Introduction

The case of Lynda O'Neill and others against Scottish Ambulance Service Board ([2025] CSOH 17) adjudicated by the Scottish Court of Session on February 11, 2025, addresses critical issues surrounding the duty of care owed by ambulance services during remote triage assessments. The pursuers, representing the family of the deceased Brian O'Neill, alleged negligence on the part of the Scottish Ambulance Service for failing to transport Mr. O'Neill to the hospital following a fall that resulted in a head injury. Central to the dispute were the actions of Ms. Elaine Noden, a trainee advanced paramedic practitioner, and Dr. Leanne Rae, a medically qualified bystander present at the scene.

Summary of the Judgment

The Court of Session, under the opinion of Lord Young, examined the circumstances leading to Mr. O'Neill's death, focusing on the sequence of events during the second 999 call made on June 27, 2020. The court evaluated the testimonies of Dr. Rae and Ms. Noden, alongside expert opinions, to determine whether the Scottish Ambulance Service failed in its duty of care. The judgment concluded that Ms. Noden failed to conduct a comprehensive triage assessment and did not adhere to the Joint Royal College Ambulance Liaison Committee (JRCALC) guidelines. Consequently, the court found the Scottish Ambulance Service liable for Mr. O'Neill's death, awarding significant compensation to the pursuers.

Analysis

Precedents Cited

The judgment referenced key precedents such as Hunter v Hanley 1955 SC 200 and Honisz v Lothian Health Board 2008 SC 235, which establish the standards for duty of care and negligence within the Scottish legal context. These cases emphasize the obligation of healthcare providers to adhere to established protocols and the ramifications of deviating from such standards.

Legal Reasoning

The court's legal reasoning centered on whether Ms. Noden's actions met the expected standard of care for an advanced paramedic practitioner. The judgment meticulously dissected the evidence, giving precedence to Dr. Rae's detailed and contemporaneous account over Ms. Noden's less comprehensive recollections. The court scrutinized the adherence to JRCALC guidelines, particularly the "conveyance decision tool" for head injuries, and found that Ms. Noden's failure to identify critical factors like Mr. O'Neill's anti-platelet medication and the potential for internal bleeding constituted a breach of duty.

Additionally, the court addressed the interplay between the paramedic's remote assessment and the role of a medically qualified bystander, ultimately determining that the paramedic retained responsibility irrespective of assurances provided by Dr. Rae.

Impact

This judgment sets a significant precedent for ambulance services and paramedic practitioners, highlighting the imperative for thorough triage assessments and strict adherence to established guidelines. It underscores the liability that healthcare providers may face when protocol deviations result in patient harm or death. Future cases involving remote triage and the reliance on bystander assessments will likely reference this judgment to ascertain the boundaries of duty of care and the expectations placed on paramedics.

Furthermore, the case may prompt a review of training programs for paramedics, particularly in enhancing decision-making skills during remote assessments and fostering clearer communication protocols when interacting with medically qualified bystanders.

Complex Concepts Simplified

Conclusion

The Lynda O'Neill and others against Scottish Ambulance Service Board judgment serves as a pivotal reference in defining the scope of duty of care within remote triage scenarios. By upholding the standards set forth in established precedents and emphasizing the critical nature of thorough assessments, the court has reinforced the accountability of ambulance services in safeguarding patient welfare. This decision not only compensates the affected family but also acts as a deterrent against future lapses in protocol adherence, ensuring that paramedics remain vigilant and methodical in their response to medical emergencies.

Moving forward, this case will influence both legal interpretations and operational practices within emergency medical services, fostering an environment where patient safety and adherence to guidelines are paramount.