Standard of Care Podcast

In this episode of The Standard of Care podcast, hosts Samantha Johnson and Nick Adams delve into the complex legal framework of patient consent in EMS. What happens when a patient refuses care, even in life-threatening situations? How should EMS professionals navigate the fine line between consent, implied consent, and refusal, all while staying within the legal boundaries? Samantha quizzes Nick on real-world scenarios, offering practical insights on handling refusals, informed consent, and what EMS providers need to know about patient capacity.Whether you're a seasoned paramedic, new to the field, or just brushing up for the National Registry exam, this episode offers valuable knowledge on critical issues you may face. Get actionable advice, hear relatable examples, and understand the nuances that could impact your next decision. Tune in now to explore this important topic—and remember, you can find The Standard of Care wherever you listen to podcasts or on our website at flightbridgeed.com/explore. While you’re there, check out our award-winning courses designed to enhance your professional skills and knowledge.Key Takeaways:Understanding patient capacity is critical in determining whether you can proceed with care, even if consent is initially given. If a patient has capacity, their refusal must be respected, even in life-threatening situations.Implied consent allows EMS providers to intervene in emergencies when a patient is unconscious or unable to give explicit consent, but only within the necessary scope of care.Informed refusals are equally important as informed consent. EMS professionals must ensure patients fully understand the risks of refusing care and document everything thoroughly.

In this episode of The Standard of Care Podcast, Samantha Johnson and Nick Adams recount their journey from attending conferences to becoming conference speakers on critical medical-legal topics in EMS. They reflect on how these pivotal experiences shaped their current work. The episode dives into highlights from recent EMS conferences, such as South Carolina EMS, Metro Atlanta EMS, and FAST24, where they engaged with street-level medics and addressed critical topics in the ever-evolving landscape of EMS law. Whether you're a seasoned provider or just starting, this episode offers valuable takeaways on the value of EMS conferences, the evolution of the Standard of Care Podcast, and the importance of staying informed and involved in industry developments. Links:National Association of EMS Physicianshttps://naemsp.org/2025 Annual MeetingJanuary 6-11, 2025https://naemsp.org/annual-meeting/ South Carolina EMS Associationhttps://scemsa.org/2025 SCEMSA SymposiumMarch 5-7, 2025https://scemsa.org/ems-symposium Metro Atlanta EMS Conference2025 Metro Atlanta EMS Conference January 30-31, 2025https://www.maemsc.org/ Prisma Health Swamp Rabbit Prehospital Medicine Conference2025 Swamp Rabbit Conference June 17-19, 2025https://www.facebook.com/ghsemsconference/ FAST25(FlightBridgeED Air and Surface Transport Symposium 2025)Lexington, KY | May 19-21, 2025https://fbefast.com FTFC/Gathering of Eagles2025 FTFC/Gathering of Eagles June 9-13, 2025https://firsttherefirstcare.com/ 

It’s back-to-school time for the kids and for paramedics and EMTs, too!  Nick is planning to renew his certification.  But we know there will be a set of medical-legal questions on the National Registry exam, and he will be sure he’s prepared.  In this series, Nick and Samantha dive deeper into the medical-legal concepts commonly tested on the National Registry and help our listeners prepare to take on these questions.  Please like and subscribe! You can get this and other podcasts anywhere you get your podcasts or from the FlightBridgeED website at https://flightbridgeed.com/standard-of-care/Key Takeaways• Understand the Difference: Criminal actions are prosecuted by the state and aim to punish and deter, while torts are civil cases seeking compensation for wrongs.• Evidentiary Standards Matter: The burden of proof is much higher in criminal cases (beyond a reasonable doubt) compared to civil cases (preponderance of the evidence).• Negligence Requires Four Elements: To prove negligence, you must demonstrate duty, breach, causation, and damages. All four must be present for a successful claim.• Know Your Legal Responsibilities: As an EMS provider, it’s crucial to act with due regard for public safety, especially in high-stakes situations like driving with lights and sirens.• Be Prepared for Legal Complexity: Cases can involve both criminal and civil aspects, and understanding how these interact is vital for protecting yourself and your practice.

