What does reasonable due diligence mean

Definition: due diligence


1 Definition: Duty of care Care is the thorough procedure whereby all essential aspects are observed, e.g. B: all rules of the art (Lege artis), the state of the art or the state of science. The opposite of care is negligence. The duty of care describes the obligation to behave prudently and to exercise the necessary care. The purpose of due diligence is to avoid unnecessary risks to others and binding liability for negligence. If the necessary care is not observed, there is negligence in the legal sense. The German Civil Code, for example, defines in 277 a diligence in one's own affairs. [1] Sources: Lexicon from Juraforum.de: care in one's own affairs; Official Journal NRW, Annex 3. VVAPO-GOSt NRW

2 Definition: Duty of care 823 BGB: As an organizer, there are traffic safety obligations which, if disregarded, result in claims for damages. There is, with the participants, a contractual liability according to 280 ff. BGB (also without entry fee). A general exclusion of liability is not possible: 309 No. 7a BGB provides: An exclusion or limitation of liability for damage resulting from injury to life, limb or health, due to a negligent breach of duty by the user or an intentional or negligent breach of a statutory duty Representatives or vicarious agents of the user are ineffective. At most, a liability committee is conceivable for simple negligence if the clause is restricted. Claus Baumann, DLV representative for the fun run,

3 Duty of care At public events there are non-excludable traffic safety obligations towards participants and spectators whose disregard claims for damages and criminal offenses exist (823 BGB). The organizer creates a state of danger in which there is an increased risk to life and limb. It is the organiser's duty of care to use concepts to ensure that these risks do not materialize. Maintaining the safety of life and limb of participants and spectators is part of the contractual liability of a public sporting event. This duty of care includes: Prevention of danger (protection against unexpected risks) Rapid and effective assistance to limit damage in the event of damage as precise as possible description of requirements and foreseeable risks of the event in the tender (comprehensive) suitable routing, safeguarding and monitoring of risky passages sufficient catering and medical post, appropriate communication As part of his duty of care, the organizer can commission a racing doctor to take care of life and limb. This requirement can significantly exceed the professional competence of the individual doctor and thus lead to a takeover fault. Possible criminal offenses if the organizer disregards the duty of care (inadequate measures to avoid risk) are: negligent bodily harm (Art 125 StGB) negligent homicide (Art. 125 StGB) failure to provide emergency aid (Art. 128 StGB) Netzle, Die Liability of the Race Doctor, Switzerland. Z. f. Sportmed. U. sports dream. 57 (1), 15-18, 2009

4 planning With the notification and approval requirement, the responsible authorities are prompted to check whether the implementation of the intended event poses a risk to public safety, in particular to the integrity of life, health or property of the general public. Based on the level of knowledge that can be obtained before the event, the authority has to decide after a risk analysis whether an event can be approved and, if so, under what conditions. In the case of health protection requirements, the authority must also check whether care by the medical service of the aid organizations is sufficient or whether additional resources and personnel are to be kept available for emergency rescue or patient transport at the event location and to what extent. The limits result from 2 to 4 Rescue Service Act. Source: Ordinance on medical and rescue services at events, MAGS NRW 2006

5 planning: A distinction must be made between public safety (spectators, etc.) and the safety of the participants. Responsibility of the organizer The decision of the authority obliges the organizer to ensure that the conditions are met. He is free to transfer the execution of tasks to aid organizations or others by means of a private-law contract, if they are able to meet the requirements. The same applies to events that do not require a permit. Here, too, the organizer can transfer the measures required for the safety and protection of the participants to aid organizations or others. The focus of official decision-making is public safety, in particular for the integrity of life, health or property of the general public (spectators, etc.). The basis of the official risk assessment and the assessment of the medical service approach is the so-called masonry scheme. In addition, there are national (VAO, IWR) regulations and international recommendations, which are primarily intended for the participants. Source: Ordinance on medical and rescue services at events, MAGS NRW 2006

6 Maurer scheme (last updated 2010) The Maurer scheme is a procedure developed by Klaus Maurer for risk assessment at major events. With the help of an algorithm, it can be determined what potential danger emanates from an event and how many emergency services of the paramedic service should be kept available. The algorithm is based on empirical values, which may still have to be adapted to the local conditions. Maurer assumes that the visitors to the event themselves are an essential factor for the potential danger posed by the event. Therefore, the number of maximum permitted and expected visitors is the basis of the calculations. The number of permitted visitors and the actually expected visitors are each assigned a point value according to a rule. These point values ​​are added and multiplied by a weighting factor. The weighting factor indicates the danger of the event and is given in a table for different event types. Point values ​​for special hazards can be added to the value calculated in this way. Source: Wikipedia, retrieved

