Whilst there is no law that forces anyone to treat a casualty this does not mean that one can simply leave a casualty who you know is in danger. To do so may make you liable through your omission to act. If you are not happy to provide First Aid treatment in the 'classic' sense there are several things you can and should do including (but not limited to): Show
These are examples of simple but important actions that can be done without 'getting your hands dirty'. What if I injure the casualty? A person who administers First Aid will only be liable for damages if negligent intervention directly causes injury which would not otherwise have occurred, or if it exacerbates an injury.(1) If First Aid is administered inappropriately or negligently and a consequential injury can be proved to have arisen from that procedure, a First Aider may be held liable for substantial damages if the standard of care he employed fell below that which could be expected of him in the given circumstances. This applies whether they are a healthcare professional, a non-professional volunteer first-aider, or simply an unskilled member of the general public. (1) For example, if a person inappropriately administered chest compressions where a casualty was not in cardiac arrest, which caused damage to the chest wall or underlying organs, they would be causing damage which would not otherwise have been suffered and, given that the casualty was not in need of emergency resuscitation, would by his intervention be leaving them in a worse position. If, however, CPR is performed on a casualty in cardiac arrest, It is difficult to see how a persons intervention could leave someone worse off since a victim would, without immediate resuscitation, certainly die. Furthermore, if an AED is being used, it will only permit the administration of a defibrillatory shock when it detects a shockable rhythm and, since patients in this state are clinically dead, it is unlikely that any intervention with this device could make the situation worse. Attending an accredited First Aid training course not only provides you with life saving skills but skills, knowledge and understanding of current best practice. A First Aid certificate is not a 'licence to treat' but it demonstrates that the candidate, at the time of the course, was able to perform tasks to a nationally recognised standard. By treating a casualty to these standards you are protecting yourself against a claim of negligence. To treat a casualty in a way that goes against the training you have received or to treat a casualty using techniques you have not been trained in but have 'seen it on the telly' exposes you to a claim for negligence. Rule 2 – Only treat in the manner you have been trained. ConsentUnder UK law any form of physical touch without consent could be interpreted as common assault. (although is more accurately described as 'battery' in England and Wales or 'wrongful interference with the person' in Scotland). Practically this is unlikely to lead to a conviction if - for example - a First Aider were to hold the hand of a casualty to reassure them, without first gaining consent. A conviction could be made if the First Aider were to use any form of force against the casualty to administer treatment. Further Reading: British Medical Association - Consent Under the Mental Capacity Act (2005) (2) a person is presumed to have the mental capacity to make their own decisions unless proved otherwise. On the basis that the casualty has the capacity to choose to refuse treatment this must be respected. It is important that the casualty is not coerced or pressured into accepting treatment, rather they are helped to make an informed decision:
Further Reading: British Medical Association - Mental Capacity How do I know if they have the mental capacity to make a decision? The criteria set out by Section 3(1) the Act for a casualty to consent / reuse treatment is that they can:
But what if the casualty does not want to be treated? This situation is not as strange as it may seem; there are several reasons why a casualty, even with serious injuries may not want you to treat them.
What if they are unconscious? If a casualty is unconscious and therefore unable to consent – or indeed they had refused consent and then became unconscious – you are permitted to undertake treatment that is only required for the purpose of saving life. You are not permitted to undertake non-life threatening treatment, such as treating minor injuries. Section 5 of the Act applies in connection with the care or treatment of another person. If a casualty is found unconscious - and therefore their mental capacity cannot be assessed nor can the casualty express refusal of treatment - it is suggested that a First Aider who administers life saving actions should not incur any liability in relation to their actions (that he would not have incurred if the casualty had capacity to consent and had consented to treatment) providing that:
Is this "implied consent"? No. It is often stated that there is implied consent when the casualty is unconscious - the unconscious casualty has not implied anything! Implied consent is non-verbal agreement; for example if you ask "Do you mind if I examine your wound?" and the casualty holds their injured hand out towards you without saying anything, their action of allowing you to get closer to their injury assumes that they consent. The best interest of the casualty is usually doing as little as you need to, rather than as much as you can. This is true whether the casualty accepts or refuses your treatment. Rule 3 – Act in the best interest of the casualty. Advanced DecisionsWhat is a 'Living Will'? A Living Will or, more accurately, an Advanced Decision allows a person over 18 years to refuse specified medical treatment for a time in the future when they might nor have the mental capacity to consent or refuse to that treatment. Advanced Notices are commonly used where a patient with a known or predicted medical condition sets out their wishes – while they have the capacity to do so – regarding future treatment. Typically this may be that an patient with a degenerative health problem may request that should they suffer a cardiac arrest, they are not resuscitated. For a patient to refuse life sustaining treatment, the Advance Notice must be:
In terms of a First Aider responding to a life threatening situation it is unreasonable to assume they would be aware of this written document. It may be that a person known to the casualty attempts to prevent the treatment of First Aid if the casualty has made an Advanced Notice. Again, it is difficult and unreasonable for the First Aider to make a judgement about the validity of this claim. Should any bystander attempt to prevent life-saving treatment of the casualty, the emergency services should be called as paramedics and other healthcare professionals can – in certain circumstances – provide life saving treatment without or against consent. Further reading: NHS - Advance Decisions Children In the ordinary course of events, of a the parents' of a child (a person under 16 years) would either refuse or consent to treatment of a child. If a child required life-saving First Aid and the parents refused consent, it would be difficult to assume implied consent. Doctors and other healthcare professionals are, again, afforded the ability to make decisions regarding life-saving treatment against the wishes of the casualty on the basis of necessity. Whether this is afforded to a First Aider is legally unclear. Can someone refuse treatment on behalf of someone else? No one can refuse Life-Saving treatment on behalf of a capable adult or child over 16. SummaryRule 1: Only treat if you are willing and able to do so Rule 2: Only treat in the manner in which you have been trained Rule 3: Act in the best interest of the casualty Examples:1. Do I move an unconscious casualty, who isn't breathing if they have a suspected spinal injury? This dilemma is frequently perpetuated on TV or even in reality (if you have ever been unlucky enough to be at the scene of a car crash) when bystanders scream "Don't move them! They might have a neck injury!" Remember the 3 Rules:
It may be that the casualty has a spinal injury and you might make it worse by opening the airway but an unconscious casualty – especially if on their back – cannot maintain their own airway. If their airway is blocked s they will not be able to breathe and this take priority over any injury. If you have treated the casualty in line with your training it is therefore unlikely a claim will be made against you. 2. Am I liable if I break someone's ribs when performing CPR? Remember the 3 Rules
It is certainly possible that a rib can be broken whilst performing CPR, even if trained and practised to the best standards. A broken rib is not a priority of a casualty in this situation. Because of these two factors it is unlikely that claim would be brought against you. |