Spencer and Chris bring in the big guns from the Standard of Care podcast, Samantha Johnson and Nick Adams! This episode is probably one of the most disturbing cases of neglect we've reviewed in a while, so you've been warned!

On a hot Texas summer day, Dallas Fire responded to a grass fire on the side of the road.  Their subsequent encounter with a gentleman named Kyle Vess – all caught on surveillance camera - led to an ongoing lawsuit alleging “an abuse of power and a deliberate indifference to the life and welfare of the underprivileged in Dallas”.  What is the role of paramedics when confronted with a possible suspect?  Is it ever appropriate to fight a patient?  Are certain policies and practices of the department contributing to a perception (or a reality) that marginalized individuals are being treated differently?  Nick and Sam discuss all this and more.  Please like, comment, and subscribe!    Links: https://youtu.be/EGrlXDYzqqk https://youtu.be/-IbjBf88gpo https://www.dallasobserver.com/news/lawsuit-dallas-paramedic-kicked-man-in-face-while-in-police-custody-12235286 https://www.dallasobserver.com/news/dallas-tries-withholding-evidence-in-lawsuit-regarding-former-paramedic-brad-cox-who-kicked-man-in-face-12941255 https://www.dallasobserver.com/news/kyle-vess-court-rules-lawsuit-against-city-and-former-paramedic-can-move-forward-14303422 https://www.dallasobserver.com/news/video-dallas-fire-rescue-employee-kicks-man-in-face-12455856See omnystudio.com/listener for privacy information.

An employee commits a terrible crime – should the employer be liable?  In this episode, we explore the nuances of negligent hiring, retention, supervision, and training.  What does it mean for an employee to be “in the scope of employment” to allow their employer to be sued in the first place?  When is an EMS agency responsible for its own negligence in keeping a problematic employee on staff?  If an employee commits a terrible crime, is the agency automatically off the hook?  Please like, comment, and subscribe!   See omnystudio.com/listener for privacy information.

Season 3 is here! The release of the police body camera footage in the cases of Earl Moore, Jr. in Springfield, Illinois and Tyre Nichols in Memphis, Tennessee show EMS personnel at their worst.  In both cases, the providers failed to assess their patients and render proper treatment.  In Illinois, these failures resulted in first degree murder charges; in Tennessee, the firings of the personnel involved.  The results of the cases may differ based upon whether the providers have qualified immunity.  In this episode, Nick and Samantha discuss the legal concept of qualified immunity and its application in the two cases.  We take a hard look at what these cases say about EMS as a profession, and what it means to have the worst of us on public display.  Please like, comment, and subscribe!    The Standard of Care now has an email address!  Contact us directly at standardofcarepodcast@gmail.com!  We want to hear from you!  Tell us about the legal issues you’ve encountered, interesting cases you’d like us to discuss, and let us know what’s on your mind.   Links:   EMS 20/20 Show – Rapid Sequence Information. (2023, January 16). Reaction: Two EMS Workers CHARGED WITH FIRST DEGREE MURDER [Video]. YouTube. https://www.youtube.com/watch?v=HCqL3DF-apE Finton, L. (2023, January 30). Three Memphis Fire Department Personnel Fired for Not Providing Aid to Tyre Nichols. The Commercial Appeal. Retrieved February 3, 2023, from https://www.commercialappeal.com/story/news/crime/2023/01/30/three-memphis-fire-department-personnel-fired-for-not-providing-aid-to-tyre-nichols/69855376007/ JEMS Staff (2023, January 31). Memphis Fire Department Fires Three in Connection to Tyre Nichols' Death. JEMS. Retrieved February 3, 2023, from https://www.jems.com/patient-care/report-tyre-nichols-may-have-survived/#:~:text=Memphis%20Fire%20Department%20Fires%20Three%20in%20Connection%20to%20Tyre%20Nichols'%20Death,-By&text=The%20Memphis%20Fire%20Department%20has,'%20death%2C%20the%20department%20announced Olsen, D. (2023, February 3). New Details Emerge in Case Against EMS Workers Charged with Murder. Illinois Times. Retrieved February 3, 2023, from https://www.illinoistimes.com/springfield/new-details-emerge-in-case-against-ems-workers-charged-with-murder/Content?oid=16407188 WAND Staff (2023, January 16). Police Release Body Cam Footage from Fatal EMS Incident. WAND. Retrieved February 3, 2023, from https://www.wandtv.com/news/police-release-body-cam-footage-from-fatal-ems-incident/article_60ac0d16-9118-11ed-8a09-43e4be2bb405.htmlSee omnystudio.com/listener for privacy information.

