Although many emergency medical services (EMS) providers are concerned about liability litigation, no comprehensive, national studies of EMS appelate cases have been published. Information about these cases and the use of liability immunity (sovereign immunity, emergency medical care immunity, or Good Samaritan immunity) as a defense could be used for EMS risk management and better patient care.

To review recent EMS system civil litigation cases to determine their common characteristics and the number that used liability immunity as a legal defense.

An observational study of the WESTLAW computerized database of legal cases from all state and federal appellate courts. All legal cases that named a member of the EMS system as a defendant, involved either a patient-care incident or ambulance collision, and received an appellate court opinion from 1987 through 1992, were studied.

Eighty-six cases were identified and analyzed. Most cases (85%) were related to a patient-care incident, and 71 % of the cases involved a death or significant physical injury. More than 49% of the patient cases alleged inadequate assessment or treatment, and 27% alleged delay in ambulance arrival or no ambulance arrival. There were 11 cases (15%) that alleged no transport of the patient to the hospital. Liability immunity was used as a defense in 53% of the cases. The appellate courts ruled in favor of 68% of the defendants that did not use an immunity defense and in favor of 72% of those that did use liability immunity.

There have been a large number of recent appellate cases involving EMS systems. The common characteristics of many of these cases demonstrate the need for providing rapid ambulance arrival, proper assessment and treatment, and rapid patient transportation to a hospital. Although liability immunity was used as a legal defense by most EMS system defendants, the appellate court outcome was similar regardless of its use.

Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.

It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.

Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.

For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).

An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.

There is reason to believe that traumatic events experienced on the job make emergency medical services (EMS) workers more skeptical about their spiritual beliefs. Little is known about the spiritual lives and experiences of emergency medical technicians (EMTs). No studies have measured the responses of EMTs to the spiritual needs of their patients.

This study investigates whether EMS workers are less spiritual than the average U.S. citizen, and what effect this has on prayer for patients and perceived happiness.

Data were collected in a major metropolitan EMS system from 125 EMTs and paramedics through a questionnaire about their beliefs and behaviors regarding their spirituality. Pearson product-moment correlation coefficients (r) were used to analyze variables. The religious attitudes of EMTs were compared with those of the general population as defined in the Gallup studies.

Ninety-one percent of the EMS workers interviewed and 94% of Gallup's sample of the general population said they believe in God. The findings on other measures in the EMT sample also were very similar to those defined in the general population. Of the EMTs, 60% said they never have doubted the existence of God. Eighty-four percent believe God still works miracles, and 80% of the EMTs believe in life after death. Eighty-seven percent of EMS workers pray; 62 % pray for their patients, and 54% pray for their coworkers. Frequency of church or synagogue attendance is positively and significantly correlated with the degree of perceived life happiness (r = 0.226, p <0.025>0.005). Frequency of prayer also is correlated positively to perceived life happiness (r = 0.182,p<0.025>0.005).

Emergency medical services workers are interested and willing to talk about their spiritual lives. They do have more doubts about the existence of God than does the average civilian, but are just as spiritual. Those EMTs with more active spiritual lives perceive themselves as happier. The majority of EMS workers pray for their patients.

Pediatric mortality is predicted by age, presence of head trauma, head trauma with a low Glasgow Coma Scale (GCS) score, a low Pediatric Trauma Score (PTS), and transport directly to a pediatric trauma center.

Studied were 1,429 patients younger than 16 years old admitted to or declared dead on arrival (DOA) in a pediatric trauma center from January through October, 1988. The trauma system, which served 3-million persons, included six pediatric trauma centers.

Data were obtained by a retrospective review of summary statistics provided to the Chicago Department of Health by the pediatric trauma centers.

Overall mortality was 4.8% (68 of 1429); 32 of the patients who died (47.1%) were DOA. The in-hospital mortality rate was 2.6%. Head injury was the principal diagnosis in 46.2% of admissions and was a factor in 72.2% of hospital deaths. The mortality rate was 20.3% in children with a GCS≤10 and 0.4% when the GCS was >10 (odds ratio [OR] = 67.0, 95% CI = 15.0–417.4). When the PTS was ≤ 5, mortality was 25.6%; with a PTS > 5, the mortality was 0.2% (OR = 420.7, 95% CI = 99.3–2,520). Although transfers to a pediatric trauma center accounted for 73.6% of admissions, direct field triage to a pediatric trauma center was associated with a 3.2 times greater mortality risk (95% CI = 1.58–6.59). Mortality rates were equal for all age groups. Pediatric trauma center volume did not influence mortality rates.

Head injury and death occur in all age groups, suggesting the need for broad prevention strategies. Specific GCS and PTS values that predict mortality can be used in emergency medical services (EMS) triage protocols. Although the high proportion of transfers mandates systemwide transfer protocols, the lower mortality in these patients suggests appropriate EMS field triage. These factors should be considered as states develop pediatric trauma systems.

The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system.

This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics.

On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment.

A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.

A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic.

This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath.

Multihospital, one large municipal hospital, one community hospital.

Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis.

All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedia, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study.

Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians.

Overall, paramedia have excellent diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.