Chapter 4. Medical, Legal, and Ethical Issues Flashcards

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1
Q

What is scope of practice?

A

-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

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2
Q

What is standard of care?

A

-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

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3
Q

What is consent?

A
  • Permission from patient to assess, treat, and transport
  • Expressed consent
  • –Must be informed
  • Implied consent
  • -Assumed consent
  • -Follow local laws and protocols.
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4
Q

Consent: Children and mentally incompetent

adults

A
  • 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
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5
Q

Consent: Involuntary transportation

A

-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

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6
Q

What to do when a patient refuses care?

A
  • 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.
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7
Q

Do Not Resuscitate Orders and Physician Orders for Life-Sustaining Treatment

A
  • 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
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8
Q

What is negligence?

A
  • 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
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9
Q

What is duty to act?

A

-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.

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10
Q

What are the good samaritan laws?

A

-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

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11
Q

What is confidentiality?

A

-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

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12
Q

special situations: medical identification devices

A
  • Necklace, bracelet, or card
  • Conditions include:
  • Heart conditions
  • Allergies
  • Diabetes
  • Epilepsy
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13
Q

special situations: organ donors

A

-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

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14
Q

special situation: safe haven

A
  • 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
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15
Q

What is a crime scene?

A
  • 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.
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16
Q

Crime scene: evidence

A
  • Examples of evidence
  • Condition of the scene
  • The patient
  • Fingerprints and footprints
  • Microscopic evidence
17
Q

crime scene: preservation evidence

A
  • Remember what you touch
  • Minimize your impact on the scene
  • Work with the police
18
Q

what are some special reporting requirements?

A
  • Child, elderly, or domestic abuse
  • 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.