Dr David Coleman: Step in and gain patient consent if possible
Whether on duty or on holiday, providing appropriate medical assistance in an emergency is the right thing to do. There may be no legal requirement for a doctor to act as a Good Samaritan in English law, but GMC guidance makes it clear that an ethical responsibility exists.
Good Medical Practice explicitly states: ‘In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence and the availability of other options for care.’
Any doctor providing emergency assistance is likely to ponder liability, particularly if the outcome is unfavourable. Cases of claims against doctors acting as Good Samaritans are rare and a further layer of protection has been provided by the Social Action and Responsibility Act 2015.
Even so, it is imperative that doctors have adequate medical indemnity. I would also encourage doctors acting as Good Samaritans to obtain consent to treatment where possible. For consent to be valid, however, a patient must have capacity, be informed and be consenting voluntarily. Clearly an unconscious patient does not have capacity, so the doctor should provide immediately necessary treatment based on the patient’s best interests.
But if the patient is unconscious and the situation is life threatening, assume the patient would consent if conscious. Do not waste time seeking a next of kin. Make detailed notes. If there are any concerns, call your defence union.
A recently published MDU survey revealed that 88% of respondents had acted as a Good Samaritan at some point in their medical careers. Fainting episodes were the most common presentation, but 12% of cases involved cardiac arrests, which emphasises the importance of life support refreshers.
The majority of us are likely to be called upon to help at some point in our careers. Some of us will feel comfortable in this situation; others will be terrified. We are not expected to demonstrate the skills of an experienced trauma surgeon, but simply to do our best with the resources available. Litigation is unlikely and should not deter us from our duty.
Dr David Coleman is a GP in Conisbrough, South Yorkshire
Dr Jim Sherifi: Help out, then hand over to a paramedic
I’ve been called on as a Good Samaritan during my career. I’d advise any GP to step in, regardless of how daunted you feel. Your duty as a doctor is to offer help when needed.
In such a situation, broadcast that you are a doctor – everyone present will look to you for leadership. Don’t worry about insurance; you will be covered by the GMC and professional indemnity insurers. It’s important to maintain control of the situation and delegate tasks so you don’t become overwhelmed.
Ensure that an ambulance is called if one is needed and stay on site until they arrive – it will be helpful for the paramedics to hear an account of the situation from a fellow medic. Once you’ve handed the patient over, I’d advise you heave a huge sigh of relief and head to the nearest pub.
Ensure there is no danger to others and check that your own family are cared for while you throw yourself into helping.
My Good Samaritan experience happened on a trans-Atlantic flight. The pilot uttered the dreaded words: ‘Would any doctor on board please make themselves known to the cabin staff?’ I reluctantly joined the paramedic and nurse who were hovering over a collapsed body. Although I didn’t feel entirely confident, I helped stabilise the patient while the pilot diverted the plane and in the end I didn’t need to worry about practising at 10,000 feet – the patient was treated when we landed.
Dr Jim Sherifi is a GP in Sudbury, Suffolk
Dr Susie Bayley: Check it is safe to help
Before stepping in, assess your own safety and if there are any factors influencing your ability to provide care, for example a language barrier, fatigue or alcohol consumption. Always ‘recognise and work within the limits of your competence’ (GMC).
Introduce yourself and explain the situation and your skills – either to the patient if they are conscious, or to relatives and onlookers. Check whether any other bystanders have skills that could help and ensure there’s a clear handover to other professionals, leaving them your contact details.
Document what happened, when it happened and who was there and make sure to liaise with your defence body. Keep in mind that you still have a duty of confidentiality to the patient. And keep up to date with resuscitation training.
The chance of being involved in a serious emergency are rare, but most of us will be involved in a Good Samaritan act during our professional lives. If you help, it will be classified as a clinical intervention, but legal action from these cases is rare. The standard expected would be commensurate with your skills and the situation.
Dr Susie Bayley is a GP in Derby
Dr Beverley Ward: Make sure you have indemnity cover in place before assisting
While, in theory, you could be held liable if something went wrong, it is extremely unusual – if not unheard of – for Good Samaritan acts to result in legal action. However, it’s important to ensure you have adequate indemnity in place. The MDU provides indemnity for doctors acting as Good Samaritans worldwide.
All doctors registered with the GMC have an ethical obligation to offer to help if emergencies arise in the community, so it is correct to intervene in this situation. Before helping out in an emergency, remember to respect patient confidentiality and keep detailed records of what took place, as you would do in your normal clinical practice. You should also bear in mind the limits of your competence, and the availability for other options of care, for example, by calling for help from the emergency services where appropriate.
Dr Beverley Ward is a medicolegal advisor at the Medical Defence Union.