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Ethical Responsibilities of a First Responder

In 1995, the U.S. Department of Transportation released a training manual formalizing the creation of a new category of emergency worker called "first responder" (FR). The curriculum, intended to fill a gap between the eight hours of training needed for a first aid provider and the 120 hours typically required for emergency medical service technicians, could be completed in 40 to 60 hours. Today, first responder certification is almost always mandatory for professional firefighters, often for police officers, and represents the minimum prerequisite for all emergency service workers who may have to respond to calls for help. FR status may also be required or recommended for other people whose jobs might put them in emergency situations, including lifeguards, teachers, school bus drivers, pilots and flight attendants.

  1. Duty to Act

    • Ordinary citizens who happen upon the scene of an accident are not legally required to render emergency assistance, but first responders are. Failure to provide care, or terminating care without ensuring that it will be taken over by another qualified medical professional, constitutes negligence or abandonment.

    Standard and Scope of Care

    • In emergency situations, first responders must use their skills to the best of their training and ability while operating within the relevant laws, policies and protocols set down by their state, locality and employer. They should advance their knowledge and keep their skills up to date with regular continuing education and refresher courses.

    Consent

    • People are legally entitled to decide what is done to their bodies, so consent must be given before first responders provide any treatment. Expressed (also known as actual or informed) consent indicates acceptance of treatment but in order to give it, the patient must be of legal age, conscious and rational. In the absence of indications to the contrary, the consent of unconscious patients may be seen as implied. When minors need emergency treatment and no parent or legal guardian is present, first responders should provide the care and let the hospital seek consent for further treatment afterward.

    Refusal

    • Patients have the right to refuse treatment, or decline further treatment, at any time. When this happens, first responders should try to persuade them to accept care, informing them of the possible consequences of refusal. The assistance of other emergency personnel and police officers may be sought, but first responders don't have the right to overrule patients' decisions.

    Advance Directives

    • Advance directives, also called living wills, generally take the form of a written order from a physician and specify that a terminally ill person is not to be resuscitated. The existence of such an order is sometimes flagged by a bracelet, necklace or card. When in doubt or in the absence of written orders, first responders should begin resuscitation.

    Crime Scene Preservation

    • First responders should notify the police if called to what they suspect might be a crime scene. Providing treatment must always be their first priority, but they should take care not to unnecessarily disturb items at the scene and to document anything that seems unusual. Whenever possible, clothing should not be cut off victims of shooting or stabbing.

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