Two Saturdays ago, my wife and I were driving home from an event in Scottsdale at 1 pm. I had bent down to pick up my phone and when I sat back up, I saw the brake lights of the tan sedan in front of us light up; the car swerved slightly to avoid traffic further up the road that had suddenly slowed down. I kept my eyes on the tan car as my wife also hit her brakes: I think she’s going to hit them! She didn’t and I was relieved for approximately 30 seconds before we were thrown forward and up onto the median by the car behind us, which hadn’t had time to stop.
We joined a large cohort of Arizonans who experience motor vehicle accidents every year. According to the 2017 ADOT Arizona Motor Vehicle Crash Facts report, there were 127,064 total crashes in the year 2017. Of that number, 919 resulted in fatalities with a total of 1000 deaths. In addition, there were 55,474 individuals injured.[1]
It’s likely everyone who reads this has either experienced or will someday be in a similar situation if they continue to live and work in a busy metropolitan area like Phoenix. From a medical ethics perspective, this is important to consider because health care providers must decide how they will respond in an emergency.
Thankfully, after our accident, everyone involved was able to walk and get out of their vehicles, so the level of emergency involved was arguably low. Even so, I spent the last two weeks wondering if there was something I could have or should have done. I didn’t have a stethoscope with me, I didn’t have my blood pressure cuff, and I spent several minutes after the crash wondering why I couldn’t see (my glasses had flown off). Still, I wondered; could I have helped somehow? I concluded that as a medical student not yet into my clinical years and experiencing a not-insignificant amount of disorientation (re: glasses) the answer was probably no.
What if I was in a car driving past an accident two or four years from now rather than a participant. Would my answer change?
Arizona Statute Title 36-2263, better known as the “good Samaritan law” protects against liability for personal injury in the use of an AED or CPR by both physicians and “Good Samaritans”. The latter is defined in the statute as “a person who uses an automated external defibrillator to render emergency care or assistance in good faith and without compensation at the scene of any accident, fire or other life-threatening emergencies.” Other Good Samaritan legislation protects individuals who break into a vehicle to save a child or pet[3] and provisions in the Arizona Opioid Epidemic Act protect people who call 911 in response to an opioid overdose.[4] Although I couldn’t find a statute specifically related to medical students taking vitals (or performing other services they felt comfortable with), I would consider the “good faith” stipulation of Title 36-2263 to indicate that a medical student, physician, or other ‘good Samaritan’ can assist in an emergency to the best of their knowledge and abilities.
The next question is whether a medical student or physician is obligated to. The answer to this seems to be no. In some countries, physicians are legally required to respond, but not in the US. Here, medical responders are protected legally if they do choose to help when off-duty, except in the case of negligence or intentional harm.[5] However, whether or not they choose to is a question of ethical duty rather than a legal obligation.
To this point, in an article from the AMA Journal of Ethics, June McKoy, MD, MPH, JD discussed the Emergency Medical Treatment and Active Labor Act (EMTALA). This act places a duty on hospitals and physicians to “stabilize” and “screen” patients seeking emergency care. There is no direct liability in the act but physicians who repeatedly violate its stipulations may face other consequences. However, McKoy points out a distinction between emergency and non-emergency care stating, “no common law duty or ethical imperative exists outside of EMTALA or patient-physician relations that requires a physician to treat every patient.”[6] Furthermore, there is a difference between the duties of a physician working in a hospital setting versus driving home on the highway.
Closer to my own questions about responsibility and duty as a medical student, in March 2018 Medscape asked their readers whether medical students should respond in an emergency. They had 1922 responses. In response to whether medical students should assist in an emergency, 40% of respondents said yes regardless of their year in school while 11% felt medical students are not qualified to assist no matter their year.[7] I find myself agreeing with the 40% on this question.
Regardless of legal imperative, I think there is an ethical imperative to help when able. This relates to a basic tenet of the medical profession, beneficence: to help when able. The principles of beneficence were included in the oath I signed during my first month of medical school and they will continue to inform my beliefs on this and similar matters. In January 2018, a medical student named Vincent Michaelson wrote a blog on Medscape after asking his peers if medical students should respond in an emergency. A classmate of Michaelson’s explained that in an emergency he had identified himself as a medical student and explained the scope of what he could do—a basic assessment including vitals.[8] Personally, I found this response met what I consider the medical students’ ethical obligation to offer assistance to the scope of their knowledge and will use it as a model for any future emergencies I find myself in.
- Arizona Department of Transportation. Arizona Motor Vehicle Crash Facts 2017. https://www.azdot.gov/docs/default-source/mvd-services/2017-arizona-motor-vehicle-crash-facts-highlights.pdf?sfvrsn=4. Accessed March 4, 2019.
- Arizona State Legislature. 36-2263 – Civil liability; limited immunity; Good Samaritan. [online] Available at: https://www.azleg.gov/ars/36/02263.htm. Accessed March 6, 2019.
- Office of the Arizona Governor Doug Ducey. Governor Ducey Signs “Good Samaritan” Legislation. https://azgovernor.gov/good-samaritan. Accessed March 6, 2019.
- Arizona Department of Health Services. Arizona Department of Health Services 2017 Opioid Emergency Response Report. https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/2017-opioid-emergency-response-report.pdf. Accessed March 6, 2019.
- Eastwood GL. What should I do when I hear the call for medical assistance in a plane? JAMA. 2017; 318(10): 907-908. doi: 10.1001/jama.2017.7187.
- McKoy, JM. Obligation to Provide Services: A Physician-Public Defender Comparison. Virtual Mentor. 2006; 8(5): 332-334. DOI: 10.1001/virtualmentor.2006.8.5.msoc1-0605
- Medscape Reader Polls 2018. Should Medical Students Respond to Medical Emergencies? https://www.medscape.com/viewarticle/894264. Accessed March 5, 2019.
- Michaelson, V. Should Med Students Help in an Emergency? http://boards.medscape.com/forums/?128@@.2a82ba44!comment=1. Accessed March 5, 2019
Charlotte Archuleta is a class of 2020 medical student at UACOM-P and a very happy Arizona transplant. She moved to Arizona in 2012 after graduating from UNC Chapel Hill with an English and Dramatic Arts degree. She also has a Master's degree in Physiology and Complementary and Alternative Medicine from Georgetown. She chose to pursue medicine because she loves learning. She is excited to bring this passion to her future health care career.