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EMT > Medical, Legal, And Ethicals Issues > Flashcards

Medical, Legal, And Ethicals Issues Flashcards

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1
Q

What are the legal and ethical standards of care for EMTs

A

do no further harm, act competency within your scope of practice, and act in good faith

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2
Q

What are the ethical responsibilities of an EMT

A

make patients needs a priority, be a patient advocate, maintain skills and knowledge, review performance and seek ways to improve, and prepare honest reports

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3
Q

What is the scope of practice for EMTs

A

A collective set of rules and duties that define your role as an EMT

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4
Q

Who developed the scope of practice for EMTs

A

USDOT EMT National Standard Curriculum and State Law as well as the Medical Director

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5
Q

What is it considered when you act outside of the scope of practice

A

Negligence

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6
Q

What is duty to act

A

your responsibility to provide care while on duty

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7
Q

in the case, that you are off duty, are you still required to assist in an emergency

A

no, in MA EMTs off duty are not legally bound to stop for an emergency

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8
Q

Do bystanders have a duty to act in the case of emergency

A

No

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9
Q

What is standard of care

A

care that is expected of an EMT with similar training managing a patient in a similar condition

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10
Q

how are standards of care established

A

local custom, the law, and textbooks

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11
Q

What is the medical practices act

A

EMTs act under medical direction and are not licensed medical professionals

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12
Q

How do we ensure EMTs are fit to perform their duties

A

via certification and licensure exams

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13
Q

What is negligence

A

deviation from the accepted standard of care resulting in injury to a patient

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14
Q

what are examples of simple negligence

A

emt fails to perform care or mistake is made in treatment

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15
Q

what are examples of gross negligence

A

willful, wanton, or reckless care, beyond careless mistakes, or intentional injury to a patient

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16
Q

What are some common complaints against EMTs filed with MA OEMS

A
  1. soliciting a patient refusal
  2. failure to use KED for seated MVA patient where rapid extraction was used but not necessary
  3. allowing or encouraging patient to walk to cot or ambulance
  4. rolling a cot in the high position without both EMTs having both hands on cot
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17
Q

What are the four components of negligence

A
  1. Duty to act
  2. Breach of duty
  3. Injury or damages
  4. Causation or proximate cause
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18
Q

what is breach of duty in accordance with negligence

A

when the EMT does not act within an expected and reasonable standard of care

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19
Q

What are damages in relation to negligence

A

when the patient is harmed in a noticeable way

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20
Q

what is causation in relation to negligence

A

must be a reasonable cause and effect: usually occurs when EMT is operating outside scope of practice

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21
Q

What is the Reasonable Person Test

A

Ability to provide the same care that a person with similar training would provide in a similar situation

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22
Q

How many of the components of negligence must exist for negligence to apply

A

All 4 of them

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23
Q

How can negligences be determined

A
  1. Res ipsa loquitur
  2. Negligence per se
  3. Torts
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24
Q

What does res ipsa loquitur mean in term of negligence

A

the cause of the injury was in control of the EMT, injury doesn’t occur unless there is negligence

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25
Q

What does negligence per se mean under the determination of negligence

A

The conduct of the person being sued is alleged to that occurred in clear violation of a statue

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26
Q

What is an example of negligence per se

A

EMT performs ALS skill that results in further injury to the patient

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27
Q

What is torts in relation to the determination of negligence

A

Civil wrongs, ie actions were not within the jurisdiction of the US criminal courts

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28
Q

What is abandonment in relation to patient care

A

Termination of care of a patient without assuring continuation of care at the same level or higher level without patients documented consent

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29
Q

Where does abandonment commonly take place

A

At the scene or in the ED

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30
Q

Is abandonment evaluated as negligence

A

Yes

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31
Q

What is consent

A

Permission given by the patient authorizing the EMT to provide care

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32
Q

What is expressed consent

A

Patient is conscious and understands the treatment options available and allows the EMT to provide said care

