Medical, Legal, And Ethicals Issues Flashcards
What are the legal and ethical standards of care for EMTs
do no further harm, act competency within your scope of practice, and act in good faith
What are the ethical responsibilities of an EMT
make patients needs a priority, be a patient advocate, maintain skills and knowledge, review performance and seek ways to improve, and prepare honest reports
What is the scope of practice for EMTs
A collective set of rules and duties that define your role as an EMT
Who developed the scope of practice for EMTs
USDOT EMT National Standard Curriculum and State Law as well as the Medical Director
What is it considered when you act outside of the scope of practice
Negligence
What is duty to act
your responsibility to provide care while on duty
in the case, that you are off duty, are you still required to assist in an emergency
no, in MA EMTs off duty are not legally bound to stop for an emergency
Do bystanders have a duty to act in the case of emergency
No
What is standard of care
care that is expected of an EMT with similar training managing a patient in a similar condition
how are standards of care established
local custom, the law, and textbooks
What is the medical practices act
EMTs act under medical direction and are not licensed medical professionals
How do we ensure EMTs are fit to perform their duties
via certification and licensure exams
What is negligence
deviation from the accepted standard of care resulting in injury to a patient
what are examples of simple negligence
emt fails to perform care or mistake is made in treatment
what are examples of gross negligence
willful, wanton, or reckless care, beyond careless mistakes, or intentional injury to a patient
What are some common complaints against EMTs filed with MA OEMS
- soliciting a patient refusal
- failure to use KED for seated MVA patient where rapid extraction was used but not necessary
- allowing or encouraging patient to walk to cot or ambulance
- rolling a cot in the high position without both EMTs having both hands on cot
What are the four components of negligence
- Duty to act
- Breach of duty
- Injury or damages
- Causation or proximate cause
what is breach of duty in accordance with negligence
when the EMT does not act within an expected and reasonable standard of care
What are damages in relation to negligence
when the patient is harmed in a noticeable way
what is causation in relation to negligence
must be a reasonable cause and effect: usually occurs when EMT is operating outside scope of practice
What is the Reasonable Person Test
Ability to provide the same care that a person with similar training would provide in a similar situation
How many of the components of negligence must exist for negligence to apply
All 4 of them
How can negligences be determined
- Res ipsa loquitur
- Negligence per se
- Torts
What does res ipsa loquitur mean in term of negligence
the cause of the injury was in control of the EMT, injury doesn’t occur unless there is negligence
What does negligence per se mean under the determination of negligence
The conduct of the person being sued is alleged to that occurred in clear violation of a statue
What is an example of negligence per se
EMT performs ALS skill that results in further injury to the patient
What is torts in relation to the determination of negligence
Civil wrongs, ie actions were not within the jurisdiction of the US criminal courts
What is abandonment in relation to patient care
Termination of care of a patient without assuring continuation of care at the same level or higher level without patients documented consent
Where does abandonment commonly take place
At the scene or in the ED
Is abandonment evaluated as negligence
Yes
What is consent
Permission given by the patient authorizing the EMT to provide care
What is expressed consent
Patient is conscious and understands the treatment options available and allows the EMT to provide said care
What is implied consent
Patient is unable to indicate consent BU EmT assumes that a reasonable person would want care in the same situation or that patient would want care if they could say so
What is the foundation of consent
decision making capacity
What criteria must patient meets in order for expressed consent to be valid
patient is of legal age, patient is informed of all procedures including benefits, risks, and alternatives to treatment, and lastly, must be obtained from conscious, competent adults before providing treatment
What are the requirements of consent
voluntary, informed, and understanding
Define voluntary in term of consent
patient is a willing recipient of care
What is informed in terms of consent
patient must be told what care they are consenting to
What does understanding mean in terms of consent
patient must be able to understand what is being done to them
Can consent be revoked at any time during treatment
yes
What is the principle of implied consent called
the emergency doctrine
Can consent be given from a spouse or relative if patient is unconscious
YES
what is involuntary consent
consent given by a guardian
When does involuntary consent apply(in what situations)
mentally ill, in behavioral crisis, and developmentally delayed
In the case of minors what kind of consent is needed to provide care
expressed consent by parent or guardian
can teachers and school officials provide consent for treatment of a child
yes
When does implied consent apply for minors
in a life threatening emergency
At what age is a patient no longer considered a minor
