Patient responsibility
Even though the tasks overlap, the responsibilities must not overlap. If the lines of responsibility are unclear, it can dilute accountability and pose a risk to patient safety. Clearly defined responsibilities are also pivotal for effectively conducting quality improvement work and ensuring proper supervisory practices. These responsibilities are described in laws (2, 3, 4) and regulations (1, 5), and the Norwegian Directorate of Health has further clarified these responsibilities in correspondence to the health trusts (6).
If the lines of responsibility are unclear, it can dilute accountability and pose a risk to patient safety
Despite this, the understanding of responsibilities is not clear-cut. In our experience, the supervisory authorities consider the understanding of responsibilities to be a critical and challenging area. Incident-based supervision by the Norwegian Board of Health Supervision (NBHS) could serve as a valuable resource for clarifying responsibilities. Only a selection of the NBHS's decisions in comparable incidents are made public, and these appear to be inconsistent. Sometimes the responsibility is placed on the ambulance service and health trusts (7), while on other occasions it lies with the doctor at the emergency clinic and primary care services (8).
According to the Health Personnel Act, all health personnel have a duty to provide appropriate and compassionate medical care. It further states that 'upon co-operation with other health personnel, the medical practitioner and the dentist shall make decisions in matters concerning medicine or dentistry respectively in relation to examinations or treatment of the individual patient' (2).
We believe that the duty to provide appropriate and compassionate medical care arises when health personnel are present and in direct contact with the patient (as opposed to video or telephone consultations between the patient and service provider). The allocation of responsibility does not therefore change even if paramedics consult a doctor via telephone or the emergency radio network. Put simply, if paramedics (or other health personnel) are with the patient, and a doctor is on the phone, the health personnel with the patient are responsible for the patient. If paramedics and a doctor are with the patient, the doctor has overall responsibility. If paramedics and a doctor are with the patient and the ambulance starts transporting the patient without a doctor, the paramedics are responsible for the patient. And just to be clear: if the doctor from the emergency clinic is with the patient and consults a hospital specialist, the emergency doctor is still responsible for the patient.