Ch. 4 EMR Book: Medical, Legal, and Ethical Issues Flashcards
What are the most important concepts to remember when treating any patient?
- Do no harm
- Provide all care in good faith with the patient’s best interest in mind
- Provide proper, consistent care while being compassionate and maintaining composure
Duty to act
EMR’s legal responsibility to respond quickly to an emergency scene and provide medical care within the limits of training and available equipment
Standard of care
The manner in which an individual must act or behave when giving care
What are the two criteria to meet when complying with the standard of care?
- Treat patients to the best of your ability
- Provide the same care a reasonable person with similar training would provide under the same circumstances
What impacts the standard of care you would provide?
The circumstances you are in
What is a tort, as defined by the legal community?
A wrongful act
What is The Emergency Medical Responder Education Standards
Specifies the skills taught in EMR courses and how the skills should be performed
Who developed The Emergency Medical Responder Education Standards
The US Department of Transportation
The Emergency Medical Responder Education Standards has evolved into what currently?
National Emergency Medical Services (EMS) Education Standards
What can modify the specifications in the education standards?
Scope-of-care laws for each state
What can the medical director use to specify your scope of care?
Medical protocols
Standing orders
Medical protocols; written documents signed by the EMS systems’ medical director which outlines specific directions, permissions, and prohibitions regarding patient care
What does it mean to treat a patient ethically?
Treating them in a manner that conforms to accepted professional standards of conduct
What are some ethical standards?
- Stay up to date with EMR skills and knowledge
- Reviewing your performance and assessing techniques used to improve performance
- Evaluate response times
- Follow up with patient care outcomes
- Be honest, especially in reports
Consent
Permission (to provide care in a medical setting)
Expressed consent (actual consent)
Consent given verbally or nonverbally, authorizing the EMR to provide care or transportation
What are the requirements for a patient giving consent?
- Must be 18 or older (depending on the state’s legal age)
- Patient must be able to make a rational decision
Informed consent
Permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been given
Implied consent
Consent to receive emergency medical care that is assumed because the individual is unconscious, underage, or so badly injured or ill that they cannot respond
How would you get consent for a minor for treatment?
From a parent or legal guardian
What if you can’t get consent from a parent or legal guardian for a minor’s treatment fast enough in a medical emergency?
Do not wait to give the needed medical care; hospital officials will determine what care can be postponed until permission is obtained
Competent
Able to make rational decisions about personal-well being
What may need to happen if a patient is showing signs of hurting themselves or others?
Arrangements need to be made to place them under medical care depending on local policies for the procedure for treating patients who don’t want treatment but don’t seem competent
What are the requirements for someone to be able to refuse treatment (even if the outcome will be serious injury or death)?
- Patient is an adult
- Patient is conscious and alert
- Patient is mentally in control or competent
Who can you contact to make handling a patient who does not seem mentally sound or competent easier?
Law enforcement
What must be explained to all patients even if they end up refusing care?
- Treatment plan
- Why the treatment is needed
- Potential risks if treatment is not provided
- Alternatives to treatment
What steps must be noted after a patient refuses care?
- Tell them to contact EMS if they change their mind
- Document patient refusals of care on reports according to agency protocols
- If required by protocol, have another person witness refusal of care
Advance directives
Documents specifying what a person would like to be done if the person becomes unable to make his or her own medical decisions
What are the three kinds of advance directives?
- Living will
- Durable power of attorney for health care
- Do not resuscitate (DNR) order
Living will
Legal document stating the types of medical care a person wants or wants withheld if they are unable to make his or her own treatment decisions; can include a DNR
What circumstance are living wills usually written in?
If a patient has a terminal or incurable condition
Can living wills let someone select another person to make decisions for them?
No
Durable power of attorney for health care (medical power of attorney)
Legal document allowing someone to designate another person to make medical decisions for them if they become unable to to make their own treatment decisions
What is a health care agent or health care proxy?
The person named in a durable power of attorney for health care document that makes treatment decisions for another person
Do not resuscitate (DNR) order
Written request giving permission to medical personnel to not attempt resuscitation in the event of cardiac arrest
What can be included in the additional terms for DNRs?
- Medical orders for life-sustaining treatment (MOLST)
- Physician’s orders for life-sustaining treatment (POLST)
What are the requirements for a DNR to be considered valid?
- Must be on yellow paper
- All fields on the document must be filled out (date, signatures, etc.)
* Be familiar with the appearance of state or local forms
What should you do if you are unable to determine whether an advance directive is legally valid?
Begin appropriate medical care and leave questions about advanmce directives to physicians
Abandonment
Failure of the EMR to continue emergency medical treatment until relieved by someone with the same or higher level of training
What signs can you refer to in order to determine if someone is dead?
- Decapitation
- Rigor mortis (muscles are stiff temporarily)
- Tissue decomposition (flesh also begins to decay)
- Dependent lividity (red or purple color on patient’s body that is closest to the ground)
What should you do if you find a dead person/people on the scene of an emergency?
- Make sure one or more signs of death are present
- Follow department protocols for dead patients on the scene
Negligence
Deviation from the accepted standard of care resulting in further injury to the patient
What must be present for a legal claim for negligence to be sustained?
- Duty to act
- Breach of duty
- Resulting injuries
- Proximate cause
When can records on patient information be released to designated people?
- When a legal subpoena is released
- Patient signs a written release while being competent and fully knowing the nature of the release
What is included in confidential information?
- Patient history
- Assessment findings
- Treatment provided
- Communication with patient
What can be considered public information depending on state?
- Patient name
- Patient address
- Patient age
- Hospital to which patient was transported
Good Samaritan laws
Laws that encourage citizens to voluntarily help an inured or suddenly ill person by minimizing the liability for any errors or omissions in providing good faith emergency care
Certification
The process by which a person, institution, or program is evaluated and recognized as meeting certain standards to ensure safe and ethical patient care
What are some crimes required by state and federal agencies to be reported?
- Knife wounds
- Gunshot wounds
- Motor vehicle crashes
- Suspected child abuse
- Domestic violence
- Elder abuse
- Dog bites
- Rape
What are two categories of reportable events required by state and federal agencies?
- Crime
- Certain infectious diseases
What are the steps for dealing with patient care on a crime scene?
- Protect yourself
- Wait in a safe location until law enforcement arrive if you suspect the scene is not safe
- Document anything that seems unusual on the scene
- Only move the patient when necessary and remember what the scene looks life if this is needed
- Only touch what is needed to gain access to the patient
- Preserve the scene for crime investigation
- Do not cut through knife or bullet holes in the patient’s clothing, cut around it
- Do not place equipment where it may destroy evidence
- Keep nonessential people away from the scene
- Work with law enforcement on the scene to ensure everyone has the information they need
- Write a report about the incident as soon as possible and make a sketch of the scene showing where and how you found the patient
What should documentation include?
- The condition of the patient when found
- Patient’s description of injury or illness
- Patient’s initial and repeat vital signs
- Treatment given to the patient
- Agency and personnel who took over treatment of the patient
- Any reportable conditions present
- Any infectious disease exposure
- Anything unusual regarding the situation
