Jeff Clawson, M.D.

Jeff Clawson, M.D.

Ask Doc

By Jeff Clawson, M.D.

Miss Arabella VanBeuge,

IAED Membership Services Manager My name is Jillian Glasgow, and I’m a summer research student in New Brunswick, Canada, working for one of the Regional Health Authorities (RHA). I am currently compiling an estimate of licensure costs for the RHA. Related to my project, I’m also looking specifically at Professional Liability Insurance and was hoping you might be able to answer a quick question for me: Do dispatchers (specifically medical dispatchers) need to carry Professional Liability Insurance? Any help you can give me is much appreciated.

Thank you,

Jillian Glasgow Summer Research Student Organizational Learning Saint John Regional Hospital Horizon Health Network Zone 2 Saint John, New Brunswick, Canada

Dear Jillian, I am in receipt of your most interesting question about liability for Emergency Medical Dispatchers (EMDs). In the Western world, especially the U.S., EMDs are exposed to a variety of critical and fast-moving situations that expose them and their centers, and the EMS systems they serve, to potential and accused liability. More specifically, you queried whether the EMD personally needs such insurance. Let me start by saying that most governmental and private EMS providers carry liability, or errors and omission, insurance for their employees and, as such, the EMD is covered under that umbrella. There have been cases where the actions of the EMD were so willful and wanton that they themselves have been sued. This is rare, however, and usually revolves around some convoluted legal responsibility, employment, governmental statute of limitations, and/or immunity issues. The bigger question is what is the best prevention for these tragedies that embroil the EMD and their center/system? By far, in my opinion, it is the following:

1) Failure to obtain and verify the caller’s location and phone number correctly

2) Failure to follow established calltaking protocols

3) Failure to provide pre-arrival telephone instructions when possible and appropriate

4) Failure to follow organizational policies and procedures

5) 1st party gone-on-arrival situations assumptions in call cancellation Ancillary to these is the often associated problem of the calltaker judging the integrity or truthfulness of the caller, which the IAED strictly prohibits. This seems to rear its ugly head as a common thread in these lawsuits, and such poor judgment routinely flirts with the above areas as they get off of the straight and narrow professional path. At times, calltakers stray this direction because of unwritten but powerful management pressure about “gate-keeping” to sort the “not-truly-deserving-of-9-1-1-help” out of the system. This is the emperor’s clothes of dispatching.

An interesting fact that you should be aware of is, of all the 3,835 communication centers in 44 countries using the IAED’s Medical, Fire, and Police Priority Dispatch System Protocols over the past 36 years, there has never been a formal lawsuit, much less a successful one. Compare that to the medical malpractice count in any one of these countries or even one hospital or clinic. It is a truly amazing record (knock on wood).

Several U.S. emergency ambulance insurers require IAED training, certification, and protocol use to even insure the agency. The IAED program is literally considered an “immunization” against dispatch liability in many quarters. In comparison, one top five-sized city has been involved in at least nine dispatch-related lawsuits in the past 25 years, with several ending in multi-million dollar judgments against them. Not surprisingly, they have shunned the IAED program all this time while continuing their forays into the courts. I must disclose that I have been an expert witness against them 6 different times. One of these, that I was not a part of, was a judgment of 50 million dollars against them.

I also refer to Chapter 11 of the “Principles of Emergency Medical Dispatch” 4th edition textbook on Legal Aspects of EMD that included a number of seminal cases that might be of interest to you in your review of these issues. Please also see Insurance Aspects of EMD in “Principles” 4th edition pages 11.31 & 11.32. Also, see the early article on the Dispatch Danger Zones published in the IAED’s Journal many years ago and accessible on our web-site (see below).

I hope this initial discussion on these issues might be helpful to you in your work. I am also copying two pre-eminent legal experts in the EMS and dispatch field, Winnie Maggiore and Doug Wolfberg, should you care to contact them also.

Please let me know if further information would be helpful in your endeavors. Just to be clear, I am not a lawyer, but I did sleep in a Holiday Inn Express recently … Doc.

Jeff Clawson, M.D. Division of Research, Standards & Academics