The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Office of Emergency Medical Services
2 Boylston Street, 3rd Floor
 Boston, MA 02116
617-753-7300
FAX: 617-753-7320

DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
JUDYANN BIGBY, MD
SECRETARY
JOHN AUERBACH
COMMISSIONER	
ADVISORY

TO:		All MA Ambulance Services
		All EMCAB Members
		All MA Accredited EMS Training Institutions
FROM:	Abdullah Rehayem, Director
DATE:		October 1, 2008 
RE:	Advisory on Ambulances with Patients on Board Stopping at Other Emergencies
This Advisory outlines the factors that EMTs must carefully weigh before deciding to interrupt a patient transport to stop at the scene of another medical emergency.  This Advisory also addresses the existing policies of certain ambulance services that require their employees to always stop during patient transport if they pass a motor vehicle crash scene.

Stopping at the Scene:

While EMTs owe a duty of care to the patient on board the ambulance, the Department recognizes that there are certain unique circumstances where EMTs may need to make a judgment as to whether to stop to assess and render treatment at another emergency scene to a potential patient or patients.  The exercise of reasonable care, judgment, knowledge and skill expected of all EMTs requires that careful weight and consideration be given to the following factors in all decisions to interrupt the transport of your patient:

•	Scene safety for the EMTs and the patient on board;  
•	The stability of the patient on board;
•	The EMS resources visible at the scene of the other medical emergency. 

Therefore, if there is a visible need for EMS resources; the patient on board is stable; patient care is not compromised by a delay in transport and the scene is safe; EMTs may, but are not required, to stop at another emergency scene. If there is uncertainty regarding any of these factors, the EMTs must continue transport of the patient on board. Typically, EMTs may appropriately assist the other emergency by contacting their dispatchers to direct an available EMS resource.  

Please be advised that in the case of any interruption of patient transport, one EMT must remain with the patient on board the ambulance at all times. As soon as there are adequate EMS resources on scene, EMTs must resume transport of the patient on board the ambulance immediately.

Ambulance services and their affiliate hospital medical directors, if appropriate, must review all decisions to stop at another scene as part of a service’s quality assurance program. For services without an affiliate hospital medical director, the service may refer the records to the regional medical director for review.
Ambulance services and their EMTs must exercise caution in making decisions to interrupt transport. The Department strongly advises ambulance services to consult their legal counsel in this regard. Ambulance services must also be sure to inform their EMTs and train them about this Advisory and the policies of the service in this regard.

Ambulance Service Policies that Require Personnel to Stop 

The Department is aware that certain ambulance services have policies instructing their EMTs to always stop at the scene of a motor vehicle crash they pass while transporting another patient.  Such a policy is invalid and without force, and must be removed from the service’s policies and procedures. Services are also required to promptly notify all EMTs and dispatch personnel of such policy and procedure change.