Chapter 4. Medical, Legal, and Ethical Issues Flashcards
What is scope of practice?
-Regulations and ethical considerations that defines the scope, or extent and
limits of an EMT’s job
-May include skills and procedures
-Determined by national, state, local laws, statutes, and protocols
What is standard of care?
-Care that would be expected from an EMT with similar training when caring
for a patient in a similar situation
-Meeting standard of care reduces risk of legal action –Scope of practice
—What you can do
-Standard of care
—How you should do it
What is consent?
- Permission from patient to assess, treat, and transport
- Expressed consent
- –Must be informed
- Implied consent
- -Assumed consent
- -Follow local laws and protocols.
Consent: Children and mentally incompetent
adults
- Minors not legally permitted to provide consent or refusal for treatment
- Obtain from parent or legal guardian
- Possible exceptions (check local law)
- -In loco parentis
- -Emancipated minors
- Possible exceptions (check local law)
- -Life-threatening illness or injury
- -Minors who have children
- -Minors serving in armed forces
- Adult patients incapable of informed decisions about care
- -State and local laws and protocols permit transport of such patients under implied consent
Consent: Involuntary transportation
-Patient considered threat to himself or others
-Court order
-Usually requires decision by mental health professional or police officer
-If patient restrained, must not risk legal
liability
What to do when a patient refuses care?
- Patient may refuse care or transport under the following circumstances:
- Patient must be legally able to consent.
- Patient must be awake and oriented.
- Patient must be fully informed.
- Patient will be asked to sign a “release” form.
- Despite all precautions, EMT may still be held liable.
- Take all possible actions to persuade the patient to accept care and transport.
- Spend time speaking with the patient.
- Listen carefully to try to determine why the patient is refusing care.
- Inform the patient of the consequences of not going to the hospital.
- Take all possible actions to persuade the patient to accept care and transport.
- Consult medical direction.
- Ask the patient if it is all right if you call a family member—or advise the patient that you would like to call a family
member. - Take all possible actions to persuade the patient to accept care and transport.
- Call law enforcement personnel if necessary.
- Subjecting the patient to unwanted care and transport has actually been viewed in court as assault or battery.
- Have witnesses to refusal.
- Inform patient that if they change their mind, they can call back.
- If possible, have friend or relative remain with patient.
- Document attempts thoroughly.
Do Not Resuscitate Orders and Physician Orders for Life-Sustaining Treatment
- Legal document expressing patient’s wishes if patient unable to speak for self
- Do not resuscitate order (DNR)
- May be part of an advance directive
- May be part of a Physician Order for Life-Sustaining Treatment (POLST)
- Should also be familiar with living wills and health care proxies
What is negligence?
- Something that should have been done was not done, or was done incorrectly
- Must prove:
- -EMT had duty to act
- -Breach of duty
- EMT failed to provide standard of care expected or failed to act.
- Must prove:
- -Proximate causation
- -Patient suffered harm because of EMT action or inaction
- Negligent EMTs may be required to pay damages.
- Res ipsa loquitur (the thing speaks for itself)
- Legal concept important in negligence cases
What is 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
-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.
What are the good samaritan laws?
-Grant immunity from liability if rescuer acts in good faith within level of
training
-Rarely apply to on-duty personnel
-May not cover EMTs in some situations
-Do not protect persons from gross negligence or violations of law
What is confidentiality?
-Information on patient’s history, condition, treatment considered
confidential.
-Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA)
-Information shared with other health care personnel as part of patient’s continuing care
-Otherwise must be obtained through
subpoena
special situations: medical identification devices
- Necklace, bracelet, or card
- Conditions include:
- Heart conditions
- Allergies
- Diabetes
- Epilepsy
special situations: 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
special situation: safe haven
- Allow person to drop off an infant or child at any fire, police, or EMS 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
What is a crime scene?
- Location where crime was committed or anywhere evidence may be found
- Once police have made scene safe, EMT’s priority is patient care.
- Know what evidence is.
- Take steps to preserve evidence.
