Effective patient transportation is an essential part of any healthcare system to ensure individuals receive the care they need in a timely fashion.
But when something goes wrong, the result can be tragic for everyone, including those who are not directly involved in the transport.
From misdiagnosis and inappropriate treatment to motor vehicle crashes, there are many ways things can go awry, leading to injuries, life-altering disabilities or even death.
Some states cap damage awards and immunities from general negligence may apply to individual EMS providers and certain entities requiring a higher evidentiary standard of “gross negligence” to prove malpractice, but that’s not always the case.
Sara Peters, a shareholder at the plaintiff personal injury firm Walkup, Melodia, Kelly & Schoenberger in San Francisco, recently secured a settlement for a patient who was left paralyzed as a result of a variety of missteps.
“The individual had presented to one hospital with an aortic dissection and required a higher level of care, necessitating transport to a different facility,” Peters said. “Part of the issue was there was a delay in the decision to transport him. Then by the time they finally decided to transport him, the weather had turned bad, and they could not find air ambulances to transport him.”
When the patient was finally on his way in a ground ambulance, Peters said he was given too much opiate medication, which caused him to stop breathing.
“Because his limbs were not getting enough oxygen, he was left a quadriplegic,” Peters said.
Peters filed a lawsuit against the sending hospital, the physicians involved in the delay, and the ambulance company, which was an independent contractor.
“The case resolved favorably with all but one physician defendant, who went to trial,” she said.
Although California damage caps (then $250,000, now higher) limited the pain and suffering portion of the award, the law did not apply to the economic damages, which were substantial given that the plaintiff was young and would need extensive care for the remainder of his life.
“In California, the standard for medical negligence is anything that veers from reasonable care,” Peters said. “The courts have held that the caps on medical negligence damages apply to paramedics and EMTs acting within the scope of their licenses, even if we’re only talking about negligent operation of an ambulance.
However, that is obviously not the case for all forms of patient transportation, Peters added.
“A paratransit provider, for example, may not be a licensed healthcare provider, in which case damages caps would not apply,” she said.
A safety misnomer
While many may assume the use of lights and sirens results in much faster arrival times and better patient outcomes, studies paint a different picture.
According to a 2023 analysis of ground ambulance crash data from 2012 to 2018 by the National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services of the 173 fatal crashes, 45.7% of the incidents occurred during the emergency operation of the vehicle.
The study specifically tracked lights and sirens between 2013-2018, with 28% of those crashes taking place when L&S were in use.
Of the 199 deaths, 34.2% were ambulance passengers, 6% included operators/drivers, 52.3% were people in other crash vehicles and 7.5% were nonoccupants, i.e. pedestrians and bicyclists.
The numbers are not a surprise to Mechanicsburg, Pennsylvania-based Page, Wolfberg & Wirth partner Stephen Wirth, whose firm represents EMS agencies and fire departments around the country.
“Vehicle crashes involving ambulances are the number one cause of liability for the EMS agency,” said Wirth, a former paramedic. “A high number of these crashes occur with the use of lights and sirens, often in cases that do not warrant their use. The few minutes that might be saved running lights and sirens to the scene or from the scene to the hospital has been shown to rarely improve the patient’s outcome except in the most critical patient situations.”
Indeed, a joint statement by the National Association of EMS Physicians and the then National Association of State EMS Directors in 2022 notes that only a small percentage of patients have better outcomes due to the use of L&S, with studies showing an average of 42 seconds to 3.8 minutes is saved, while the chance of a vehicle crash increases by 50%.
Read part 2 of this story here.
