Chapter 3 Medical, Legal, & Ethical Issues Flashcards
Scope of Practice
The action and care that EMT’s are legally allowed to perform in the state that the work. It also identifies which activities would be deemed illegal if practiced without a license.
Standard of Care
Care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation.
2 Principles of Standard of Care
1) Did the EMT provide the right assessment and emergency care for the patient?
2) Did the EMT perform the assessment and emergency care properly?
Duty to Act
refers to your legal obligation to provide service, weather you think the patient needs and ambulance or not.
Duty to Act - Off Duty
Most states you have no more legal obligation to act than any other citizen. You could legally do the following:
- Stop and help a victim at the scene.
- Pass the scene and call for help.
- Pass the scene and not call for help.
Duty to Act - Off Duty (states that require aid)
Some states require off duty EMT to stop at emergency and render aid
Duty to Act - Important Note
When off duty. If a EMT stops at an accident he/she creates a Duty to Act by stopping.
Duty to Patient
Respecting the right of the patient (provide competent care for injury-illness- emotional needs, confidentiality, privacy, & do no further harm.
Duty to Self
obtain necessary credentials, maintains skills to level of proficiency & maintain good physical/mental health.
Duty to Partner
Ensure that he is mentally and physically fit, to report alcohol/drug abuse on the job, & have their back.
Duty to Equipment
Ensure that all equipment is in working order.
Good Samaritan Law
are laws or acts offering legal protection to people who give reasonable assistance to those who are injured, ill, in peril, or otherwise incapacitated.
Sovereign immunity
is the legal privilege by which the American federal, state, and tribal governments cannot be sued. Local governments in most jurisdictions enjoy immunity from some forms of suit, particularly in tort.
Statue of Limitations
is an enactment in a legal system that sets the maximum time after an event that legal proceedings based on that event may be initiated.
contributory negligence
It applies to cases where plaintiffs/claimants have, through their own negligence, contributed to the harm they suffered.
Consent
permission before providing care
Under the law, the conscious, competent, and rational patient has the right to refuse or accept medical care.
Informed consent
is a process for getting permission before conducting a healthcare intervention on a person.
Expressed consent
Known as: Emergency doctrine
(consent which is not implied) may be in verbal, nonverbal, or written form and is clearly and unmistakably stated. Verbal consent is given by using verbal communication.
Nonverbal consent is given by using nonverbal communication.
implied consent
is a controversial form of consent which is not expressly granted by a person, but rather inferred from a person’s actions and the facts and circumstances of a particular situation (or in some cases, by a person’s silence or inaction).
minor consent
In most jurisdictions, a doctor or hospital may not legally treat a minor child without consent of a parent or legal guardian.
Exception: emancipated minors
a minor who is married, pregnant, a parent, financially independent living away from home, in the armed forces, declared by a court.
involuntary consent
refers to medical treatment undertaken without a person’s consent. In almost all circumstances, involuntary treatment refers to psychiatric treatment administered despite an individual’s objections. These are typically individuals who have been diagnosed with a mental illness and are deemed by a court to be a danger to themselves or others.
Advance directive
is a set of written instructions that a person gives that specify what actions should be taken for their health, if they are no longer able to make decisions due to illness or incapacity.
DNR (Do Not Resuscitate)
is a legal order written either in the hospital or on a legal form to respect the wishes of a patient not to undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing.
Living Will
A living will is a legal document that a person uses to make known his or her wishes regarding life prolonging medical treatments. It can also be referred to as an advance directive, health care directive, or a physician’s directive.
Durable Power of Attorney (health care proxy)
designates a person who is legally empowered to make health care decisions for the signer of the document if unable to do so for themselves.
Physicians orders for life sustaining treatment (POLST)
is both a holistic method of planning for end-of-life care and a specific set of medical orders that ensure patients’ wishes are honored. The POLST Paradigm is built upon conversations between patients, loved ones, and health care professionals, during which patients can determine the extent of care they wish to receive. As a result of these conversations, patients may elect to create a POLST form, which translates their wishes into actionable medical orders. The POLST form assures patients that health care professionals will provide only the care that patients themselves wish to receive, and decreases the frequency of medical errors.
Steps to Protect yourself in a DNR or POLST situation
1) consider initiating treatment immediately so that if the issue cannot be resolved you are not found negligent for not providing treatment or delayed treatment, (2) contact medical direction on how to proceed, (3) continue treatment until the problem has been solved.
Competency
A patient is deemed to be lucid if he is able to accurately prove orientation to “person, place, and time.”
Refusal of treatment
Under the law, to refuse treatment or transport a patient must be informed of and fully understand the treatment, and all the potential risks, and the consequences of refusal, up to and including the possibility of death.
Steps to protect self in Refusal of treatment situation
1) explain treatment and consequences of refusal
2) have patient sign a release from liability form
3) Document everything!!!!
breach of your legal duty
2 types of liability in breach: criminal & civil
Tort
is a civil wrong, act, or damage where a plaintiff seeks monetary compensation.
Negligence
is a tort were there is no intent to do any harm to a patient but in which there was a breach of duty to act.
proximate cause
it must be determined that the injuries suffered by the patient were a direct cause of the EMT.
Intentional tort
is an action knowingly committed by an individual that is considered to be civilly wrong under the law.
Example: abandonment, assault, battery, false imprisonment, & defamation.
Abandonment (EMT)
if you stop treatment without transferring care to another competent professional of equal or high licensure
Assault
is the willful threat to inflict harm on a patient.
Can occur without touching
If the patient has the apprehension of bodily harm, and the EMT has the ability to do so it would be consider assault.
Battery
is the act of touching a patient without his consent.
False imprisonment
taking a patient to a hospital against his wishes
Defamation
releasing information to the public either written or spoken that is construed to be damaging to that’s person’s character, reputation, or standing within the community
Slander
is the spoken form of defamation
Libel
is putting the false or damaging statement in written form or via mass media.
Confidentiality
is a set of rules or a promise that limits access or places restrictions on certain types of information.
EMT’s are require to keep confident patient information.
The Health Insurance Portability and Accountability Act of 1996
defines policies, procedures and guidelines for maintaining the privacy and security of individually identifiable health information as well as outlining numerous offenses relating to health care and sets civil and criminal penalties for violations.
This act gives the right to privacy to individuals from age 12 through 18. The provider must have a signed disclosure from the affected before giving out any information on provided health care to anyone, including parents
(COBRA) Consolidated Omnibus Budget Reconciliation Act of 1985
act that, among other things, mandates an insurance program giving some employees the ability to continue health insurance coverage after leaving employment.
Medical Emergency Labor Treatment Act
It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.
Donors and Organ Harvesting
An individual is a patient first and a donor last.
Medical Identification insignia
has important medical information
Bracelet, necklace, or card
Medical Alert tattoo
placed on wrist, arm, chest
Signs of death (in the Field)
- absence of a pulse, breathing, breathe sounds
- Complete unresponsiveness to stimuli
- No eye movement or pupil response
- Absence of blood pressure
- No Reflexes
Medical examiner called for
- Homicide
- Suicide
- Violent death
- Crash-related death
- Unusual scene characteristics (burns, electrocution).
- SIDS
- DOA
Special Reporting situations
abuse, crime, & drug related injuries
Baby Safe Haven law
“Baby Moses laws”, in reference to the religious scripture) are statutes in the United States that decriminalize the leaving of unharmed infants with statutorily designated private persons so that the child becomes a ward of the state. “Safe-haven” laws typically let mothers remain nameless to the court, often using a numbered bracelet system as the only means of linking the baby to the mother.