7 Criticism of the mason scheme Thesis: A strength assessment according to the mason scheme is not sufficient to fulfill the duty of care at running events because the mason scheme is not scientifically validated and assumes that the main risk comes from the audience. The scientific data shows that this does not apply to running events. The extensive scientific studies on incidents at running events (state of the art) and their rescue medical treatment requirements (state of the art) are not taken into account. The established strengths remain well below the IAAF recommendations

8 Recommendations of the professional organizations I: National regulations: IWR IWR, status Annex 2: Medical service at sporting events (unchanged since 11/1995): At public running events, adequate medical care must be guaranteed on the routes and at the finish (14 No. VAO), In the case of important ( = international) events the position of a "competition doctor" is to be filled. This rule has no meaning for national events. 823 (1) BGB: Anyone who organizes a public event must take the necessary and reasonable measures to (prevent the emergence of danger, provide quick and effective assistance in limiting damage in the event of damage). the more likely a hazard will materialize, the greater the precautions must be taken to limit the damage. Decisive for the necessity of calling in a medical service is therefore the potential risk of the event. This results from: type of event (athletics does not represent a particular source of danger, therefore there is no need for a medical service purely due to the event), audience (medical service not under 1500 spectators (ASB, 1995), an emergency doctor from at least 5000 spectators (IM NRW) ) Place of the event (medical service at particularly remote sports facilities) other circumstances (e.g. particularly high temperatures). Source: retrieved

9 Recommendations of the professional organizations II: National regulations: VAO event regulations, (VAO, stand), 14 6 Protection regulations 6.1 To protect the participants, the following information should be observed: Start times for long-distance competitions under 20km: June / July / August until 9.00 a.m. or after a.m. Starting times for long-distance competitions from 20 km upwards from 20 km: June / July / August until 8.00 a.m. or after May / September until 9.00 a.m. or after 6.2 a.m. On hot days with temperatures above 20 degrees and high humidity the organizer must set up additional refreshment points (water points) along the route. 6.3 The responsible LV decides on exceptions and is entitled to impose conditions under special conditions. The official recommendations for exercising with high ozone levels should be observed. 11 Routes, route monitoring, medical service 11.3 At the events, sufficient medical care must be ensured on the routes and at the destination. Source; retrieved

10 Recommendations of the Professional Organizations III: International IAAF (International Association of Athletics Federations, 1912) Competition Medical Handbook for Track and Field an Road Racing, 3rd Edition, Part II Medical Management and Administration for Long Distance Racing The handbook provides the most well-founded and most evidence-based recommendations currently available for medical planning for long-distance races: suggestions for medical personnel and material resource planning action-oriented event planning from a medical point of view concepts for medical runner education organization and stocking of refreshment points organization and stocking of medical and rescue service posts and vehicles on the route and, in the end, advanced training content relevant emergency images for the med. Personnel with action algorithms Recommended equipment and quantities for medical and rescue services Templates for emergency protocols Source:

11 Recommendations of the professional organizations IV: International IAAF (International Association of Athletics Federations, 1912) Competition Medical Handbook for Track and Field an Road Racing, 3rd Edition, Part II Medical Management and Administration for Long Distance Racing Recommendations for / Medical Service: Runs> 10km and with more than 500 attendees, should have a medical medical director familiar with run-related disorders and CPR. Doctors and nurses should be familiar with running-related conditions and CPR. Every medical post should be equipped with a doctor. The medical team should be insured through the organizer. There should be 5-10 medical workers and 4-6 non-medically trained workers for every 1000 runners. AED-equipped motorbikes and bicycles are recommended. Medical care should be available every 2-4km. An ambulance is calculated for races <25km and 2 ambulance for races <25km. First aid deployment times should be <4 minutes, the first RM should arrive <8 minutes. Source:

12 How do we deal with this in Münster? The planning is updated every year on the basis of: Maurer scheme (as the calculation basis of the competent authority and relevant from an expert opinion in the event of damage) Orientation on the IAAF recommendations Analysis of incidents from previous events (standardized recording by the racing doctor since 2007) Reference to the current scientific study situation Reference to the current state of rescue medical technology and medical art. Feedback in the 2x annual technical meeting

