Chapter 4 Flashcards
Scope of Practice
The extent and limits of an EMT’s job
What is the primary ethical consideration to the patient?
Make patient care and well-being a priority, even if it requires some personal sacrifice
Standard of Care
The care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation
what three levels of emergency care can be improved?
Crew
Agency
Individual
T or F never accept suggestions from others to improve your skills, communication, and patient outcome.
False, always look for constructive criticism.
What is part of the process known as quality improvement?
Participation in mutual critique
What is consent?
permission from the patient, it is required for any treatment or action taken by the EMT
T or F. Expressed consent must be obtained from every conscious, mentally competent adult after providing care and transportation.
False. Need consent BEFORE
What are 3 types of consent?
Expressed, implied, and consent to treat minors or incompetent patients.
Expressed consent
consent given by adults who are of legal age and are mentally competent to make rational decision with regard to their medical well being, must be obtained from all patients who are physically and mentally able to give it.
T or F. Expressed consent must be informed consent
True
Informed consent
Patients must understand the risks associated with the care they will receive..
Who is not legally allowed to provide consent or refuse medical care and transportation?
Children and mentally incompetent adults
Who is not legally allowed to provide consent or refuse medical care and transportation?
Children and mentally incompetent adults. but the guardians have legal authority to give consent and that must be obtained.
in what cases would consent not be necessary from these parents or guardians in order to give care?
When a child care provider or school authority acts in loco parentis (in place of parent).
In cases of life threatening illness or injury when they are not present, care may be given based on implied consent.
in some states, statutes allow emancipated minors to provide consent. what is an emancipated minor?
those who are married or of a certain age.
T or F. minors who have children and those who served in the armed forces may not provide consent.
False. they can provide consent for their care.
Under what circumstances would a patient be transported or cared for against their will?
decision made by officer bc they believe the patient poses a threat to themselves or others.
Or as a result of a court order
T or F. Physical restrainment of a patient is not a very significant legal responsibility.
False. It IS a significant legal responsibility.
What are the 4 basic reasons one would refuse hospital care?
Denial
Fear
Failure to understand the seriousness of situation (That is why you take EXTRA care to inform them)
Intoxication
What is a primary responsibility as an EMT for the patient’s care?
Be sure that the patients are fully informed about their situation and the implications of refusing care.
What 4 conditions need to be fulfilled in order for a patient to refuse care?
Must legally able to consent. (of legal age or emancipated minors)
Patients must be awake and oriented (no impaired judgment or altered mental status)
Must be fully informed (mental capacity to understand the situation completely)
Asked to sign a ‘release’ form. (designed to release the ambulance agency and individuals from liability.
What is a leading cause of lawsuits against EMS agencies and providers (even if it was the patient who refused)?
leaving a patient who will not accept care or transport
Take all possible actions to persuade patient to accept care or transportation. Some ways include: (7 things)
Talk to the patient (accommodate)
Listen carefully to determine why they dont want to go
(listening is key)
Inform them of the consequences of not going (this is an essential componant of every refusal-of-care situation)
Consult medical direction (let the on-line doctor speak to them)
Ask if you can call a family member (It is considered consent to call family if they agree or do not object)
Call law enforcement if necessary (be sure there is incompetence bc you are assuming possible legal liabilities if you are wrong)
Ask them to sign a refusal of care by your agency (if they refuse to, document all the steps taken)
assault
placing a person in fear of bodily harm
battery
causing said harm or restraining
Subjecting patients to unwanted care and transport has been viewed in court as what?
assault and in some instances, battery.
What should you advise the patient to do in all cases of refusal? (2 things)
Tell them to call back at anytime if they have a problem or wish to be transported/cared for.
Recommend that the family physician is called to report the incident and arrange follow-up care.
What is a DNR?
Do not resuscitate. it is a legal document that states the patient has a terminal illness and does not want to prolong life through resuscitative efforts.
Advance directive
A DNR order; instructions written in advance of an event
physician’s order for life sustaining treatment (POLST)
physician’s order for life sustaining treatment which may include not just whether patients wish resuscitation attempts but also whether patients wish artificial feeding or antibiotics if unable to express their desires later
DNR can be found in two places, what are they?
