Legal Challenges in EMS and the Need for Better Constitutional Education

Legal challenges for providers in Emergency Medical Services (EMS) are not new issues, recently these challenges have come to include accusations of violations of the patient’s civil rights. The framers of the Constitution fought to ensure that the American people had the opportunity to pursue life, liberty and happiness which is the central theme to the first ten amendments to the Constitution known as the Bill of Rights. EMS providers are being found guilty in the legal system of violating the rights of their patients with excessive force, or their treatment decisions for the patient. Among the challenges that EMS providers face is that of ethical decision making in an unpredictable environment, that has an increased potential for violence to be committed against them. The legal landscape is an ever-changing environment for EMS providers to navigate, with education in Constitutional Law absent for many of these providers. A clearer understanding of the legal impact they may face is crucial for EMS providers to protect themselves and their patients from potential civil tort claims, criminal charges, and rights violations. EMS providers need improved education on the legal challenges that they may encounter concerning possible Constitutional civil rights violations.

Emergency Medical Services (EMS) has developed into an essential service in the United States, with providers ranging from the first responder to those trained to the paramedic level. A vast majority of American citizens are served by volunteers, EMS providers that are members of their communities. There is a concern that there will be a potential shortage challenging the EMS industry nationwide. EMS is a regulated industry under the Department of Transportation (DOT) that has delegated the administration of EMS to agencies designated by each State in the U.S. (Bledsoe et al., 2013). Consistency across the states is difficult to identify, with some states allowing an expanded scope of service, while other states maintain a tighter control over their providers. Training for an EMS first responder can range from a 40-hour weeklong course to a course that takes up to a year and over 1200 hours of education and clinical experience to complete. Certification curriculum of these courses are mapped out by the DOT, but each state and respective educational organization can decide how much time will be spent on individual subjects.

Legal matters that EMS providers may encounter is a critical part of the training that perspective providers undertake in their educational and certification process. The medical-legal component of this training consists of a one-hour lecture that largely focuses on the issue of consent, negligence, duty to act and living wills (Bledsoe et al., 2013). Updates to the providers textbooks dedicate 1 paragraph to the issue of potential civil rights violations and EMS providers (Bledsoe et al., 2013). Educational programs only direct a provider to remain current and up to date on the laws of their states for future reference. The need for better education about legal issues that EMS responders may encounter needs to be a greater part of any educational component to the certification process as well as a part of required continuing education. A specific need to address the Constitutional rights of the patient, and how a provider can potentially violate these rights is lacking in the education of EMS providers.

EMS and Civil Rights Violations

High profile incidents have been brought into the national spotlight as EMS providers have come under scrutiny that was previously held only by law enforcement officers. Many of these incidents have brought to attention the violations of the 4th Amendment protections found in the Constitution of the United States as the use of reasonable force or using sedative chemicals to subdue a patient that exhibits abnormal behavior (Obasogie & Zaret, 2021). The 4th amendment has been the standard in court precedence in determining if a law enforcement officer (LEO) has exceeded the reasonable force standard and therefore denied a subject of their rights (Obasogie & Zaret, 2021). A reasonable argument can be made that EMS providers may be identified under similar standards as LEO’s concerning the reasonable force use when managing patients that are combative, agitated or just being uncooperative. The relationship the LEO’s have with EMS providers has been highlighted in many of these high-profile cases in recent years, with that relationship coming under further scrutiny. In the past, courts have found that a diagnosis of excited delirium could be used to justify an escalation of the use of force by LEO’s as well as EMS responders (Osagie K Obasogie, 2021). Debate of this justification is centered on the issue that excited delirium is not a medical diagnosis that is recognized by the Psychiatric community (Osagie K Obasogie, 2021). Based on this evidence, it is critical that providers work together to ensure that all first responders are held accountable for their actions, with an emphasis on patient care and doing no further harm to a person.

