Bad Decision Making In EMS


There is a lot of it, some by management, some by medical control, a lot of it by providers. Usually it’s just something we gripe about and bad decisions don’t necessarily result in bad patient care or bad patient outcomes.

Then there are incidents like this.

Jury Awards $172 Million in Verdict Against New York City

A girl who suffered brain damage while waiting for an ambulance won a $172 million judgment against New York City on Wednesday when a Bronx jury determined that Fire Department paramedics could be held liable for giving her mother bad advice.

Bad advice? What kind of bad advice could two EMTs give a family member that would result in a huge judgement ?

This sort:

Tiffany’s mother, Samantha Applewhite, called 911, and the city sent two Fire Department medics in a basic ambulance, without the advanced life support equipment she needed, the documents said. One medic began cardiopulmonary resuscitation while the other called for an ambulance with the proper equipment. The city paramedics also failed to bring oxygen or a defibrillator, evidence at trial showed.

Ms. Applewhite begged the city paramedics to take her daughter to Montefiore Hospital, a few minutes away, but they advised her to wait for the private ambulance with advanced life support equipment to arrive, the evidence showed.

There’s both bad practice and bad advice going on here. First for reasons that aren’t explained in the article, the BLS crew went to the patient without two pieces of equipment that should be brought in on every call, every time. I’m pretty sure that FDNY-EMS  has a rule about that. I’d bet on it as a matter of fact. That was bad enough, but under several court decisions that would not be enough to sue the city or probably the individual providers.

What the family could sue the city for is the part where the EMTs told her that it was better to wait for the ALS  unit to arrive. Monumentally bad advice and again, probably a violation of the FDNY rules. Maybe not though, since sometimes management does come up with goofy rules about waiting for ALS. “Management” including regulatory agencies in some cases.

The rule I worked under both as an EMT and a paramedic was this. If you can get the patient to a hospital before the paramedics can get to you, don’t fart around on scene. Go. To. The. Hospital. Everything (and more) that the paramedics can do, the hospital can do.

The Bronx jury decided the medics had crossed a line by advising the family to wait rather than taking the girl immediately to a hospital and thus were liable for her brain injuries.

People joke a lot about how juries are composed of 12 people not smart enough to get out of jury duty. The truth is jurors generally pay attention to the testimony and the judge’s instructions before they go into their deliberations. Even if the joke is correct, the jury got this one right and I’m willing to bet that they aren’t even EMTs!

The call happened in 1998, so it took a long time to get to trial and get a verdict. The case may not be over because the city can always appeal that verdict and the amount. Still it’s an interesting case and potentially a very important decision. At least if you work in EMS in New York State.

Keep this in mind the next time you’re tempted to say something like, “I don’t think you need to go to the hospital, it’s probably just the flu.”

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


  1. …”against New York City”… And NYC gets it’s money by earning it? No by stealing it from the people of NYC, the city just says screw it, and raises taxes.

  2. We have a great refusal form done by Doug Wolfberg. We akways taught you have a duty to scare people by highlighting the possible negative consequences of not seeking treatment and they can call us back anytime. You will get in less trouble with a transport that didnt have to happen vs. One that was needed and didnt happen. With most of our transport times in under 15 minutes there is no real reason to wait for ALS beyond the ED staff complaining.

    • One principal I always lived by was that we don’t work for the ED. Our responsibility is to the patient, first, foremost, and always. Which is why I never did IVs or anything else because “that’s what the ED wants.” Because if the shit hits the fan no one in the ED is going to lift a finger to help you.

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