It’s the stuff of nightmares and horror stories: the dead rising from the grave.  On August 23, 2020, it happened in Michigan after a woman who was declared deceased by the responding EMS crew “woke up” in a funeral home.  Her case has been described as an instance of “Lazarus Syndrome”, or “autoresuscitation after failed cardiopulmonary resuscitation”, but was it this rare condition or negligence on the part of the providers?  Nick and Samantha discuss the family’s $50 million lawsuit against the City and the providers and examine the clinical and legal issues around patients presumed to be deceased.  Please like, comment, and subscribe!       Links:     Erika Lattimore, as Guardian of Timesha Beauchamp, An Incapacitated Person v. City of Southfield, Michael Storms, Scott Rickard, Phillip Mulligan, and Jake Kroll, In Their Individual Capacity, Jointly And Severally, United States District Court for the Eastern District of Michigan, Civil Action File No. 2:20-cv-12738, filed October 8, 2020.  Complaint available at: http://www.firelawblog.com/wp-content/uploads/sites/19/2020/10/US_DIS_MIED_2_20cv12738_COMPLAINT_filed_by_All_Plaintiffs_against_All_Defe.pdf   Michael Storms, Scott Rickard, Phillip Mulligan, and Jake Kroll v. Oakland County Medical Control Authority et al., United States District Court for the Eastern District of Michigan, Civil Action File No. 4:20-cv-12457, filed September 8, 2020.   Katherine Mims Crocker, Qualified Immunity, Sovereign Immunity, and Systemic Reform, 71 Duke L.J. 1701-1780 (2022), available at: https://scholarship.law.duke.edu/dlj/vol71/iss8/1   Hutchinson, D. and MacDonald, M., (2020, September 16, updated 2020, October 19), “She’s Still Breathing”: Hear 911 Call From Moment Workers Realized Southfield Woman Declared Dead Was Alive, ClickOnDetroit https://www.clickondetroit.com/news/local/2020/09/16/shes-still-breathing-hear-911-call-from-workers-realized-southfield-woman-declared-dead-was-alive/   Kaur, H. et al., (2020, October 20), Family of Woman Who Died Weeks After She Was Found Alive at a Funeral Home Sues Paramedics For $50 Million, CNN, https://www.cnn.com/2020/10/20/us/timesha-beauchamp-dies-lawsuit-trnd   McEvoy, M., (2019, June 21), “Dead Wrong”, EMS1.com https://www.ems1.com/ems-products/medical-monitoring/articles/dead-wrong-RXW3893p2D3u8R3T/   Varone, K. (host). (2020, September 13).  Interview With Attorney For Disciplined Michigan Firefighters In Mistaken Death Pronouncement (No. 35) [Audio podcast episode]. Fire Law Blog. https://podcasts.apple.com/us/podcast/podcast-episode-35-interview-with-attorney-for/id876773998?i=1000491102861   White, E., (2020, December 10), Paramedics Who Wrongly Pronounced Timesha Beauchamp 'Dead' Can Regain Licenses, Detroit Free Press https://www.freep.com/story/news/local/michigan/2020/12/10/timesha-beauchamp-paramedics-regain-licenses/3883480001/   WXYZ Detroit, (2020, October 8), Fieger Files $50 Million Lawsuit in Case of Woman Found Alive After Being Pronounced Dead, https://www.wxyz.com/news/fieger-files-50-million-lawsuit-in-case-of-woman-found-alive-after-being-pronounced-dead  See omnystudio.com/listener for privacy information.

