Chapter 3: Medical, Legal and Ethical Issues

Question 1

What service do EMT’s provide?

Answer 1

emergency medical care - Immediate care or treatment

Question 2

Define consent as a basic concept

Answer 2

consent - permission to render care.

An adult who is conscious, rational and capable of making informed decisions has a legal right to refuse care.

If the patient refuses care you may not care for the patient

Question 3

Define decision-making capacity

Answer 3

decision-making capacity - the abilit of a patient to understand the information you are providing, coupled with the ability to process that information and make an informed choice regarding medical care.

Question 4

The right of a patient to make decisions concerning his or her health is known as _______ .

Answer 4

Patient autonomy

Question 5

What is the crucial difference between decision-making capacity and competence

Answer 5

Competence is generally regarded as a legal term and is often decided by the courts where as decision-making capacity is more commonly used in health care to determine whether a patient is capable of making health care decisions.

Question 6

What factors should be considered when determining a patients decision-making capacity?

Answer 6

• is the patient’s intellectual capacity impaired by mental limitation or any type of dementia?
• Is the patient of legal age (18 in most states)?
• Is the patient impaired by alcohol or drug intoxication or serious injury or illness?
• Does the patient appear to be experiencing significant pain?
• Does the patient have a significant injury that could distract him or her from a more serious injury?
• Are there any apparent hearing or visual problems?
• IS a language barrier present? Do you and your patient speak the same language?
• Does the patient appear to understand what you are saying?
• Does the patient ask rational questions that demonstrate an understanding of the information you are trying to share?

Question 7

What is express consent?

Answer 7

expressed consent - Type of consent in which a patient gives verbal or non-verbal authorization for provision of care or transport

To be valid, the consent that the patient provides must be informed consent which means they were informed about the nature of treatment being offered, the potential risks and benefits, alternatives to treatment and the potential consequences of refusing treatment.

Question 8

What is informed consent and why does it matter?

Answer 8

informed consent - the patient must be informed about the nature of treatment being offered, the potential risks and benefits, alternatives to treatment and the potential consequences of refusing treatment.

Question 9

What is implied consent?

Answer 9

Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment.

Applies to unconscious or otherwise incapable patients including those who are intoxicated, mentally impaired or suffering from certain conditions such as head injury.

Only applies when a serious medical condition exists, never used without threat to life or limb.

Question 10

What is the emergency doctrine?

Answer 10

The principle of law that permits a health care provider to treat a patient in an emergency situation when the patient is incapable of granting consent because of an altered level of consciousness, disability, the effects of drugs or alcohol or age.

Question 11

What is involuntary consent?

Answer 11

Applies to an adult patient who is mentally incompetent and cannot grant consent. Consent should be obtained from someone who is legally responsible for the patient, such as a guardian or conservator.

Question 12

When working with minors who can give consent?

Answer 12

A parent or legal guardian when available, if unreachable you should treat the child as consent is implied.

Question 13

What does in loco parentis mean?

Answer 13

The legal responsibility of a person or an organization to take on some of the functions and responsibilities of a parent.

Question 14

When can you legally forcibly restrain a patient?

Answer 14

Only when a patient is combative and poses a risk to the rescuer, it is best to wait for Police and contact medical control before attempting to restrain

Question 15

What does it mean to have the right to refuse treatment?

Answer 15

Adults who are conscious, alert and appear to have decision-making capacity have the right to refuse treatment or withdraw from treatment at any time, even if doing so may result in death or serious injury.

Question 16

Before leaving a right to refuse patient, what should you do?

Answer 16

• encourage the patient to permit treatment, remind them to call 9-1-1 if they change their mind or their condition worsens
• advise them to contact their physician asap
• have the patient sign the refusal of treatment form and document all refusals
• document any finding and all efforts that you made to obtain consent
• a description of possible consequences of refusing treatment and transport
• have the patients signature witnessed by a family member or a police officer

Question 17

If a parent refuses treatment for a child what documentation should you have?

Answer 17

• Any assessment findings
• The care you provided
• Your efforts to obtain consent
• Your consultation with medical control
• The responses to your efforts

IF they refuse to sign the release, inform medical control and document the situation and the patients refusal.

Question 18

What is protected health information (PHI)?

Answer 18

Any information about health status, provision of health care, or payment for health care that can be linked to an individual. This definition is interpreted rather broadly and includes any part of a patient’s medical record or payment history.

Question 19

What is the difference between a presumptive sign of death and a definitive sign of death?

Answer 19

A presumptive sign of death includes:
- Unresponsive to painful stimuli
- Lack of a carotid pulse or heartbeat
- Absence of chest rise and fall
- No deep tendon or corneal reflexes
- Absence of pupillary reactivity
- No systolic blood pressure
- Profound cyanosis
- lowered or decreased body temp

These signs MIGHT indicate death but are not definitive unless combined

A definitive sign of death includes:
- Obvious mortal damage, such as decapitation
- Dependent lividity: blood settling in the lowest point of the body
- Rigor mortis: the stiffening of body muscles cause by chemical changes within muscle tissue
- Algor mortis: the cooling of the body to ambient temperature
- Putrefaction: decomposition of body tissues

Question 20

What is scope of practice?

