No Recovery For Swooning Virginia EMT

Repeat After Me: “Correlation Doesn’t Mean Causation”

The Virginia Court of Appeals recently reversed an award of workers’ compensation benefits to an emergency room paramedic who fainted, sustaining a skull fracture and hematoma, as the physician he was assisting began to insert a needle into a patient’s lumbar spine [Lynchburg Gen. Hosp. v. Foster, 2018 Va. App. LEXIS 90 (Apr. 10, 2018)]. The Court acknowledged that while the EMT’s injury certainly occurred in the course of his employment, he had failed to prove that the accident arose from that employment. Stressing the fact that Virginia used what its courts call the “actual risk test,” the Court noted that the causative danger must be peculiar to the work and not “common to the neighborhood.”


At the time of the incident, Foster, an ER paramedic, was assisting a physician with a lumbar puncture procedure. Foster stood in front of the patient to stabilize him during the procedure. As the physician started to insert the needle into the patient’s spine, Foster testified that he felt “light-headed” and “dizzy.” Foster lost consciousness and fell to the concrete floor, sustaining a skull fracture and hematoma. His injuries required emergency surgery that day. A subsequent medical record from a nurse practitioner noted that Foster “had a vasovagal reaction.” Metabolic, blood, and glucose panels were performed after Foster’s accident. Foster’s panel results indicated that he had an abnormally high glucose level.

Foster testified that he assisted with approximately six to twelve similar procedures prior to the day of the accident, that he experienced “weird” reactions, or lightheadedness, when observing lumbar needles being used in the past. However, he never lost consciousness in such a situation until the day of the accident.

The EMT as a Medical Expert?

Based on Foster’s training and experience as a paramedic, he testified that a vasovagal episode was a lowering of the heart rate or the blood pressure, usually in reaction to something that leads to a loss of consciousness or a syncopal episode. He testified that the episode could result from dehydration, pain, or standing too long. He stated that even though he had not eaten prior to the accident, he was not suffering from any of these potential triggers of a vasovagal episode on the morning of the accident. However, Foster testified that he does suffer from a heart condition called Kawasaki disease and food allergies severe enough to necessitate carrying an EpiPen.

Commission’s Decision Based Upon Speculation

The Court said the Commission was wrong when it held—in a split decision—that there was sufficient evidence to prove that Foster’s injuries were compensable. The Court stressed that here, the medical records merely established a correlation between Foster having observed the procedure and his loss of consciousness. There were several other potential causes that were not ruled out by evidence.

The Court added that Commission inferred that the cause of Foster’s vasovagal episode was an emotional reaction to observing the use of the lumbar puncture needle. However, the medical records relied upon by the Commission, at most, established a correlation between Foster’s observation of the procedure and his loss of consciousness. in short, Foster had established what took place; he had not shown why it took place—i.e., he had not shown a causal relationship between the fainting and his employment.

Virginia in Minority as to “Unexplained Falls”

Practitioners should recognize that if these facts were repeated in other states, the outcome might have been different. A majority of the states award benefits for “unexplained falls” [see Larson’s Workers’ Compensation Law, § 7.04]. That same majority usually does not, however, award benefits if the cause of the fall, and resulting injury, is idiopathic. That is to say, an idiopathic fall isn’t really “unexplained.”  Many courts hold that where the employee has an idiopathic condition that could have been associated with the fall, it is completely fair to require that employee to prove that it was the employment—and not the idiopathic condition—that caused the injury.

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