The GoodSAM app: legal and ethical considerations for health practitioners providing emergency assistance

A recently released free smartphone app, GoodSAM, is helping to save the lives of Australians by alerting voluntary ‘responders’ in the community to cardiac emergencies. This article explores legal and ethical considerations for health practitioners in providing emergency assistance both via the app and generally.

Introduction

A recently released free smartphone app, GoodSAM, is helping to save the lives of Australians by alerting voluntary ‘responders’ in the community to cardiac emergencies. Anyone with first aid training can sign up to receive notifications, via the GoodSAM app, to the location of a person nearby experiencing cardiac arrest. Notifications are sent within seconds of a Triple Zero (000) call and nearby responders can choose to accept the call and attend the scene to commence cardiopulmonary resuscitation (CPR) and, if available, automated external defibrillation (AEDS). At the same time, the closest available ambulance is sent to the patient. Registered health professionals who are signed up as responders may also render care extending beyond CPR and AEDS.

The GoodSAM app is currently available in Victoria, NSW and South Australia and is facilitated by the respective state ambulance services. GoodSAM has already reportedly resulted in the lives of numerous Australians being saved,¹ however there are some relevant legal and ethical considerations to take note of in relation to the innovative new app.

Statutory protection for ‘good samaritans’ and health practitioners providing emergency assistance

Civil liability legislation throughout Australia provides protection for ‘good samaritans’ rendering assistance in a medical emergency.

The purpose of these statutory protections is to encourage people to assist in the case of an emergency without the fear of legal consequences. For example, in South Australia section 74 of the Civil Liability Act 1936 (SA) provides a good samaritan incurs no personal civil liability for an act or omission done or made in assisting a person in apparent need of emergency assistance. Similarly, in NSW, Victoria, Tasmania and the ACT, a good samaritan is a person who provides assistance to a person who is inter alia ‘at risk of being injured’ or ‘apparently at risk of death or injury’. Western Australian legislation provides protection for a person ‘at the scene of an emergency’ who ‘assists a person in apparent need of emergency assistance’. In Queensland, a medical practitioner, nurse or member of an organization listed in the regulations is not liable for acts done in good faith and without gross negligence and the Civil Liability Act 2003 also protects people who provide duties to enhance public safety for entities specified in the regulations.

However, there are some qualifications and exceptions to the protections which vary slightly from state to state, including:

• the protection only applies in relation to emergency medical assistance or any other form of assistance to a person in an emergency;
• the good samaritan must act without expectation of payment or other consideration;
• the good samaritan’s capacity to exercise due care and skill must not be significantly impaired by alcohol or another recreational drug (all states and territories except in Queensland and Victoria); and
• the immunity does not extend to a liability that falls within the ambit of a scheme of compulsory third party motor vehicle insurance (South Australia, ACT).

These statutory protections extend to medically qualified people including registered health practitioners.

Considerations for health practitioners

Many health practitioners worry about their legal liability if they assist in an emergency situation. However, doctors in particular should be more concerned if they choose not to assist in an emergency and may in fact face disciplinary action in certain circumstances where they fail to do so.

The Medical Board of Australia’s Code of Conduct sets out medical practitioners’ obligations when providing treatment in emergencies, and states that:

‘Treating patients in emergencies requires doctors to consider a range of issues, in addition to the patient’s best care. Good medical practice involves offering assistance in an emergency that takes account of your own safety, your skills, the availability of other options and the impact on any other patients under your care; and continuing to provide that assistance until your services are no longer required.’²

Similarly, AHPRA and the National Boards’ Shared Code of Conduct (which applies to various other types of health practitioners³) provides:

‘Treating patients in emergencies requires practitioners to consider a range of issues, in addition to providing best care. Good practice means you should offer assistance in an emergency that takes account of factors such as your own safety, your skills, the availability of other options and the impact on any other patients under your care, and continue to help until your services are no longer needed.’⁴

In New South Wales, the definition of 'unsatisfactory professional conduct' in section 139C of the Health Practitioner Regulation National Law (NSW) includes 'refusing or failing, without reasonable cause, to attend (within a reasonable time after being requested to do so) on a person for the purpose of rendering professional services in the capacity of a medical practitioner if the practitioner has reasonable cause to believe the person is in need of urgent attention by a medical practitioner, unless the practitioner has taken all reasonable steps to ensure that another medical practitioner attends instead within a reasonable time.' In the Northern Territory, failing to render assistance in an emergency is in fact a criminal offence under section 155 of the Criminal Code Act 1983, which states that 'any person who, being able to provide rescue, resuscitation, medical treatment, first aid or succour of any kind to a person urgently in need of it and whose life may be endangered if it is not provided, callously fails to do so is guilty of an offence and is liable to imprisonment for seven years.'

