“AND THAT’S MAGIC!”—MAKING PUBLIC BODIES LIABLE FOR FAILURE TO CONFER BENEFITS

2000 ◽  
Vol 59 (3) ◽  
pp. 421-471
Author(s):  
Tom Hickman
Keyword(s):  
Brain Damage ◽  
High Probability ◽  
Respiratory Arrest ◽  
Ambulance Service ◽  
Duty Of Care ◽  
Similar Response ◽  
Reasonable Explanation ◽  
Asthma Attack ◽  
Ambulance Crew ◽  
Public Bodies

THE facts of Kent v. Giffiths [2000] W.L.R. 1158 were that the claimant had suffered an asthma attack and was attended by a doctor at her home. At 4.25 p.m. the doctor called an ambulance, gave the patient’s name, address, age and condition, and requested that she be transferred immediately to casualty where she was expected. Ambulance control replied “Okay doctor”. At 4.35 p.m. the claimant’s husband was assured, on making a second call, that the ambulance was on its way. He was told to hang on for another seven or eight minutes. A similar response was given to a third call made sixteen minutes later. The ambulance finally arrived forty minutes after the initial call was made. The claimant suffered respiratory arrest resulting in brain damage and a miscarriage. At trial Turner J. held that the London Ambulance Service (LAS) was liable for breach of a duty of care. He found not only that there was no reasonable explanation for the delay, but also that the ambulance crew had falsified their records ([1999] Lloyds Rep. Med. 424). Had the ambulance arrived when it should, there was a high probability that the respiratory arrest would have been averted.

Respecting an autonomous decision to refuse life-saving treatment: a case study

2020 ◽  
Vol 12 (8) ◽  
pp. 304-309
Author(s):  
Emma Moore
Keyword(s):  
Treatment Options ◽  
Respiratory Arrest ◽  
Professional Autonomy ◽  
Prehospital Setting ◽  
Fundamental Aspect ◽  
Duty Of Care ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Life Saving ◽  
Ambulance Crew

Background: Autonomy is a key ethical principle in healthcare, giving patients the right to be involved in their own care. Allowing patients to make decisions based on their own values and beliefs is a fundamental aspect of evidence-based practice. Professional autonomy allows paramedics to make critical decisions around patient care in an emergency, enabling them to provide life-saving treatment. A patient's autonomy can conflict with that of a paramedic, leading to complex ethical situations which can affect the way a paramedic performs their duty of care. Decision-making is a fundamental skill for paramedics and often in the prehospital setting, paramedics have to manage situations with a certain degree of risk if they are to manage patients effectively and safely, while respecting patients' legal and ethical rights. Case presentation: An ambulance crew were called to attend a 62-year-old woman with a history of chronic obstructive pulmonary disease, respiratory arrest and stage 2 respiratory failure, who had breathing difficulties. She was deemed to have capacity by the ambulance crew under the Mental Capacity Act. The patient refused to be taken to hospital for treatment against paramedic recommendation, as she wished to receive no further treatment or hospital admission and wanted to die at home. The ambulance crew referred her to her GP. Conclusions: Paramedics experience great difficulties in making decisions, as information and alternative treatment options are often limited in the prehospital setting. One major limitation to autonomy is where an autonomous patient is refusing life-saving treatment. This can create ethical dilemmas for paramedics, leaving them to feel a sense of vulnerability and anxiety around performing their duty of care. The law is clear: an autonomous patient's decision to refuse treatment, even if it may seem unwise, must be respected in accordance with the Human Rights Act 1998.

Cardiac and Respiratory Arrest in a 12-Year-Old Girl with Acute Permethrin Toxicity: A Case Report

2021 ◽  
Author(s):  
Hesam Adin Atashi ◽  
Hamid Zaferani Arani ◽  
Seyyed Mojtaba Ghorani ◽  
Mahya Sadat Teimouri Khorasani ◽  
Masoumeh Moalem
Keyword(s):  
Case Report ◽  
Brain Damage ◽  
Respiratory Arrest ◽  
Spontaneous Circulation ◽  
Type I ◽  
Medical Problems ◽  
Present Case Report ◽  
Case Presentation ◽  
Hypoxic Brain Damage ◽  
Hypoxic Brain

Abstract Background: Permethrin (PER) is widely employed as the most frequently used type I synthetic pyrethroid insecticide. Despite its worldwide application, reports of pediatric toxicity following permethrin administration are scarce.Case presentation: The present case report involves a 12-year-old Afghan girl, with no previous medical problems, who drank an unknown insecticide covertly at home. Two hours after ingestion, she was taken to the emergency room with neither breathing signs nor a heartbeat. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room, and her spontaneous circulation was returned after a few minutes of CPR. She was then intubated, volume resuscitated with intravenous normal saline, and connected to the mechanical ventilator after being transferred to the ICU ward. The patient remained comatose without spontaneous breathing, her pupils became bilateral mydriasis, and central diabetes insipidus became evident after three days due to apnea and hypoxic brain damage following insecticide ingestion. The chemical analysis of the insecticide bottle showed 10% permethrin without organophosphates, as initially expected. Unfortunately, after seven days, the patient passed away due to resistant hypotension and severe brain damage.Conclusion: Permethrin is widely used globally as an insecticide. However, there are many unmet needs in permethrin toxicity treatment, and the treatment is mainly supportive. Depending on the amount and dose of permethrin, the most common symptoms can vary from headache, dyspnea, and vomiting to metabolic acidosis and cardiac and respiratory arrest, which can lead to hypoxic brain damage and death, as was the outcome in our case.