Dispatchers, call-takers, emergency communications officers – our 911 communications staff are our first first responders.  They work to ensure that patients receive the right resources for their emergencies.  But sometimes, it goes wrong.  According to a recently filed lawsuit, a Pennsylvania dispatcher refused to send an ambulance to a patient, resulting in the patient’s death.  The incident was allegedly so egregious that the local district attorney filed criminal charges against the dispatcher and his leadership.  In this episode, Nick and Samantha discuss the case of Titchennell v. Greene County, Pennsylvania, and explore the liability issues for 911 centers.  Please like, comment, and subscribe!       Links:     Kelly D. Titchenell, Administratrix of the Estate of Diania L. Kronk, deceased v. Greene County and Robert J. “Jeff Rhodes”, individually and as an employee of Greene County Emergency Management/911 Communications Center; and Leon Price, individually and as an employee of Greene County Emergency Management/911 Communications Center, Individually and Severally, United States District Court, Western District of Pennsylvania, No. 2:22-CV-890.   CBS Interactive. (2022, July 22). 3 More Charged After 911 Operator Accused of Not Sending Help. CBS News. Retrieved September 1, 2022, from https://www.cbsnews.com/news/911-operator-accused-of-not-sending-help-three-more-charged/ Mark Scolforo | The Associated Press. (2022, July 8). Pa. 911 Dispatcher Charged with Manslaughter After Failing to Send Ambulance. Pennlive. Retrieved September 1, 2022, from https://www.pennlive.com/news/2022/07/pa-911-dispatcher-charged-with-manslaughter-after-failing-to-send-ambulance.html  See omnystudio.com/listener for privacy information.

In April 2022, 81-year old Celeste Salanitri died twelve days after being resuscitated by paramedics.  Unfortunately, she never wanted to be resuscitated in the first place.  Do Not Resuscitate (DNR) laws – and the accompanying forms and rules – can be confusing.  In this episode, Nick and Samantha explain what DNR is – and is not – and explore the legal, ethical and clinical implications of DNRs for EMS providers.  Please like, comment, and subscribe!     Links:   Walser, A. (2022, May 9).  “She Didn’t Want to Be Resuscitated”: Family Says Paramedics Ignoring DNR Order Led to Suffering, ABC Action News/WFTS Tampa Bay https://www.abcactionnews.com/news/local-news/i-team-investigates/she-didnt-want-to-be-resuscitated-family-says-paramedics-ignoring-dnr-order-led-to-suffering State of Florida Do Not Resuscitate Order: https://www.floridahealth.gov/licensing-and-regulation/trauma-system/_documents/dnro-form-multi-lingual2004bwyw.pdf State of Florida Frequently Asked Questions About a Do Not Resuscitate Order (DNRO): https://www.floridahealth.gov/licensing-and-regulation/trauma-system/_documents/dnro-faq.pdf Pope, T., Unwanted Medical Treatment, https://www.thaddeuspope.com/unwantedtreatment.htmlSee omnystudio.com/listener for privacy information.

On this very special crossover episode, Nick and Samantha join Chris and Spencer on the EMS 20/20 podcast to enjoy a multi-layered case discussion peppered with legal issues.  This one is full of exciting flavors: capacity, refusals, maybe a little kidnapping, and a potentially justified assault.  Pull up a chair and join us as we serve up tips for handling a really difficult situation.  Please like, comment, and subscribe!  See omnystudio.com/listener for privacy information.