18
What are the exceptions for minors, ie, in what circumstances can they give consent for themselves being under 18
- emancipation
- court ordered treatment
- pregnant minor or minor w/ child
- minor in the military
- married, widowed, or divorced
How many extremities need to be constrained if a patient is deemed a danger to themselves or others
4
What is section 12 in the state of MA
Allow transport of restrained patient in order for immediate hospitalization which may be against their will
Do patients need to go with EMTs in the case of a section 12
Yes
What kind of restraints are best used for patients
soft restraints
Who can file a section 12
physician, psychiatric nurse, psychologist, or police officer
what is required for a section 12 to be filed
mental illness and substantial risk of serious harm if the person is not restrained
Does the section 12 need to be filled out prior to patient transport
Yes
What is assault in terms of contact without consent
placing a person in fear of immediate bodily harm
What is battery in terms of contact without consent
volitional, unwanted touching
what is kidnapping in terms of contact without consent
seizing, confining, abducting, or carrying away by force
what is false imprisonment in terms of contact without consent
unauthorized confinement of a person
what is defamation
communication of false information that damages a persons reputation
what does libel mean in terms of defamation
written false information
what does slander mean in terms of defamation
spoken false information
what is patient refusal
she a mentally competent adult refuses care or revokes consent
True/False: EMTs should never be encouraging a refusal
true
How do we asses the patients ability to make an informed decision
ask and repeat questions, assess the patient’s answers, and observe the patient’s behavior
when in doubt what should we do as EMTs
provide care without endangering yourself and until I’ve law enforcement if necessary
What do you do in the instance of patient refusal
encourage patient to allow care once more, ask the individual to sign a refusal of care form, ask a witness to sign the form as well, and document all refusals
How do you document a refusal
assessment, care given, persuasion attempts, and risks that were outlined for the patient
Is a witness required for patient refusal
yes
What is advance directive
written documentation that specifies medical treatment for a competent person should they be unable to make a decision
What are advanced directives
living wills, health care proxy, health care directive, DNR or DNI
what are living wills
cover more general health issues like long term life support, ventilators, and feeding tubes
what is a MOLST and POLST
MOLST: medical ordered life sustaining treatment
POLST: physician ordered life sustaining treatment
what information does a MOLST/POLST contain
acceptable interventions for the designated patient
what is a healthcare proxy
designates a person decisions for the signer if they are unable to do so for themselves
What are DNR orders
patients right to refuse resuscitative efforts
Do DNRs require written physicians signature
yes
What requirements must DNR forms meet
statement of patients medical problems, signature of patient or legal guardian, signature of physician or health care provider, and lastly, not expired
if there is proven doubt what is our duty as EMTs
provide care
what form is used in the state of MA to honor a DNR
comfort care(CC) or MOLST
What is the comfort care protocol
verifies DNR orders, clarifies the role of EMS personnel at the scene and during transport of patients with a valid CC or DNR order
What kind of care is acceptable under a DNR or CC
palliative or comfort care
Can EMTs accept a copy of DNR or CC forms
Yes
Why might a DNR have an expiration date
if a patient has a chronic illness and they were expected to die by X date but lived past it
What must EMTs do if they encounter a DNR/CC form
confirm the identity of the patient with the CC form and ensure the form is current and valid(ie not expired)
What can’t EMTs do if they encounter a DNR form
- Insert OPA
- Ventilate
- Utilize advanced airways
- Initiate CPR
- Administer chest compressions
- Administer cardiac resuscitation drugs
- Defibrillate
- Transport
What CAN EMTs do in the case of an active DNR form
- Suction airway
- Administer oxygen
- Apply cardiac monitor
- Initiate an IV line
- Control bleeding
- Splint
- Provide emotional support
- Position the patient comfortably
- Contact medication control
What should an EMT do in the case of a DNR but emergency is not related to respiratory or cardiac issues
provide full treatment
If resuscitation efforts are initiated prior to a valid DNR being located, what must be discontinued after verification
CPR, ventilation, cardiac medications, and advanced airway measures
What should be held in place if resuscitation efforts were started prior to a valid DNR being located
IVs and advanced airways
What should be documented by EMS providers in the case of a call where a valid DNR was present
the DNR, showing that it was present, current, and blind, the expiration date, and care that was provided to the patient given the circumstances
If there is an question regarding the validity of a DNR, but the patient is conscious, what should be done
the patient should be asked, and medical control should be contacted
If there is any question regarding the validity of a DNR, but the patient is unconscious what should EMS personnel do
resuscitate
