Harmonized
Emergency
Forensic Medicine
นพ. เอนก ยมจินดา
Emergency
Medical Services
( EMS )
Liability
นพ. เอนก ยมจินดา
Defensive Medicine Practiced among ER. Staffs Fearing Lawsuits
11 pm Tuesday , EMS responds to a private home to find elderly man cardiac arrest
Rx. Defib & ALS , patient dies in ER.
children are moved to quiet room ,
where doctor informs their father has died
days follow , Family questions
proper paramedic care ?
Finally , son calls EMS provider to describe his concerns
the procedures performed
Supervisor shows
great reluctance to
discuss the provided
care
Not sympathetic
EMS provider,
missing opportunity to Defend & Educate ,
Forces family
to seek
other lines of communication
“ The Attorney ! ”
Lack of Compassion
Communication
Customer Service Skills
Not Clinical Errors
RISK MANAGEMENT
StrengtheningEMS System
Risk Management relatively New to EMS
EMS Risk Management Strategies
Full-Time Risk Manager
Proactive
Pre-Loss RM Strategies
( How To Prevent a Lawsuit )
Reactive
Post-Loss RM Strategies ( How To Survive a Lawsuit )
Pre-Loss RM Strategies
Taken One Step Further
Proactive Risk Management
How To Prevent a Lawsuit
Nature of ER.
1. limited relationship
2. Patient’s Expectations
3. Overcrowded
Elephant in the room
Documentation
1. lack of documentation
2. Adds & Changes 3. Review of other records
4. Discharge Instructions
Differential Diagnosis
Common misdiagnoses
Continuity of Care
Patient of Unknown Origin
Admission & Discharge
Consultations in ER.
Labs & Radiological Studies
4 Distinct Elements Necessary to Prove Medical Negligence :
1. Duty /Standard of Care
2. Non-Conformity 3. link NC to the injury
4. Damages
Duty, Begins
before physical
contact patient
when call for
assistance comes into the center
Duty, Ends
generally ends with Transfer of Care To The Receiving Facility
9-1-1 center do not provide
pre-arrival instructions or
response-mode recommendations
Because of Fear of Litigation
Duty, Begins with The Call to 9-1-1
Standard of Care
Degree of care / Reasonable care
Defined by Organization' Policies/ Procedures
Become Standard of Care
Standard
EMS Systems
Standard
Providers Practice
Standard Equipments
Triage / Mass Casualty Protocol
Continuing Education Programs /CQI.
EMS Risk Management Strategies
Full-Time Risk Manager
Proactive
Pre-Loss RM Strategies
( How To Prevent a Lawsuit )
Reactive
Post-Loss RM Strategies ( How To Survive a Lawsuit )
Litigation is the legal retrospective form of
Quality Assurance ; To Correct EMS system Defects
Post-Loss RM Strategies
Taken One Step Further
Reactive Risk Management
How To Survive a Lawsuit
Notice of Suit & Suit
Mediate don’t Litigate
Trial Preparation & Testimony