Ambulance

Thijs Gras’ Letter from Amsterdam
Isn’t it Time that Patients Take Responsibility as Well?
Below our thoughtful and thought-provoking Dutch correspondent, Thijs Gras, explains the high level
of legal responsibility for the patient assumed by Dutch ambulance nurses every time they go on-shift.
He also asks whether or not now is the time we should finally also make patients legally responsible for
co-operating with the ambulance nurse or paramedic so they can actually provide them with the high
levels of patient-care that they rightly expect… but without harassment or interference!
In our work we should always strive for the
best in caring for a patient. This is pretty
obvious - so obvious that it has almost
become a hollow sentence. We know
that in practice there is tension, especially
when patients’ interests and colleagues’
interests are conflicting. For example, a
delay of several seconds when one takes
over the call of another ambulance in order
to prevent them doing overtime. Will the
patient notice this? No. Will he or she suffer
damage from this? I would say ‘no’ to this
too. Maybe those seconds make it possible
to take a crossing more smoothly so you
make up for it.
More serious are the cases where the team
disagrees about how to handle a case.
Luckily this is not very common. We all
know we should not discuss these things in
front of a patient. In our Dutch system we
have a nurse and a driver, so it is clear who
is medically responsible and whose decision
in patient care is final.
Judicially, the patient has a lot of power in
our country. We are obliged to inform the
patient about what we are going to do and
in the end the patient decides if he is treated
or transported and he or she can even
indicate the hospital where he or she wants
to go to. Of course there are some limits,
for example because that hospital lacks the
facilities or is too far away.
We respect people who have indicated that
they do not want to be resuscitated. These
always present precarious situations and in
those cases our family doctor system really
helps. Patients have spoken beforehand
to their doctor who generally knows the
situation well and can safely tell us to stop
the resuscitation attempt. We also refrain
from setting IV’s if a patient really opposes
it even though it deprives him or her from
effective analgesia.
In quite a number of cases we just advise
the patients and we do not transport them
to the hospital. This happens in about 25-
30% of cases and this percentage is rising.
The cause of this is still not clear: do people
call more often? Is this
due to the use of triage
systems in the control
room?
There are a few
possibilities: we were
really not necessary at
all (for example a young
girl with abdominal pain
due to her periods), we
may give treatment on
the scene (reviving a
diabetic with glucose),
we may advise people
to call or visit their
family doctor or we
may advise them to
go to the hospital with their own means of
transport.
In all of these cases, legally we are on thin
ice because we were the last medical
professionals to have seen the patient
and until the next professional makes
contact with the patient; this means we are
responsible.
But let us not only talk about the patients’
rights, but also about his duties. I think
more attention is needed on this aspect
of patient care. First of all the patient is
obliged to let us help him or her. This is
sometimes quite tricky with people under
the influence of alcohol, drugs or mental
disorders. Then it would certainly help if he
or she is polite to us. We do not deserve
swearing and cursing while we help
someone.
And then there is the following of our
advice. Who is to blame when we
instructed a non-drunken, well behaved
person to go to the A&E department
himself and he does not do this but suffers
from damage as a result? I would say it is
not the ambulance crew. Who is to blame
when the control room instructed a caller
to call his family doctor, but he decides
to wait and gets into trouble because an
inflammation that could have been tackled
earlier now gets the chance to do more
harm? I would say it is not the control room
dispatcher, though legally (according to
Dutch laws) he is.
It is time to write in the law something
about patient duties. These involve not
only behaviour, but also listening well to
ambulance personnel and doing something
with the advice given. If the patient refuses
this, that is his or her own decision and
it is his or her responsibility. For with
rights come duties, with power comes
responsibility. That goes for us ambulance
people, but also for patients. If the doctor
says you should stop smoking and you
refuse this, your next heart attack cannot
be blamed on the doctor.
Tell Thijs what you think about this
article by emailing him at:
thijsgras@upcmail.nl
This edition of Ambulance Today goes out to all 25 Dutch Ambulance Regions courtesy of Procentrum
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Spring 2016 | Ambulancetoday
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