sick individual unless there is a preexisting physician–patient relationship or other statutory or contractual relationship. Although morally reprehensible, it is not illegal for a physician to drive past the scene of an accident where his or her services could be lifesaving or to refuse to provide cardiopulmonary resuscitation to a fellow diner at a restaurant. If the physician does choose to help, there is one central rule for volunteers: do not make the victim worse off.
The classic legal example is the person drowning in a lake. There are several boats within sight of the victim, and one of them heads toward the victim. The others stay away so as not to complicate the rescue. The original rescuing boat now has a duty to continue the rescue because it has interfered with the victim’s chance to get other help. In the same way, once a physician stops to help at an accident, the help must be continued until the patient may be safely transferred to another medical care provider or until the patient is no longer in need of medical attention.
Physicians should be careful not to interfere with other persons who have superior skills for the task at hand. If there is ambulance service available, it should be summoned. The paramedic on the ambulance may be much better at resuscitation than the physician is. And a veterinarian with an active farm practice may be a much better candidate for delivering a baby than an internist who has not seen a delivery in 20 years. The internist should stand by, however, in case the veterinarian needs advice or assistance in the care of a human.
Physicians should not be offended if they are asked to provide identification at the scene of an accident. All emergency professionals are plagued by people who join in the excitement. Following the fire brigade is as old as organized fire fighting; impersonating a police officer has been criminalized because it is common and dangerous to society. There are also people who impersonate physicians in hospitals and at the scenes of accidents. Many states provide wallet-sized copies of the medical license to use as identification. Physicians should understand the need for such identification and be willing to provide it.
Although physicians do not have a duty to carry medical equipment with them, it is recommended that they carry basic equipment when traveling. If the physician does volunteer help in an emergency, it is extremely disconcerting not to have the necessary tools available. Many emergency medical technicians, nurses, and doctors keep first-aid equipment in their cars or at home because they do not want to be in an emergency situation without the equipment necessary to save a life. This is especially important for physicians who practice in small towns where there are no paramedics with a readily available and fully equipped ambulance.
Once a physician has assumed the care of a patient in an emergency, the duty to the patient does not end until the patient is assured of proper follow-up care. If the patient is taken away by ambulance, it is wise to notify the hospital that the patient is coming and to pass on medical information. A follow-up call to make sure the patient arrived is also a good idea. Unless there is no question of undetected injury, the patient should not be allowed to assume that the roadside care is all that is required. An emergency room record with notations from the physician at the scene will improve the quality of care a patient receives if late complications develop.
Physicians may be faced with rendering emergency care in a state where they are not licensed. The drowning on the beach, the car accident, or the call for a physician in the air terminal may expose the vacationing physician to the need to practice medicine without a license. Considerations of licensure should not stop a physician from saving a life. The physician should make a good-faith effort to help and should turn the case over to qualified medical personnel as soon as possible. The same rules on relinquishing care and follow-up should be followed as if the physician were licensed. Most state licensing laws explicitly allow for emergency care by nonlicensed personnel, and no state would prosecute a physician for volunteering emergency medical care.