Client Advisory

Fabiola Vieites, Felicia D. Brodock

In Almonte v. Township of Union, the New Jersey Supreme Court unanimously upheld paramedic immunity pursuant to the Emergency Medical Services Act (“EMSA”), N.J.S.A. 26:2K-7 to -20 (1984).  N.J.S.A. 26:2K-14 grants civil liability immunity to paramedics who cause harm while providing advanced life support (“ALS”) services, so long as these services are performed “in good faith” and “in accordance with” the statute. Pursuant to N.J.S.A. 26:2K-10, a paramedic acts “in accordance with” the EMSA when the paramedic (1) “maintains direct voice communication with” and (2) is “taking orders from a licensed physician” while administering ALS.

In Almonte, the defendant paramedics responded to a call placed by the minor-plaintiff’s mother when he began convulsing after a running-related injury. The paramedics made two separate phone calls to a licensed physician while responding to the call, during which the physician instructed the medical personnel to administer medications and make multiple intubation attempts, the third of which was successful, before the minor-plaintiff was transported to the hospital. The paramedics’ calls to the physician were approximately thirteen minutes apart. The minor-plaintiff arrived at the hospital in cardiac arrest, although the paramedics continued their attempts to intubate him for ten additional minutes before he was transferred to the hospital’s trauma center. He was ultimately discharged over a month later with an anoxic brain injury diagnosis and significant physiological repercussions.

The plaintiffs’ parents filed suit against the ambulance company and paramedics. The trial court granted the defendants’ motion for summary judgment, which the Appellate Division affirmed. The Supreme Court granted limited certification as to whether the paramedics should be granted immunity pursuant to the EMSA.

Upon review, the Supreme Court considered plaintiffs’ arguments that the paramedics did not render ALS services to minor-plaintiff “in accordance with” the EMSA because the paramedics did not “maintain direct communication” with the physician due to the elapsed time between the phone calls; the paramedics did not appropriately take orders from the physician when they delayed minor-plaintiff’s transfer to the emergency room to continue attempts at intubation; and that the EMSA’s legislative intent is to increase oversight of paramedics and limit their immunity.

Finding that the paramedics’ conduct fell squarely within the statute’s definition of ALS services, the Court considered whether the paramedics “maintained direct voice communication” with the physician.  Because this phrase was undefined by the statute, the Court turned to the plain meaning of the phrase but found it was subject to multiple definitions. It thus considered the EMSA’s legislative history, which evinced a clear intent to expand immunity for paramedics.

The Court also found that the paramedics clearly took orders from a licensed physician as required by the statute, as evidenced by the phone calls between the paramedics and physicians, which signaled that the paramedics were following the physician’s orders as they responded to the call.  Further, the statute’s legislative intent supported paramedics performing duties “necessary” to transfer ALS care to hospital staff upon arrival at an emergency room, and therefore, the paramedics’ decision to continue intubation attempts even after arrival at the hospital fell within the EMSA’s requirements to invoke immunity from civil liability.

Finally, the Court disagreed with the plaintiffs’ interpretation of the EMSA’s legislative intent as increasing the oversight of paramedics and limiting their immunity, instead finding the EMSA was enacted to empower paramedics “to act swiftly and decisively, without the potentially paralyzing fear of civil liability.”

Therefore, the Supreme Court determined the paramedics’ conduct was protected by the plain meaning and legislative intent of the EMSA in favor of civil liability immunity.

Key Takeaways: The plain language and legislative intent of the EMSA support paramedic immunity from civil liability, empowering paramedics to provide ALS services to respond to emergencies as necessary. Clients providing emergency medical services should consider: (1) retaining counsel to assist with implementing policies that will help litigation counsel build a strong record supporting the application of the EMSA; and (2) retaining litigation counsel before a complaint is filed to facilitate early collection of evidence to support an EMSA-based motion for summary judgment.