We are now two years out from the beginning of “The Situation”, which means that it’s time for the lawsuits.  In this episode, Nick and Samantha review a case from Klamath County, Oregon, where the alleged malpractice of the responding paramedics led to a woman’s death from complications of Covid.  This case has some very sad – and shocking – facts.  But it’s not just the medics who may be at fault – it’s the fire chief, his deputy chief, and even the department’s lawyer!  From federal Section 1983 civil rights claims to state law claims for intentional infliction of emotional distress, Nick and Samantha break down why everyone gets the blame.  Is that blame justified here?   Please like, comment, and subscribe!       Links:   Richard Vaughn, Jr. Individually and as Personal Representative for The Estate of Teresa Vaught, Deceased, Richard L. Vaughn, Sr., Marjo Vaughn, Larry Vaughn, Debra Blank, and Vivian Kimbol v. Klamath County Fire District No. 1, an Oregon Special District, Gregory Davis, an individual, Matthew Hitchcock, an individual, Stephen R. Hedlund, P.C., John Does 1-10 and Jane Does 1-5, United States District Court for the District of Oregon, Civil Action File No. 1:22-cv-00161, filed January 31, 2022.   Klamath County Emergency Medical Services, Standing Orders, March 1, 2020   Klamath County Fire District No. 1, Covid-19 Directive, March 17, 2020   Klamath County Emergency Medical Services, Standing Orders, April 1, 2020See omnystudio.com/listener for privacy information.

In late December 2017, Vanderbilt nurse RaDonda Vaught administered the wrong medication to a patient who subsequently died of an anoxic brain injury.  On March 25, 2022, a Tennessee jury found her guilty of gross neglect of an impaired adult and criminally negligent homicide.  Should providers – especially EMS providers – be worried that a medication error in the field could lead to jail time?  Is every treatment decision potentially a basis for not only civil liability, but criminal as well?  Nick and Samantha ask you to take your seat in the jury box as they discuss what actually happened.  Was this case truly just an “error”, or was there more to the story?  Given the facts as they were presented, and the law that applies to the case, would you have made the same decision?  Please like, comment, and subscribe!    See omnystudio.com/listener for privacy information.

On this episode of the Standard of Care Podcast, Nick and Samantha take a look at some of the liability issues surrounding the use of red lights and sirens.  What does the law allow the driver of an emergency vehicle to do?  What is “due regard”, anyway?  Are shorter response times making drivers more unsafe?  How does a plaintiff prove his or her case against the driver of an emergency vehicle, and what can you as the driver do to protect yourself?  Please like, comment, and subscribe!      Links:  Epps, K. (2019, May 04). EMT sentenced to 1 year in jail for fatal ambulance wreck. Retrieved November 19, 2020, from https://www.ems1.com/ambulance-crash/articles/emt-sentenced-to-1-year-in-jail-for-fatal-ambulance-wreck-o70N1PhOFiuyvdBK/ Janofsky, M. (1993, December 22). Domino's Ends Fast-Pizza Pledge After Big Award to Crash Victim. Retrieved November 19, 2020, from https://www.nytimes.com/1993/12/22/business/domino-s-ends-fast-pizza-pledge-after-big-award-to-crash-victim.html Jarvis, J. L., MD, MS, EMT-P, FACEP, FAEMS, Hamilton, V., MA, EMT-P, Taigman, M., MA, &  Brown, L. H., PhD. (2020). Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed? [Abstract]. Prehospital Emergency Care. doi:10.1080/10903127.2020.1797963, from https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1797963 Jarvis, J. L., MD, MS, EMT-P, FACEP, FAEMS & Verkest, M., A.A.S, CCP-C, FP-C, C-NPT, Paramedic. (2019, August 7). The EMS Lighthouse Project: A Dangerous Proposition: Use of Red Lights and Sirens Study [Audio blog post]. Retrieved 2020, from https://www.flightbridgeed.com/index.php/emslighthouseproject-podcast/13-ems-lighthouse-project-podcast/468-a-dangerous-proposition-use-of-red-lights-and-sirens Kupas, D.F., MD, EMT-P, FAEMS, FACEP, et al., (2022, February 14).  Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses, Retrieved 2022, from https://www.nvfc.org/wp-content/uploads/2022/02/22Feb-Joint-Statement-on-Red-Light-and-Siren-Operations.pdf Kupas, D. F., MD, EMT-P, FAEMS, FACEP. (2017, May). Lights and Sirens Use by Emergency Medical Services (EMS): Above All Do No Harm [Pdf]. Washington DC: U.S. Department of Transportation, National Highway Traffic Safety Administration, Office of Emergency Medical Services (EMS), from https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf LLP, A. (2018, June 30). Louisiana Jury Awards $117 Million to Woman Injured in Ambulance Accident While Pregnant. Retrieved November 19, 2020, from https://www.prnewswire.com/news-releases/louisiana-jury-awards-117-million-to-woman-injured-in-ambulance-accident-while-pregnant-164761026.html Mikkelson, D., & Mikkelson, D. (2011, April). Do Mail Trucks Always Have the Right of Way? Retrieved November 19, 2020, from https://www.snopes.com/fact-check/four-play/See omnystudio.com/listener for privacy information.

