Associated matters

Legal aspects of first aid

When rendering first aid you are required to act with reasonable care and common sense and are required to render the first aid to the best of your ability, but within the limits of your training and qualifications.

Consent

It is preferable to obtain the consent of the patient, where the circumstances permit, prior to treatment. The patient should also be acquainted with your particular experience in medicine or first aid. If the patient is given this information and consents to your treatment, he/she cannot expect a higher standard of skill than your training provides. You should, however, act sensibly. If the patient is unable to give consent (e.g. due to unconsciousness) or cannot give legal consent (e.g. an infant or person of unsound mind) and the urgency of the situation warrants immediate treatment, first aid should be given. Where further medical treatment is required, the decision as to when, where and by whom further treatment is to be given should be left to the parents, guardians or next-of-kin

If consent is refused, do not treat the patient unless ordered to by some person in authority or unless the patient requires urgent medical treatment. Treatment should then only be given after the patient is advised of the possible consequences of refusal. It should be borne in mind that certain treatments are restricted to qualified medical practitioners or nursing sisters, such as administering prescription drugs and giving injections.

Death

Only a qualified medical practitioner can certify that a person is dead. Therefore, if treatment is started, it should not be stopped until a doctor certifies death or a person in authority orders the treatment stopped. However, in some situations where it appears that the casualty is dead, a decision must be made whether to start or stop treatment (as the case may be).

The generally accepted signs of death include:

  • fixed dilated pupils, not responding to apparently effective resuscitation efforts
  • absence of spontaneous heart beat (palpable carotid pulse) in spite of prolonged resuscitation
  • rigor mortis (stiffening of the body) is a late but reliable sign of death.

When to stop heart massage in the absence of return of spontaneous heart beat is an individual decision based on circumstances, but there should be very good reasons for stopping in less than one hour. Only in exceptional circumstances should artificial respiration be stopped when there is spontaneous heart beat but no breathing. Resuscitation should never be stopped when medical aid is imminent. It should be noted that adequate heart massage should produce an artificial carotid pulse.

Injury to rescuers

If a rescuer is injured in the course of rescue, that person may have a claim against the injured person and or the person whose negligent action caused the injury which necessitated the rescue action. Therefore, even where the rescuer is fully aware of the nature of the risk and of the extent of the danger, if the rescuer is injured during the rescue he/she can, in most cases, claim damages against the negligent party. It may be possible, however, for the negligent party to show that the rescuer did not, in all the circumstances, take reasonable precautions for his/her own safety and thus it may be held that the rescuer contributed to his/her own injuries. In an action for damages by the rescuer, this would result in a reduction of award for damages based upon contributory negligence of the rescuer. These type of circumstances underline the position that negligent leaders owe a duty of care, not only to those who are injured by their careless acts, but also to those who go to their rescue and suffer as a result.