13 Back of start number standard Volksbank-Münster-Marathon

14 Suggestion: back of start number standard Volksbank-Münster-Marathon Why additional weight information during the course of the race? The IMMDA (International Marathon Medical Directors Ass.) Recommends weighing runners at risk of hyponatremia every 10 km to identify athletes at risk of hyponatremia (> 4% weight loss)

15 Example: Volksbank-Münster-Marathon: Emergency log 2008 Version 1.07, available at all medical supply points Logging of rescue equipment on DIVI logs not recorded here with little filled out: drinking points and drink thirst / hunger for salt Where misunderstandings: knee problems are interpreted as abnormal motor skills, painful restriction of movement interpreted as a non-intact blood flow

16 Further development of the protocol 2009 page 1

17 Further development of the protocol 2009 page 2

18 Example Volksbank-Münster-Marathon: Race doctor evaluation of the emergency protocols Protocols were evaluated of which 50 (69.4%) with comprehensible and sufficient documentation, of which 44 (61.1%) with comprehensibly meaningful and completely adequate medical care: Deficits were e.g. in the event of overuse problems no cooling in the case of (cut) wounds no bandage 17 runners (23.6%) stopped running because of medical problems. Mean age of the runners treated: 34.3 years ± 10.46

19 Main hazards on the running route: What needs to be done where and when? It makes sense to operate all medical points from 10:00 a.m., setting up for peak times makes sense

20 Evaluation: Type of emergency expected spectrum Importance of prevention: Recommend training for musculoskeletal injuries to the participants (mentor training)

21 Diagnoses Muscle spasm is missing as a cross-check diagnosis in internal emergencies, poor diagnosis and documentation

22 Evaluation: Quality control of medical care for 26 internal medicine patients too little diagnostics are carried out even with unconscious people no blood sugar etc. The racing doctor exerts influence in order to improve the quality of the med. Supply and documentation by the HiOrgs

23 Therapy 3x documented infusion therapy without medical inspection (?) Medication: 2x Magnesium 2x Akrinor 1x MCP 1x Glucose 40%

24 The whereabouts of the patients Insufficient documentation of recommendations and the whereabouts of the transports mostly primarily after being found by the ambulance field Run aborted / continued: 30x (41.6%) no answer 17x (23.6%) aborted 16x (22.2%) regularly terminated Continued 8x (11.1%)

25 Part of hazard prevention: Runners' education. Targeted information is provided and the runners comply with the DGSP precautionary standards before they register, med. Network (implementation of the GRR questionnaire on health care for marathon novices via a mentoring program, training events by the racing doctor, training plans, training runs (MüMa on Tour), relay run as an introduction instead of 0 to 42 running medicine on the homepage, newsletter, forum brochure 42 tips for 42km nationwide marathon medicine -Symposium

26 Future Perspectives I What should be standardized nationwide and centrally recorded (co-op MS-Marathon with SpoHo Cologne)? Health questionnaire (DGSP-oriented) Emergency pass on the back of the start number. Emergency protocol at the medical supply points. Local and central evaluation of the emergency protocols

27 Future Perspectives II Why should standardization be implemented? Determination of data on: Health and risk profile of the participants Type, frequency and distribution of medical emergencies on the route Justification for standards on: Medical service approach Type and distribution of equipment and rescue equipment Equipment and training recommendations for the medical supply points Training of organizers and medical staff : Fulfillment of the duty of care through sensible planning Special features of the road from a medical point of view

28 Future Perspectives III How Should Standardization Be Made? Event-internal evaluation of the back of the start number and medical supply protocols (excel table) Nationwide evaluation by GRR (sending the excel table to the GRR Medical Team) Feedback of the results exclusively to the races involved Scientific publication as an initiative of the GRR-affiliated organizers (signal effect) Aim : Establishment of nationwide standards based on the data collected

29 Future prospects IV Future prospects for GRR runs The standardization of medical service processes enables: The fulfillment and documentation of the organizer's duty of care (see Zugspitzlauf) The sensible cost-effective resource planning of the medical service The monitoring and improvement of the medical service quality of the event (doctors / non-doctors) The collection of nationwide data on fun runs as an initiative of the organizers (and not associations, etc.) The establishment of standards for medical prevention and care for incidents during fun runs

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31 Thank you for your attention!