On 8/22/2021, a Colorado grand jury handed down a 32-count criminal indictment against the police officers and EMS personnel involved in the incident that led to Elijah McClain’s death. On this episode of the Standard of Care, Nick and Samantha try to untangle what these indictments could mean for the EMS community. We reach out to our resident experts - former prosecutor (now business lawyer) Chris Timmons and defense attorney (and Samantha’s law school classmate) Stephen Coxen – for answers. How do prosecutors even decide to file charges in a case like this? How does a grand jury work? What are the strengths and weaknesses of the prosecution’s case, and how does a criminal defense attorney defend a client against these charges? What can EMTs and paramedics do to protect themselves from potential criminal liability? Please like, comment, and subscribe!See omnystudio.com/listener for privacy information.

COVID-19 has strained the healthcare system to its breaking point. In this episode of the Standard of Care, Nick and Samantha are joined by Beth Sivertsen, Medical Ethicist and critical care nurse. We examine “crisis standards of care” and what those words mean for EMS. What are crisis standards of care? Who declares that they are in effect? What impact do crisis standards have on EMS providers’ legal obligations to patients? What is the ethical thing to do in a situation where resources are limited, and how should those decisions be made? Please like, comment, and subscribe!See omnystudio.com/listener for privacy information.

On this episode of the Standard of Care Podcast, Nick and Samantha take on the controversial topic of religious accommodations for the COVID-19 vaccines under Title VII of the Civil Rights Act of 1964. Can employees request religious exemptions from vaccinations? What is a “sincerely held religious belief”? What information should employees provide, and what can employers request? What is an “undue hardship” for an employer?See omnystudio.com/listener for privacy information.

Fatigue in EMS isn’t new. Almost every EMT and paramedic has a story. So grab a coffee or an energy drink and join us as Nick and Samantha take a look at a recent case that happened in our own backyards. We consider the criminal and civil liabilities that fatigue creates for EMTs, paramedics, and EMS agencies. What can the tired EMT or paramedic do? What should agencies be doing to decrease the fatigue suffered by employees in the face of increased call volumes and staffing challenges? Will it take a nuclear verdict or two for everyone to get serious about fatigue?See omnystudio.com/listener for privacy information.

Intubations are risky business. Paramedics – and their patients – benefit from the right tools, education, and training. But when does “practicing intubations” become an issue of legal liability? On this episode of the Standard of Care Podcast, Nick and Samantha review the case of the Bellingham, Washington fire department’s intubation practice on a deceased patient. The incident spawned several lawsuits and resulted in the City’s public release of its outside counsel’s confidential investigation. What can an EMT or paramedic faced with a similar situation do? How should an agency handle a patient who dies in the ambulance? What should agencies do to ensure that medics receive proper training on intubations? What options will the agency’s lawyer have – if any? Please like, comment, and subscribe!See omnystudio.com/listener for privacy information.

On this episode of the Standard of Care Podcast, Nick and Samantha try to help EMS providers make sense of one of the most widely known (yet least understood!) laws on the books, the Emergency Medical Treatment and Labor Act (EMTALA). What is the law meant to address? Is EMTALA different for hospital-based and non-hospital-based EMS providers? Can your ambulance be parked at the ER ramp, or your patient turned away? What does the 250-yard rule have to do with care? Has COVID changed the way that EMTALA applies, and can we expect to see these changes continue? Please like, comment, and subscribe!See omnystudio.com/listener for privacy information.