First responders respond to unexpected situations daily and this highlights the need for ethical decision making by first responders (Torabi et al., 2018). To provide high quality patient care, providers must be trained on how to expediate patient care without sacrificing their safety (Brenner et al., 2018). Scenarios should include de-escalation techniques coupled with self-defense techniques that relate to a reasonable force policy that is consistent with 4th amendment rights. Historically studies done in the EMS industry have focused on the systems of the industry with little information on the factors that determine providers thought process on these difficult calls (Henderson, 2013). Understanding the motivational factors that are present in these situations can have an impact on future EMS education, with a focus on ethical decision making with high quality patient care and legal challenges in mind. This educational component needs to address the fundamental right that the framers of the Constitution fought for the right to pursue life, liberty, and happiness during these difficult situations.

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Workplace Violence in EMS

EMS providers experience workplace violence at a rate that is higher than the average American citizen in their jobs, which can have an impact on their decision-making process. These violent experiences can be brought on by the patient, a family member, a bystander or by another EMS Provider (Reichard & Jackson, 2010). EMS providers should be educated on the prevention of the injuries that can be sustained when they are the recipient to workplace violence (Taylor et al., 2016). Dealing with the process when assaulted as an EMS Provider can lead to underreporting of incidents of violence in EMS and a feeling that the judicial system has failed the provider (Wright et al., 2019). A common perception of the judiciary and the general public is that for EMS providers, it is “just a part of the job”, which can lead to frustration for those providers that have been assaulted while performing their job (Wright et al., 2019).

?EMS organizations need to develop policies and procedures that create a comprehensive systemic approach to reducing exposure to violence in the workplace for EMS providers (Murray et al., 2020). The determination of the patient’s medical needs in these volatile situations is often vague, incomplete and can lead to fatal outcomes for the provider and/or the patient, highlighting the need for better education in this matter (Henderson, 2013). The 14th amendment in the Bill of Rights under section 1 states that “nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.” Equal protection under the law should be applied to first responders that encounter situations of workplace violence, regardless of the “it’s just a part of the job” mentality.

The Constitution and EMS

The framers of the Constitution came from established communities with a common belief system that is reflected in the constitutions of the early states as well in the words of the U.S. Constitution (McClellan, 1989). The laws and statutes that they developed in these early communities were based on what type of society that they wanted to become, beginning at the local town level (Tocqueville et al., 2012). Congress was given substantial control over the laws of the federal government, with the judicial branch overseeing the constitutionality of those laws (Harrison, 2018) Through the Supremacy Clause of the Constitution it has been established that the Constitution is the law of the land and supersedes any laws that are not in line with it (Harrison, 2018). While the advent of regulatory and administrative agencies would not have been something the framers of the Constitution were acquainted with, their existence is within the parameters of the Constitution. Congress has been given the authority to establish laws, statutes and regulations that are designed to meet the needs of the people as they deem necessary (McClellan, 1989). For these agencies to function properly however, they too need to be sure that their regulations and processes are compliant with the enumerated powers that have been established in the Constitution.

?Through their work, the framers established in the Constitution a guarantee to the American people that they would have a form of Republican government, yet they did not clearly define what that form of government would consist of (Louk, 2020). Self-representative government was the model of the republicanism that the framers were attempting to bring about for the American people, leading to the many debates of the federalists and the anti-federalists during the ratification process (Louk, 2020). Through these debates the Bill of Rights was a compromise that encouraged the ratification of the Constitution to establish the federal government. Accusations of civil rights violations are occurring more often in the EMS industry and for this reason improved education is necessary for EMS providers to ensure that they are compliant with the Constitutional rights of their patients.

References

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Wright, J. Y., Davis, A. L., Brandt‐Rauf, S., & Taylor, J. A. (2019). “Felony assault should stick:” Assaulted EMS responders’ frustration and dissatisfaction with the legal system. American Journal of Industrial Medicine, 62(11), 938-950. https://doi.org/10.1002/ajim.23036