Today’s burning question: I was in your class at FDIC 2014 on Duty to Act, which was a real eye-opener. We were discussing it in the station today and one of the paramedics mentioned a smartphone app called PulsePoint, that can notify you if someone nearby is having a heart attack. Doesn’t that raise some duty to act questions?
Answer: GOOD LORD…. THAT IS THE UNDERSTATEMENT OF THE DECADE!!!
For those not familiar, Pulsepoint is a smartphone app which the developers explain as follows:
“PulsePoint empowers individuals, within covered communities, with the ability to provide life-saving assistance to victims of cardiac arrest. Application users who have indicated they are trained in cardiopulmonary resuscitation (CPR) are notified if someone nearby is having a cardiac emergency and may require CPR. If the medical emergency is in a public place, the application uses sophisticated location-based services to alert trained citizens in the immediate vicinity of the need for CPR. The application also directs these citizen rescuers to the exact location of the closest public access Automated External Defibrillator (AED).”
As envisioned, when an emergency dispatcher becomes aware of a patient in the community needing CPR, the app is used to notify those who have registered who are nearby. Ingenious!!! It is a phenomenal idea that no doubt has the potential to save countless lives.
But let’s think it through from the duty to act perspective using case history to guide us.
The poster child for a duty to act case gone-wrong involves the two FDNY EMTs who went into an Au Bon Pain on December 9, 2009 at about the time an employee, Eutisha Rennix, began having an asthma attack. Rennix was pregnant at the time, and she and her baby died.
Her family alleged that the two EMTs ignored her as they sat drinking coffee and eating bagels claiming to be on a coffee break. The truth… well that is an entirely different story from what the family alleged: the EMTs were actually dispatchers who were on a coffee break from the dispatch center. They were standing in line getting coffee to go and were recognized by Au Bon Pain employees as dispatchers. They were not asked to help the woman – but rather they were merely asked to summons an ambulance – which they did indeed do. The resulting firestorm of outrage brought on by Ms. Rennix’s grieving family resulted in criminal charges, disciplinary actions, and civil suits being filed.
The Au Bon Pain case is useful for us as we start to consider the implications of the new technology. So let’s think of the implications:
While enroute to a CO alarm an on-duty firefighter is notified by the app that someone is having a heart attack on the very street he is on. The truck does not stop but proceeds on the run as dispatched, and the heart attack victim dies. Might the family spin the story as we saw in the Au Bon Pain case?
What about a paramedic driving to work… does she have a duty to respond to the app? Does it matter if she is within the boundaries of the community that she works for or is in a neighboring community? If she is under a duty to act and she is injured, is she covered by workers comp? What if she is off duty… does she have a duty to act?? What is the impact of having a few adult beverages to the duty to act???
Lots to ponder. Here is more on the app:
The volunteer fire service deals with this commonly. If a department operates on a call back basis (does not have duty shifts for volunteers) the volunteer makes a decision on receiving the page as to whether or not they will respond. If they choose to go they have assumed a duty to act and if they choose to stay home they have not assumed this duty. Wouldn’t this app be the same thing? If you choose to respond you are assuming the duty to act but if you look at it and choose not to respond then you have not assumed the duty. This would apply to your off duty paramedic as well. As for the on duty firefighter in route to a CO alarm, protocols exist for multiple calls in most jurisdictions. If they were following their established protocol would they not be protected?
James – yes and no. Theoretically – yes it would be like a pager to a volunteer WHEN THE SUBSCRIBER IS OFF DUTY. What about when the subscriber is a paid firefighter and is on duty… and perhaps is assigned by the department to do something different, like putting out a fire, responding to an alarm (that may later turn out to be nuisance alarm), treating another patient nearby, or even something like going to a random drug screening, etc. etc. etc. What if the person is on light duty due to a previous injury and is not supposed to engage in anything physical… there are many many possibilities that can make for a very difficult situation.
