Texas ambulance and emergency medical technician (EMT) roles and medical malpractice

According to the Texas Department of State Health Services State EMS Director, there are 748 different EMS providers and 598 first responder organizations in Texas. That probably gets across the picture that the EMS system is by no means centralized.

These EMS and first responder organizations have over 34,000 EMTs, nearly 20,000 EMT-paramedics, nearly 8000 licensed paramedics, over 3000 advanced EMTs, and over 2000 emergency care attendants. That’s a lot of people.

How fast should an ambulance arrive?

Someone calls for an ambulance once every seven seconds in Texas.

When that 911 calls comes in, the dispatcher essentially conducts a triage to determine the seriousness of the call, categorizing them in one of three priorities.

Priority 1: Most severe

Priority 2: Moderately severe

Priority 3: Least severe

Ambulance and EMS providers are required to follow these response guidelines at least 90% of the time:

Priority 1 (most severe) response times:

Urban 9:59, Suburban 11:59, Rural: 14:59, Frontier: 16:59

Priority 2 (moderately severe) response times:

Urban 11:59, Suburban 13:59, Rural: 15:59, Frontier: 18:59

Priority 3 (least severe) response times:

Urban 15:59, Suburban 17:59, Rural: 19:59, Frontier: 22:59

Ambulance wrecks

I’m sure it’s not surprising that ambulances are in more motor vehicle collisions than the average car or truck. The Texas Transportation Code allows ambulance crews responding to an emergency to exceed the speed limit, but only if it doesn’t endanger life or property. When there’s a wreck, the plaintiff must prove that the ambulance driver crew was reckless, rather than merely negligent.

On top of that, Texas only requires ambulances to carry a minimum of $30,000 in car insurance coverage.

There is an interesting case that was decided last year that raised the question of whether an ambulance wreck was a health care liability (medical malpractice) claim. This is, of course, an important question because Texas tort reform laws require medical malpractice plaintiffs to have expert reports to establish negligence of healthcare providers. That’s not the case in normal motor vehicle claims.

In the case styled Amanda Marie Coci and Heart of Texas EMS, Inc. d/b/a Heart of Texas EMS v. April Dower, the 13th Court of Appeals, in Eastland, ruled that the ambulance wreck “negligence cause of action is not found in standards that arise from professional duties owed by [the ambulance crew] as health care providers.” Instead, the court noted that the plaintiff alleged that the ambulance driver failed to follow the rules of the road, which is negligent motor vehicle operation that applies to everyone.

The end result of the Eastland Court of Appeals decision was that the case could proceed without the plaintiff having a medical expert, as would be required under tort reform for a medical malpractice case. While I think that this was absolutely the right decision, I was surprised that the Texas Supreme Court didn’t take the opportunity to reverse the decision of the intermediate appellate court. By denying the EMS company’s petition for review, on January 10, 2020, the Supreme Court allowed the decision to stand.


EMS, EMTs, and medical malpractice

EMTs or paramedics are trained on how to calmly assess a patient, despite background scenes that can sometimes be chaotic or even dangerous.

EMT personnel are supervised by a physician medical director, who grants authority to administer certain emergency medications, such as epinephrine. EMTs can also perform an EKG (electrocardiogram) in the ambulance or even intubate (insert a plastic breathing tube through the mouth into the trachea/airway) a patient who’s having difficulty breathing.

Like other healthcare providers, EMS and EMT providers are expected to follow the standard of care. When they do not and it results in serious injury or death of the patient, they can sometimes be held responsible for their medical malpractice.

I say sometimes because there are some special considerations regarding EMS providers that are government-run. Like all government agencies in Texas, government-run EMS providers and their employees are protected by sovereign and official immunity laws. There are narrow notice requirements that must precede filing a lawsuit and other technical legal requirements that must be satisfied before going after a small amount of damages allowed under the law.

In my experience, one of the most dangerous things that EMS crews can do when transporting a patient to the hospital is make biased or speculative comments to physicians and the nursing staff in the emergency room (ER).

Bias comes in all shapes and forms, but the truth is we are all impacted by the psychological concept of primacy. The first information we are told about a person or subject has a powerful impact on our thinking.

If you find yourself in a situation where you or a family member need help from an ambulance and EMTs, but the providers don’t really think you need care, beware of the risk that they could jump to a false conclusion. Even worse, that false conclusion could taint the care that you receive in a hospital emergency room (ER).

That’s exactly what happened to a client of mine who had obvious symptoms of stroke. An EMT told an ER nurse and a young doctor that this young patient just needed sleep off a hangover, despite the fact that she had textbook symptoms of an ischemic stroke.

Within a few hours of arriving at the emergency room and an EMT sharing this false information with healthcare providers, a young ER doctor discharged the patient from the hospital without proper workup, testing, or treatment. His diagnosis? Psychogenic reaction, which basically means it’s all in your head.

If you’ve been seriously injured because of poor EMT or emergency care, then contact a top-rated experienced Houston, Texas medical malpractice attorney for help in evaluating your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.