In Dekker v Medical Board of Australia⁵, the Medical Board of Australia brought disciplinary proceedings against Dr Dekker in the State Administrative Tribunal (Western Australia) for leaving the scene of a motor accident in order to notify the police, without stopping to assess whether anyone was injured and in need of medical assistance. The Tribunal found Dr Dekker guilty of improper professional conduct. However, Dr Dekker successfully appealed the decision in the Court of Appeal (WA). The Court held that the relevant test was whether Dr Dekker's conduct would reasonably be regarded as improper by professional colleagues of good repute and competency generally in 2002 and that the Tribunal had erred in making that finding in the absence of any expert or other evidence.

If you are a health practitioner considering signing up to be a responder with GoodSAM, it is important to read GoodSAM’s terms and conditions and consider the following:

• patient privacy is of paramount importance and responders must not share or disclose information gained from participating in the program other than to emergency services, unless legally required to do so.⁶ Information that responders provide to GoodSAM, including personal information provided to the relevant state or territory ambulance service, is stored and accessed in accordance with the respective state ambulance services’ privacy policies⁷;
• never provide emergency assistance if you are significantly impaired by alcohol or recreational drugs, or otherwise impaired by a medical, physical or mental health condition such that you cannot exercise due care and skill;
• responders are responsible for their own health and safety. When responders are alerted via the GoodSAM app, they can choose to accept or reject the alert. When accepting an alert, responders should not enter a location if they believe it may be unsafe to themselves or others. If a serious risk is identified, responders should find a safe location and phone Triple Zero (000) for assistance;
• responders should arrive by foot, where possible. Responders may consider driving to an event if distance prevents arrival by foot. In this instance, normal road rules apply. The use of hazard or warning lights and sounds are not allowed while responding and there are no exemptions from the Australian Road Rules, the relevant road traffic legislation or any other applicable laws as a result of being alerted via the GoodSAM app;
• responders must carry or have access to necessary personal protective equipment (PPE) such as gloves, face mask and eye protection;
• ambulance service staff should note that normal workplace policies and procedures apply in relation to their involvement or activities with the GoodSAM program, including when responding to alerts. Where there is inconsistency between a workplace policy, procedure or guideline and GoodSAM’s terms and conditions, the relevant workplace policy, procedure or guideline generally takes precedence; and
• if you are considering opting in to GoodSAM alerts, it may be worthwhile checking with your professional indemnity insurer as to your coverage for providing care in an emergency via the GoodSAM app.

Conclusion

The GoodSAM app is a promising innovation and is already demonstrating its ability to save lives. However, if you are a health practitioner considering signing up to be a responder, or if you are unsure as to whether you should provide assistance in the case of an emergency, it is important to understand your legal and ethical obligations.

¹ Lifesaving app helps off-duty paramedic save boy being crushed by BBQ (News.com.au, 13 September 2023), 'Unconscious and not breathing': Simple phone alert helps couple save man's life (9News, 18 July 2023)
² ‘Good medical practice: a code of conduct for doctors in Australia’ – section 3.5.
³ Aboriginal and Torres Strait Islander health practitioners, Chinese medicine practitioners, chiropractors, dental practitioners including dentists, dental specialists, dental hygienists, dental prosthetists, dental therapists and oral health therapists, medical radiation practitioners, occupational therapists, optometrists, osteopaths, paramedics, physiotherapists, podiatrists and podiatric surgeons.
⁴ AHPRA & National Boards: Code of conduct, section 1.4.
⁵ [2014] WASCA 216.
⁶ Victoria: Health Privacy Principles contained within the Health Records Act 2001 (Vic) and Information Privacy Principles contained in the Privacy and Data Protection Act 2014 (Vic); South Australia: Information Privacy Principles (PC012) and/or section 93 of the Health Care Act 2008 (SA).
⁷ Victoria: https://www.ambulance.vic.gov.au/privacy-policy/; South Australia: https://saambulance.sa.gov.au/privacy-policy/