Now remember – the technology we are talking about knows exactly where you are through your cellphone’s GPS – and it can document where you were when the request for help was issued. A simple pager used by most volunteer fire departments does not leave a digital trail of evidence that can PROVE a volunteer was available to respond to an alarm and chose not to (I know a few fire chiefs would love to have that capability for those members who cherry-pick their runs). When you couple that kind of technology with the death of a patient – and consider the predicable response of some grieving family members who are looking for somewhere to place the blame – even volunteer firefighters would not be immune from the kind of outrage that was directed at the 2 EMTs in the Au Bon Pain case.
One problem with the NYC case is this: is it really a good idea to dress dispatchers — who rarely (if ever) interact with the public face-to-face — in uniforms? The average citizen wouldn’t bother to read the patch or nameplate that says “Dispatcher,” he’ll just see an FDNY uniform and assume the uniformed personnel are firefighters (which may be our own fault, for having become so good at everything).
It would seem that if an EMS professional (i.e., full-time paid career department) were worried about the liability aspects, he simply would not sign up. Or perhaps a department could prohibit full-time members from signing up, or at least from responding to pages during work shifts. Remember, this new system is aimed primarily at citizens (“good Samaritans”). Of course, most full-timers probably *would* sign up, as a logical extension of their desire to help.
You bring up a good point about on duty staff who have other assignments. If they are committed to another incident then I would have to think that it would be handled no different than any other instance multiple incidents for the organization. But if they are on light duty or they are out for admin purposes like a drug test or a meeting it could be a different story. It also brought to mind if they are on duty and completing a non emergency assignment with a fire agency that does not respond to EMS alarms. In those cases having your location recorded could be an issue and it will be interesting to see if (when) it does develop.
As for the family and community response, the fact is that this happens and often the facts lay out a much different reality than that presented in those cases. In our business we will always see hurt families and some of those will seek to lay blame at our door (sometimes rightfully so unfortunately). As a fire administrator I am of the mind that getting ahead of this with some policies is a good idea but at the same time you can’t write policies for everything and technology is progressing much faster than we can keep up with.
Excellent points. Again – without an app like Pulsepoint – a person’s whereabouts are not tracked – so a volunteer who chooses not to respond has not created a cybertrail that proves he was within 200 yards of an emergency when a run came in (although as you suggest someone may claim to have seen him there). The visual sighting – unless publicized – might never be discovered by the victim’s grieving family. However when you combine the technology with the reality of a grieving family – it is inevitable that some families will demand to know why it took so long… did people who “should have” responded, not respond. I 100% agree with you – policies are a necessary tool of leadership, and we cannot have policies for everything… a leadership paradox.
Andrew – Good point. I recall a city that will remain nameless – that dressed civilian fire inspectors up so they looked like firefighters (FD patch and FD badge on a white shirt) and when the FFs’ union complained – said “its none of your business” and the fact that firefighters wore blue shirts made the inspectors clearly distinguishable…
As for whether professional EMS personnel should sign up… the jury is out. If there was some assurance that the technology did not retain the data about who was contacted and where they were – it would solve my immediate concerns… however that same info is what PulsePoint would need to prove their system worked!!! It is inconceivable they would not track it – and even if they promised not to release it – it still could be obtained via court order.
Yeah at the end of the day having your location recorded could be a real problem. As in your comment below it would be worthwhile not to track that information.
PulsePoint cannot identify an individual. PulsePoint notifies the “device” (it knows the location of the physical phone) but nothing about the user. It is designed very specifically to be anonymous.
From the website FAQs at http://www.pulsepoint.org/pulsepoint-respond/#faqs
The PulsePoint app is a Location-Based Service (LBS) with the ability to make use of the geographical position of your mobile device. The LBS capabilities of the app allow you to see your current location relative to the incidents occurring around you. This is an optional feature that is not enabled by default – you must specially opt-in to utilize this functionality. In addition, if you opt-in to the CPR/AED notification, the PulsePoint server will store your current location for immediate reference during an emergency where you may be nearby. In this case, only the current location of your device is stored (no movement history is maintained) and your identity is never known to the PulsePoint application.