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A Qualitative Study of Paramedic Duty to Treat During Disaster Response

Published online by Cambridge University Press:  10 April 2018

Erin Smith Open the ORCID record for Erin Smith [Opens in a new window] ,
Frederick Burkle Jr ,
Kristine Gebbie ,
David Ford  and
Cécile Bensimon
Erin Smith*
Affiliation:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia Division of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
Frederick Burkle Jr
Affiliation:
Harvard Humanitarian Initiative, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts Woodrow Wilson International Center for Scholars, Washington, District of Columbia
Kristine Gebbie
Affiliation:
College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
David Ford
Affiliation:
School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
Cécile Bensimon
Affiliation:
CMA, Ottawa, Canada
*
Correspondence and reprint requests to Dr Erin Smith, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia. (e-mail:Erin.Smith@ecu.edu.au)
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Abstract

Objectives

Disasters place unprecedented demands on emergency medical services and can test paramedics personal commitment as health care professionals. Despite this challenge, guidelines and codes of ethics are largely silent on the issue, providing little to no guidance on what is expected of paramedics or how they ought to approach their duty to treat in the face of risk. The objective of this research is to explore how paramedics view their duty to treat during disasters.

Methods

The authors employed qualitative methods to gather Australian paramedic perspectives.

Results

Our findings suggest that paramedic decisions around duty to treat will largely depend on individual perception of risk and competing obligations. A code of ethics for paramedics would be useful, but ultimately each paramedic will interpret these suggested guidelines based on individual values and the situational context.

Conclusions

Coming to an understanding of the legal issues involved and the ethical-social expectations in advance of a disaster may assist paramedics to respond willingly and appropriately. (Disaster Med Public Health Preparedness. 2019;13:191–196)

Keywords

paramedicdisasterduty to treatprofessional obligationscode of ethics
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 2 , April 2019 , pp. 191 - 196
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2018 

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References

1. World Health Organisation (WHO) Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). Geneva: WHO; 2003.Google Scholar
2. Smith, E. The disaster after 9/11: first responders and their families share their stories. Presented at the Australian and New Zealand Disaster and Emergency Management Conference, Gold Coast, Australia, May 2017.Google Scholar
3. Gebbie, K, Peterson, PA, Subbarao, I, White, KM. Adapting standards of care under extreme conditions. Disaster Med Public Health Prep. 2009;3(2):111-116. https://doi.org/10.1097/DMP.0b013e31819b95dc.Google Scholar
4. Grinnell, M, Dixon, M, Patton, M, et al. Ebola virus disease in health care workers—Guinea, 2014. Morb Mortal Wkly Rep. 2015;64(38):1083-1087.Google Scholar
5. Annas, G. Legal risks and responsibilities of physicians in the AIDS epidemic. Hastings Cent Rep 1988;18(2):26–32.Google Scholar
6. Daniels, N. Duty to treat or right to refuse? Hastings Cent Rep 1988;21(2):36–46.Google Scholar
7. Ruderman, C, Tracy, CS, Bensimon, CM, et al. On pandemics and the duty to care: whose duty? who cares? BMC Medical Ethics. 2006;7(5). https://doi.org/10.1186/1472-6939-7-5.Google Scholar
8. Iverson, KV, Helne, CE, Larkin, GL, Moskop, JC, Baruch, J, Aswegan, AL. Fight or flight: the ethics of emergency physician disaster response. Ann Emerg Med. 2008;51:345-353.Google Scholar
9. Zuger, A, Miles, SH, Zuger, A, et al. Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations. JAMA. 1987;258:1924-1928.Google Scholar
10. Huber, SJ, Wynia, MK. When pestilence prevails…physician responsibilities in epidemics. Am J Bioethics. 2004;4(1):W5-W11.Google Scholar
11. American Medical Association. Declaration of Professional Responsibility. Chicago, IL: American Medical Association. Adopted by the AMA House of Delegates, December 2001. http://www.ama-assn.org/ama/pub/ category/7491.html. Accessed August 9, 2015.Google Scholar
12. Smith, E, Burkle, FM Jr, Woodd, C, Jensen, S, Archer, F. Paramedics and public health emergencies: is there a ‘duty to respond’ in Australia? Aust J Emerg Manag. 2010;25(2):48-55.Google Scholar
13. Emanuel, EJ. The lessons of SARS. Ann Intern Med. 2003;139(7):589-591.Google Scholar
14. Bensimon, CM, Tracy, CS, Bernstein, M, Shaul, RZ, Upshur, REG. A qualitative study of the duty to care in communicable disease outbreaks. Soc Sci Med. 2007;65(12):2566-2575.Google Scholar
15. Sokol, DK. Virulent epidemics and scope of healthcare workers’ duty of care. Emerg Infect Dis. 2006;12(8):1238-1241.Google Scholar
16. Bevan, JC, Upshur, RE. Anesthesia, ethics, and severe acute respiratory syndrome. Can J Anaesthesia. 2003;50(10):977-982.Google Scholar
17. Masur, H, Emanuel, E, Lane, HC. Severe acute respiratory syndrome: providing care in the face of uncertainty. J Am Med Assoc. 2003;289(21):2861-2863.Google Scholar
18. Reid, L. Diminishing returns? Risk and the duty to care in the SARS epidemic. Bioethics. 2005;19(4):348-361.Google Scholar
19. New South Wales Public Health network. Progression and impact of the first winter wave of the 2009 pandemic H1N1 influenza in New South Wales, Australia. Euro Surveill. 2009;14(42). https://doi.org/10.2807/ese.14.42.19365-en.Google Scholar
20. Smith, E, Burkle, FM Jr, Holman, P, Dunlop, J, Archer, F. Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia. Disaster Med Public Health Prep. 2009;3(Suppl 2):S154-S159.Google Scholar
21. Bielajs, I, Burkle, FM Jr, Archer, FL, Smith, E. Development of prehospital, population-based triage-management protocols for pandemics. Prehosp Disaster Med. 2008;23(5):420-430.Google Scholar
22. Moser, A, Mabire, C, Hugli, O, Dorribo, V, Zanetti, G, Lazor-Blanchet, C, et al. Vaccination against seasonal or pandemic influenza in emergency medical services. Prehosp Disaster Med. 2016;31(2):155-162.Google Scholar
23. Gershon, RRM, Vandelinde, N, Magda, LA, Pearson, JM, Werner, A, Prezant, D. Evaluation of a pandemic preparedness training intervention of emergency medical services personnel. Prehosp Disaster Med. 2009;24(6):508-511.Google Scholar