Book Review: Legal Considerations for Tactical Medical Responders

Except in short chapters in EMS textbooks and occasional articles in trade journals, little information about legal aspects of prehospital care has been readily available for EMS practitioners lacking access to a law library and some experience in legal research. Legal texts discuss medical malpractice in depth, but little attention has been paid to prehospital medicine issues.

In an increasingly litigious society, the prospect of being sued is ever present. New and emerging roles for providers complicate legal relationships for both medics and employers. One of the newest roles is the tactical medical responder or "SWAT medic."

In Legal Considerations for Tactical Medical Responders: For Both the Individuals and Agencies, Raffaele M. Di Giorgio provides a basic survey of legal issues and problems that might be encountered by tactical medical responders and for the agencies utilizing them as well. This book should also be helpful to any prehospital medical provider who has an interest in legal aspects of prehospital care.

While not a lawyer, the author has experience in medical education, security and protection, and tactical operations. His comments are spot on concerning the complex relational issues that may arise from tactical situations involving medical personnel who are assisting government-based tactical forces.

The author explores differences in liability considerations among law enforcement officers and entities, civilian medical contractors and volunteers. Concepts of agency and sovereign immunity are discussed, as well as the effects of Good Samaritan Laws. A review of basic concepts such as duty to act, breach of duty and standard of care, who is liable and to whom, and many other legal matters, should assist medics and administrators alike in understanding basic legal issues, regardless of the role being filled.

Differences between civil liability, criminal negligence and crimes are reviewed, and a brief summary of HIPAA requirements is presented along with examples of novel privacy issues that may arise.

And perhaps most important, the author gives practical hints on how to prevent a claim from arising, how to preserve evidence, and how to prepare to defend and contest a claim.

While it should be apparent that formal written policies and procedures should be in place to govern the relationships between a law enforcement agency and outside medical personnel, this should not be taken for granted.

Any volunteer or contractor who intends to function as a tactical medic should explore all relative policies and procedures in detail so that the exact nature of the relationship in terms of insurance benefits, defense against claims, liability and damage protection are clear to both the medic and the governmental agency.

The author stresses that a comprehensive written contract document should be in effect between the parties. Lawyers for each side should be involved in reviewing contracts so that nothing is left to chance. The time for the first legal review of contracts and relationships should precede a claim, not follow it.

For example, who furnishes and pays for equipment, uniforms and supplies should be covered and spelled out in detail. Who will supervise the medic and at what level should be clearly defined. Chain of command must be clearly delineated. Law enforcement considerations may be different from medical considerations. Who makes the decision when conflicts arise? The time to discuss and work out these complexities should be before the medic begins a tactical medic relationship, and all terms should be clearly stated in writing.

While governmental entities may be protected by so-called Sovereign Immunity, individuals are usually not. Although usually not famous for wealth, practicing prehospital medical caregivers may still be sued personally and held liable for damages. Legal expenses for defense of a lawsuit will be large, and no one should begin work as a tactical medic without complete written assurances that she or he is covered by insurance or that the governmental entity will pay any damages that may be awarded against them. Personal insurance policies may not cover a tactical medic. Anyone planning to practice as such should consult with the insurance carrier to be sure that coverage is available and that there will be no surprises in event of a claim.

Medical responders often give little thought to what happens if they are injured or killed in the line of duty. Complex relationships exist between governmental agencies and hired civilian employees or civilian volunteers. The author explores the various issues related to Workers' Compensation, tort liability and death benefits.

The book is clearly written, precise and to the point, and contains many useful legal references. It should be a valuable addition to the EMS literature. However, as the author makes emphatically clear, it does not purport to provide legal advice. Yet, its information can provide groundwork for the reader in discussing matters with his or her own attorney.