Advance directive
POLST
Living Wills
statements signed by the patient regarding use of long term life support and comfort measures (ex. respirators, intravenous feedings, pain meds)
Proxy
person who the signer of the document names to make health decisions when the signer cannot make the decisions.
Are oral requests of there being a DNR (but not seeing one) reason to not resuscitate?
No, not usually. ultimately just result to providing care.
Can you resuscitate bc the family wants you to even if there is a DNR?
Not typically, call medical direction. But you have to respect the patients requests.
Negligence
Something that should have been done was not done or was done incorrectly
negligence requires all of the following circumstances to be proved. (3 things)
- E M T had duty to act
- Breach of duty
- E M T failed to provide standard of care expected or failed to act
- Proximate causation
- Patient suffered harm because of E M T action or inaction
If you preform CPR and the patient dies, is there proximate causation between you and the patients death?
No
Lawsuits against E M Ts are usually classified as torts. define Torts
A civil not a criminal offense in action or injury caused by negligence from which a lawsuit may arise
What is a concept used in Tort law?
Res ipsa loquitur (the thing speaks for itself)
-Legal concept important in negligence cases bc it allows the finding of negligence even when there is no specific evidence of an negligent act.
What are the two most common and significant lawsuits against EMTs are what?
Patient refusal
ambulance collision
How to stay legally safe (3 things)
Follow protocols
Treat people well
Ask for help when needed
Duty to Act
Obligation to provide care to a patient Duty to act is not always clear. -Off duty -On duty but out of jurisdiction Follow local laws and protocols. Follow own conscience.
Abandonment
Abandonment
Once care is initiated, it may not be discontinued until transferred to medical personnel of equal or greater training.
Failure to do so may constitute abandonment.
Good Samaritan laws
Grant immunity from liability if rescuer acts in good faith within level of training
May not cover E M T s in some situations
Do not protect persons from gross negligence or violations of law
Confidentiality
Information on patient’s history, condition, treatment considered confidential
T or F. Patient info should not be disclosed based on verbal permission
True. only in writing
In court you may (if subpoenaed)….
legally disclose patient info
Patient info also may be shared with…
other health care pros who will have a role in the patients care.
Libel
when info is false and injurious to another is spread in written form
Slander
when info is shared in verbally
Medical identification devices
For particular medical conditions
Necklace, bracelet, or card
(possibly tattoos)
Conditions include: Heart conditions Allergies Diabetes Epilepsy
Organ donors
Completed legal document allowing donation of organs and tissues in event of death
May be identified by family members, donor card, driver’s license
Receiving hospital and/or medical direction should be advised per protocol
Oxygen delivered to body cells by CPR helps preserve_____ until they can be harvested
Organs
Safe haven laws
- Allow person to drop off an infant or child at any fire, police, or E M S station
- States have different guidelines for ages of children included
- Protect children who may otherwise be abandoned or harmed by parents unwilling or unable to care for them
Crime scene
Location where crime was committed or anywhere evidence may be found
T or F. Even if scene isn’t safe, attend to the patient before police get there.
False. Once police have made scene safe, E M T’s priority is patient care.
Know what evidence is and take steps to preserve it (7 examples)
Condition of the scene
The patient
Fingerprints and footprints
Microscopic evidence
(preservation)
Remember what you touch
Minimize your impact on the scene
Work with the police
What are some special reporting requirements? (8 things)
- Child, elderly, or domestic abuse
- Human trafficking
- Violence (gunshot wounds or stabbings)
- Sexual assault
- Situations where restraint may be necessary
- Intoxicated person with injuries
- Mentally incompetent people with injuries
- Check local laws and protocols.
Morality:
Personal opinions about right and wrong
Ethics:
Standard of behavior for a profession
Ethical expectations for E M T:
8 things
- Be honest in reporting
- Refrain from actions that cause harm to a patient
- Work to help the patient
- Respect the right of adult patients to make their own decisions
- Treat all patients fairly and justly
- Assist others to learn your profession
- Report misconduct
- Make sure research is approved