scholarly journals Refusal to travel in the National Ambulance Service: A retrospective examination of calls from 2017.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Emergency Department ◽  
Life Support ◽  
Advanced Life Support ◽  
Light Response ◽  
Respiratory Arrest ◽  
Ambulance Service ◽  
Quality Improvement Initiative ◽  
Southern Area ◽  
Course Of Action ◽  
Rate Of Increase

<p><strong>Introduction </strong></p><p>When a member of the public calls for an ambulance through the 999/112 system, the only permitted course of action for the responding National Ambulance Service (NAS) staff is to convey the patient to an emergency department. Regardless of the clinical level, NAS staff do not have the authority or scope of practice to discharge the patient from the scene or make any other arrangements for the treatment of that person(1). The patient, meeting certain criteria, can refuse treatment or transport (RTT) of their own volition(1). Mortality rates for non-conveyed patients vary from 0.2%-3.5% within 24hours and are twice those of patients discharged from an emergency department(2, 3). In 2017, the refusal to travel rate in Ireland jumped from 7-8% of calls (2012-2014) to a national average of 11.3% (24,735) of total AS1 calls(4). Although this level of non-conveyance would still be below international norms the rate of increase was concerning(3).</p><p><strong>Aim.</strong></p><p>A quality improvement initiative necessitated identification of baseline RTT information.</p><p><strong>Methods</strong></p><p>Retrospective data collection was conducted on all calls closed with a ‘refusal to travel’ or ‘refusal of treatment’ occurring between 1st Jan 2017 and 9<sup>th</sup> Nov 2017 and was gathered from the National Emergency Operations Centre (NEOC).</p><p><strong>Results</strong></p><p>The top three dispatch classification that resulted in RTT were falls, unconsciousness or near fainting, and generally unwell patients. This was followed by chest pain, seizures, traffic incidents and breathing problems. It was noted that the time at which RTT calls occurred peaked nationally between 2000 and 2059. In the Southern area, peak RTT occurred between 2000-2059h and 0000-0100. 33.6% of RTT calls in the Southern Area were designated as Delta calls. This designation requires an advanced life support and a blue light response and is the call level with the second highest acuity below an Echo call, the designation for Cardiac or Respiratory arrest.</p><p><strong>Conclusions</strong></p><p>The NAS specifically utilises a risk adverse triage system. Examination of dispatch priorities may be warranted. The peak close of RTT calls between 2000-2059 may align with a shift changeover at 2000. Further study is required.</p>

PP34 The experiences and attitudes of ambulance staff towards the counter-terrorism ‘PREVENT’ training: a survey-based service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A14.2-A14
Author(s):  
Tessa Mochrie ◽  
Theresa Foster ◽  
Larissa Prothero ◽  
Nigel South
Keyword(s):  
Service Evaluation ◽  
Ambulance Service ◽  
Future Research ◽  
Duty Of Care ◽  
Training Module ◽  
Counter Terrorism ◽  
Service Setting ◽  
Emergency Ambulance ◽  
Question Survey ◽  
Do So

BackgroundUnderstanding the views and opinions of ambulance clinicians about counter-terrorism is limited, as are the roles they have in identifying individuals vulnerable to radicalisation. The aim of this survey was to investigate ambulance clinician views and preparedness to identify individuals at risk of radicalisation and whether the current national PREVENT training offered is suitable for this clinical setting.MethodsA purpose-designed, 18-question survey, was developed to understand staff attitudes and content knowledge of the national PREVENT training module. The survey was opened to all emergency ambulance clinicians in one UK ambulance service during August 2020, resulting in a sample of 123 responses which were analysed using descriptive and thematic approaches.ResultsMost respondents (87%; n=107) were aware of the PREVENT strategy, with almost three-quarters (73%; n=90) receiving training within the previous three years. Respondents were asked to score training received: the majority (89%; n=110) reported 5/10 or less. Whilst most (79%; n=97) identified the correct way to refer an individual, few had completed a PREVENT referral (9%; n=11). ‘Gut instinct’ was utilised by respondents to support their knowledge obtained via PREVENT training (70%, n=86). Respondents felt the national PREVENT training lacked relevance to their role and recommended ambulance-specific training packages be made available. They recognised their responsibility of identifying radicalisation and the opportunities their unique position offered to do so. Having a ‘duty of care’ and ‘moral responsibilities’ to make PREVENT referrals, and the importance of treating individuals as patients (not criminals), was also highlighted.ConclusionsAmbulance staff have highlighted the importance of a clear and robust referral pathway for individuals vulnerable to radicalisation. Current training lacks specificity and effectiveness for the ambulance service setting. As this survey was limited to one ambulance service, future research is warranted to ensure PREVENT training is appropriate for all ambulance staff.

