Healthcare & Public Safety: A medicolegal risk comparison of Paramedicine models; for patient safety in adverse patient events

Across Canada we have a wide variation in the Paramedic service delivery models, licensure and qualification of Paramedics.  Debate has ensued for as many decades as Paramedicine has been an organized profession across the country as to the best model.  This talk explores the effects of the different models on patient safety and Paramedics as a result of how adverse events are handled by organizations.

In this talk the audience will be taken on a tour of the Canadian landscape through medicolegal introductions of various delivery models and qualification schemes for Paramedicine. While exploring the models the audience will be introduced to concepts as they affect Paramedics and Paramedic service delivery within the laws of Canada and some of the associated risks.

Tort law is the grounds for civil litigation of harm resulting from negligence in Canada. When a clinician fails to meet an accepted standard of care, they are open to proceedings under tort law. What are the differences that may affect a Paramedic and/or a service with regards to a negligence suit, what is the employer’s vicarious liability when Paramedics are self-regulated versus certified or licensed as in the varied models? Human Resource departments most often look at adverse events through a tort law or negligence-based lens.

Building a trusting organization with a just culture is paramount to a patient-centred and patient safety environment. Without trust and psychological safety, one cannot truly reach a place of learning in adverse patient events.  How does the law and legislation treat paramedics honest and truthful account of circumstances during an investigation process?

In some province with Paramedicine falling under the healthcare system, all aspects of an adverse patient event investigation are protected and privileged. Such investigations cannot be used against Paramedics in human resources processes, civil or criminal litigation. In other provinces and with the public safety model, this information is not protected and presents a significant barrier to patient safety. Are the public safety model potentially harming patients?

It’s not a surprise that many Paramedics across Canada find themselves in a quandary considering current Canadian events with Paramedics being charged criminally and internal service investigation documents in the hands of prosecutors.  Deep consideration needs to be given to understanding the various aspects of medicolegal risk for paramedics, the effects on organizational culture and ultimately the effects downstream on patient safety.

The modern safety science evidence is abundantly clear when it comes to patient safety and which model has superior outcomes. Do we have the collective will to unify, change the landscape across the country and establish consistent leadership systems that support patient safety as a priority?

This talk will explore the concepts by weaving an adverse patient care event throughout the talk, to show where demonstrated differences in the handling by various systems can change the potential outcomes and downstream effects of each given system.

Objectives of this talk:

  • Provide an overview of the various paramedic service delivery models and paramedic qualification schemes in relation to where they fit in Canada, with respect to tort law and negligence liability;
  • Review the Canadian Tort law system and requirements to constitute negligence in a medical case;
  • Provide an overview of healthcare-based legislation that protects paramedics participation in adverse quality event reviews with privilege and those systems that lack such legislated evidentiary protection;
  • Show the impact on patient safety based on having this type of legislation present and applicable to a Paramedic service;
  • Pose the question and challenge the audience on how we are going to bring all Paramedic services in Canada into a healthcare patient-centred risk model for patient safety.

Disclaimer: This talk covers elements of the Canadian legal system and interpretation of law. The presenter is not a lawyer and any legal discussion within this talk is not given for the purpose of, nor should it constitute legal advice. The content is based on evidence-based literature, case law and professional or academic reviewers to ensure high quality and as much accuracy as possible.