Question: When a hospital is on "consideration" and we are not accepted by this particular hospital due to their CTAS score or related clinical condition and they are to deteriorate while en-route to the next receiving hospital. What liability do we as paramedics wear in these situations?
Great question. Unfortunately, there is risk and liability in virtually everything we do. If one looks retrospectively at various EMS systems with adverse events in similar situations, we know that the liability is shared by everyone from the front line providers to the policy makers.
One essential element is to remember is to ensure that if a patient is unstable or is deteriorating while en-route as you suggest, perhaps the CTAS score is now actually higher and the patient's destination should now not be affected by a hospital being on "consideration".
It is imperative that every paramedic is familiar with accurate CTAS calculations (it is complicated!), their own patient priority systems, and local destination policies to assist them in their destination decision making.