Answer 20

Most commonly defined by state law: outlines the care that the EMT is able to provide for the patient.

Question 21

The manner in which you must act or behave is called the ______.

Answer 21

Standard of Care

Question 22

Define standard of care

Answer 22

Written, accepted level of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.

Question 23

What is the definition of an emergency?

Answer 23

An emergency is a serious situation that threatens the life or welfare of a person or group of people and requires immediate intervention.

Question 24

______ is the process by which an individual, institution, or program is evaluated and recognized as meeting certain predetermined standards to ensure safe and ethical patient care.

Answer 24

Certification

Certification is the process by which an individual, institution, or program is evaluated and recognized as meeting certain predetermined standards to ensure safe and ethical patient care.

Question 25

________ is the process by which a competent authority, usually the state, grants permission to practice a job, trade, or profession.

Answer 25

Licensure

Licensure is the process by which a competent authority, usually the state, grants permission to practice a job, trade, or profession.

Question 26

________ is an established process to determine the qualifications necessary to be allowed to practice a particular profession or to function as an organization.

Answer 26

Credentialing

Credentialing is an established process to determine the qualifications necessary to be allowed to practice a particular profession or to function as an organization.

Question 27

________ is how a reasonably prudent person with similar training and experience would act under similar circumstances, with similar equipment, and in the same or similar place.

Answer 27

Standard of Care

The standard of care is how a reasonably prudent person with similar training and experience would act under similar circumstances, with similar equipment, and in the same or similar place.

Question 28

Define duty to act

Answer 28

A medicolegal term relating to certain personnel who either by statute or by function have a responsibility to provide care.

Question 29

When do you have a duty to act?

Answer 29

-You are charged with emergency medical response.
-Your service’s or department’s policy states that you must assist in any emergency.

Once your ambulance responds to a call or treatment is begun, you have a legal duty to act.

In most cases, if you are off duty and come upon a crash, you are not legally obligated to stop and assist patients.

If you choose to intervene while off duty, you must continue to provide competent care until an equal or higher medical authority assumes care of the patient.

Question 30

What is Negligence?

Answer 30

the failure to provide the same care that a person with similar training would provide in the same or a similar situation.

Question 31

What are the factors that a determination of negligence is based on?

Answer 31

Duty: The EMT has an obligation to provide care and to do so in a manner that is consistent with the standard of care established by training and local protocols.

Breach of duty: A breach of duty occurs when the EMT does not act within an expected and reasonable standard of care.

Damages: Damages occur when a patient is physically or psychologically harmed in some noticeable way.

Causation:
- There must be a reasonable cause-and-effect relationship between the breach of duty and the damages suffered by the patient.
- If an EMT has a duty and abuses it, thereby causing harm to another individual, the EMT, the agency, and/or the medical director may be sued for negligence. This is often referred to as proximate causation.

Question 32

What is abandonment?

Answer 32

Abandonment is the unilateral termination of care by the EMT without the patient’s consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient.

Once care is started, you have assumed a duty that must not stop until an equally competent EMS provider assumes responsibility.

Question 33

When might an EMT commit assault?

Answer 33

Threatening to restrain a patient who does not want to be transported could be considered assault.

Assault is unlawfully placing a person in fear of immediate bodily harm.

Question 34

What is battery and when might an EMT perform the action?

Answer 34

Battery is unlawfully touching a person, including providing emergency care without consent.

Any life saving act committed against the patients expressed wishes

Question 35

What is defamation?

Answer 35

Defamation is the communication of false information that damages the reputation of a person.

Question 36

What is the libel?

Answer 36

Defamation that is in writing is referred to as libel.

Question 37

What is slander?

Answer 37

Defamation that is spoken is known as slander.

Question 38

When might an EMT be guilty of defamation?

Answer 38

A legal claim for defamation could arise out of:

A false statement on a run report
Inappropriate comments made on social media
“Station house” conversations
Sharing “war stories” with friends, relatives, or neighbors

Question 39

What is gross negligence?

Answer 39

Gross negligence is defined as conduct that constitutes a willful or reckless disregard for a duty or standard of care.

Question 40

When are you obliged to report suspected child or elder abuse?

Answer 40

Whenever you witness it.

Statutes frequently grant immunity from liability for libel, slander, or defamation of character to the individual who is obligated to report, even if the reports are subsequently shown to be unfounded, as long as the reports are made in good faith.

Question 41

What are ethics?

Answer 41

Ethics is the philosophy of right and wrong, of moral duties, and of ideal professional behavior.

Question 42

________ is a code of conduct that can be defined by society, religion, or a person, and which affects both character and conscience.

Answer 42

Morality is a code of conduct that can be defined by society, religion, or a person, and which affects both character and conscience.

Question 43

_______ addresses issues that arise in the practice of health care.

Answer 43

Bioethics addresses issues that arise in the practice of health care.

Question 44

The manner in which principles of ethics are incorporated into professional conduct is known as _______.

Answer 44

Applied Ethics