Under what circumstance should EMS consider a DNR not valid
the patient revokes it themselves, the patient orders the destruction of it, or it is present partially destroyed
Who else can revoke a DNR order
patients legal guardian or healthcare proxy
What should be done upon the revoking of a DNR order
documentation should be filled out that shows it was revoked
What does HIPAA stand for and what year was it established
Health Insurance Portability and Accountability Act; 1996
What does HIPAA do
Defines confidential information for EMS, limits movement of information that could affect future care of patients, and denies EMS personnel details of exposure to communicable diseases
What will happen if HIPAA is violated
civil or criminal action
What is considered confidential information
patient history, assessment findings, and treatment rendered
What are the exceptions for release of information protected by HIPAA
subpoena, other health care personnel treating patient, mandatory reporting, and insurance billing
With whom can you share your treatment plan for a given patient
other health care provider taking over treatment
why would you share patient information with insurance
for billing and claims
why would you share patient information with healthcare operations
for quality improvement and research
Under what other circumstances can patient information be released
if the patient signs off on its release or a legal subpoena is presented
Why might EMS personnel not begin resuscitation efforts
the patient has trauma inconsistent with life
Can EMTs pronounce a patient dead, if not, what do we do
no, we cannot. in this situation we must transport to the nearest hospital and the patient will be pronounced dead.
What are some examples of trauma inconsistent with life
decapitation, transaction of the torso, complete destruction of the brain or heart, incineration, or cardiac arrest clearly caused by blunt or penetrating trauma
What is the physician responsible for when a patient has died
- pronounce death(officially)
- determine cause of death
What are definitive signs of death
Complete decomposition or putrefaction, dependent lividity, rigor mortis, algor mortis
What is dependent lividity
blood settling to the lowest point of the body, causing discoloration of the skin
What is rigor mortis
stiffening of the body, occurs within 2-12 hours after death
What is algor mortis
cooling of the body until it matches the ambient environment
Why is it essential to provide care to a decreased patient in the case of organ donations
maintenance of vital organs and tissues
Some people have bracelets, necklaces, keychains or cards indicating what about their medical history
presence of DNR order, allergies, diabetes, epilepsy, or other serious condition
Why is it so important to keep reports of all patient cases
courts considered an action not recorded an action that was not performed and untidy or incomplete reports are evidence of poor emergency medical care
Why is the Good Samaritan law so important
protects those not receiving compensation from any civil action due to errors or omissions if they were trying to aid in an emergency situation
What are the requirements for the Good Samaritan law to apply
acting within scope of practice, acting in good faith, and acting without compensation
In the state of MA are people required to report an emergency if they can do so without causing injury to themselves? Do they have to intervene as well?
Yes residents are required to report emergencies but they don’t have to intervene
What should EMTs do when working in a crime scene
ensure their safety at all times, don’t touch anything unless required for care, observe and document anything unusual, and leave alone holes in clothing that are a result of GSW or stabbing
In the case of a hanging, are ems allowed to untie the knot
No
What might EMTs be asked to do if they moved objects in a crime scene
return to the scene and in detail address their movements, as well as point out where they stepped
In documentation situations, what must EMTs keep in mind
avoid opinions, use objective statements, and place others words in quotes
What situations must be reported by EMTs
Abuse of any kind, injury, assault, sexual assault, domestic violence, attempted suicides, mental incompetence, transportation of a patient in restraints, scene of a crime, drug related injury, childbirth, infectious disease exposure, dog bites, and death
To report in MA how long should it take for one to call the hotline and report incident of abuse
24 hours
How long is allotted for a person reporting abuse to submit the designated form
48 hours
How can EMS personal act in court
They can be a witness or a defendant
If you are subpoenaed as an EMT who should you notify
your service director and legal counsel
What might you be required to do as an EMT witness in court
review the run report as evidence
If you are the defendant in a count case, what can you utilize as an EMT
statues of limitations, governmental immunity, and contributory negligence
What are interrogatories
written requests or questions
What are depositions
orals requests or questions
What can be done to allow both sides to gain more information in the instance of a lawsuit against EMS personnel
interrogatories and depositions
Do medical cases normally go to trial
No
What are statues of limitation
limits on amount of time that passes between incident and lawsuit
What is contributory negligence
the patient is partially to blame for injury or damage