2. Negligence: duty of care

2020 ◽  
pp. 23-58
Author(s):  
Carol Brennan ◽  
Vera Bermingham
Keyword(s):  
Duty Of Care ◽  
Physical Injury ◽  
Legal Knowledge ◽  
Property Damage ◽  
Key Points ◽  
History Of ◽  
The Way ◽  
Public Bodies

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams, and exercises help readers to engage fully with each subject and check their understanding as they progress. Negligence is a tort in its own right and involves an unintentional wrong as opposed to trespass which involves an intentional wrong. It has three main elements: duty of care (whether the defendant owes the claimant a duty of care), breach (whether the defendant has breached that duty), and damage (whether that breach has caused damage of a legally recognized kind to the claimant). Duty of care is determined by proximity, foreseeability, and policy and is most likely to be established in cases of positive acts which cause physical injury or property damage. This chapter provides an overview of the history of negligence and discusses the function of duty of care in negligence. It also considers the way duty of care has been defined and developed and applies the principles of duty of care in the areas of omissions and liability of public bodies.

6. Special duty problems: public bodies

2021 ◽  
pp. 138-187
Author(s):  
Kirsty Horsey ◽  
Erika Rackley
Keyword(s):  
Emergency Services ◽  
Armed Forces ◽  
Duty Of Care ◽  
Private Law ◽  
Exclusionary Rule ◽  
Current State ◽  
Public Body ◽  
The Law ◽  
Special Duty ◽  
Public Bodies

This chapter explains what happens when a public body owes a private law duty of care to an individual who claims against it in negligence. It remains the case that public bodies will be liable where the negligent exercise of their powers makes a situation worse than it already was. The discussions cover the general exclusionary rule; the current state of the law; the background to D v East Berkshire [2005]; rules for claims brought against the emergency services (including the police) and armed forces; other types of public body; and new types of claims: education-based claims and ‘social’ claims.

Shaddock (L) & Associates PTY LTD and Another v Parramatta City Council

1982 ◽  
Vol 13 (1) ◽  
pp. 95-103 ◽  
Author(s):  
Graeme E J Johnson
Keyword(s):  
City Council ◽  
Duty Of Care ◽  
Financial Loss ◽  
Public Bodies

Torts — Negligence — Negligent mis-statement — Duty of care — Persons on whom a duty of care exists — Advice and information — Liability of public bodies for negligent mis-statement — Hedley Byrne v Heller and MLC v Evatt In the burgeoning field of negligent mis-statement causing financial loss there are now three cases which attempt to establish the prerequisites for the existence of a duty of care: Hedley Byrne & Co Ltd v Heller & Partners Ltd,2 Mutual Life & Citizens' Assurance Co Ltd v Evatt,3 and Shaddock (L) & Associates Pty Ltd v Parramatta City Council.4

6. Special duty problems: public bodies

Tort Law ◽  
2017 ◽  
Author(s):  
Kirsty Horsey ◽  
Erika Rackley
Keyword(s):  
Emergency Services ◽  
Armed Forces ◽  
Duty Of Care ◽  
Private Law ◽  
Exclusionary Rule ◽  
Current State ◽  
Public Body ◽  
The Law ◽  
Special Duty ◽  
Public Bodies

This chapter explains what happens when a public body owes a private law duty of care to an individual who claims against it in negligence. The discussions cover the general exclusionary rule; the current state of the law; the background to D v East Berkshire; rules for claims brought against the emergency services (including the police) and armed forces; other types of public body; and new types of claims: education-based claims and ‘social’ claims.

4. Breach of duty

2018 ◽  
Author(s):  
Vera Bermingham ◽  
Carol Brennan
Keyword(s):  
Duty Of Care ◽  
Physical Injury ◽  
Legal Knowledge ◽  
Property Damage ◽  
Key Points ◽  
History Of ◽  
Breach Of Duty ◽  
The Way ◽  
Public Bodies

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams, and exercises help readers to engage fully with each subject and check their understanding as they progress. Negligence is a tort in its own right and involves an unintentional wrong as opposed to trespass which involves an intentional wrong. It has three main elements: duty of care (whether the defendant owes the claimant a duty of care), breach (whether the defendant has broken that duty), and damage (whether that breach has caused damage of a legally recognized kind to the claimant). Duty of care is determined by proximity, foreseeability, and policy and is most likely to be established in cases of positive acts which cause physical injury or property damage. This chapter provides an overview of the history of negligence and discusses the function of duty of care in negligence. It also considers the way duty of care has been defined and developed and applies the principles of duty of care in the areas of omissions and liability of public bodies.

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