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33
Q

What is implied consent

A

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

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34
Q

What is the foundation of consent

A

decision making capacity

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35
Q

What criteria must patient meets in order for expressed consent to be valid

A

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

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36
Q

What are the requirements of consent

A

voluntary, informed, and understanding

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37
Q

Define voluntary in term of consent

A

patient is a willing recipient of care

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38
Q

What is informed in terms of consent

A

patient must be told what care they are consenting to

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39
Q

What does understanding mean in terms of consent

A

patient must be able to understand what is being done to them

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40
Q

Can consent be revoked at any time during treatment

A

yes

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41
Q

What is the principle of implied consent called

A

the emergency doctrine

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42
Q

Can consent be given from a spouse or relative if patient is unconscious

A

YES

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43
Q

what is involuntary consent

A

consent given by a guardian

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44
Q

When does involuntary consent apply(in what situations)

A

mentally ill, in behavioral crisis, and developmentally delayed

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45
Q

In the case of minors what kind of consent is needed to provide care

A

expressed consent by parent or guardian

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46
Q

can teachers and school officials provide consent for treatment of a child

A

yes

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47
Q

When does implied consent apply for minors

A

in a life threatening emergency

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48
Q

At what age is a patient no longer considered a minor

A

18

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49
Q

What are the exceptions for minors, ie, in what circumstances can they give consent for themselves being under 18

A
  1. emancipation
  2. court ordered treatment
  3. pregnant minor or minor w/ child
  4. minor in the military
  5. married, widowed, or divorced
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50
Q

How many extremities need to be constrained if a patient is deemed a danger to themselves or others

A

4

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51
Q

What is section 12 in the state of MA

A

Allow transport of restrained patient in order for immediate hospitalization which may be against their will

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52
Q

Do patients need to go with EMTs in the case of a section 12

A

Yes

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53
Q

What kind of restraints are best used for patients

A

soft restraints

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54
Q

Who can file a section 12

A

physician, psychiatric nurse, psychologist, or police officer

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55
Q

what is required for a section 12 to be filed

A

mental illness and substantial risk of serious harm if the person is not restrained

56
Q

Does the section 12 need to be filled out prior to patient transport

A

Yes

57
Q

What is assault in terms of contact without consent

A

placing a person in fear of immediate bodily harm

58
Q

What is battery in terms of contact without consent

A

volitional, unwanted touching

59
Q

what is kidnapping in terms of contact without consent

A

seizing, confining, abducting, or carrying away by force

60
Q

what is false imprisonment in terms of contact without consent

A

unauthorized confinement of a person

61
Q

what is defamation

A

communication of false information that damages a persons reputation

62
Q

what does libel mean in terms of defamation

A

written false information

63
Q

what does slander mean in terms of defamation

A

spoken false information

64
Q

what is patient refusal

A

she a mentally competent adult refuses care or revokes consent

65
Q

True/False: EMTs should never be encouraging a refusal

A

true

66
Q

How do we asses the patients ability to make an informed decision

A

ask and repeat questions, assess the patient’s answers, and observe the patient’s behavior

67
Q

when in doubt what should we do as EMTs

A

provide care without endangering yourself and until I’ve law enforcement if necessary

68
Q

What do you do in the instance of patient refusal

A

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

69
Q

How do you document a refusal

A

assessment, care given, persuasion attempts, and risks that were outlined for the patient

70
Q

Is a witness required for patient refusal

A

yes

71
Q

What is advance directive

A

written documentation that specifies medical treatment for a competent person should they be unable to make a decision

72
Q

What are advanced directives

A

living wills, health care proxy, health care directive, DNR or DNI

73
Q

what are living wills

A

cover more general health issues like long term life support, ventilators, and feeding tubes

74
Q

what is a MOLST and POLST

A

MOLST: medical ordered life sustaining treatment
POLST: physician ordered life sustaining treatment

75
Q

what information does a MOLST/POLST contain

A

acceptable interventions for the designated patient

76
Q

what is a healthcare proxy

A

designates a person decisions for the signer if they are unable to do so for themselves

77
Q

What are DNR orders

A

patients right to refuse resuscitative efforts

78
Q

Do DNRs require written physicians signature

A

yes

79
Q

What requirements must DNR forms meet

A

statement of patients medical problems, signature of patient or legal guardian, signature of physician or health care provider, and lastly, not expired

80
Q

if there is proven doubt what is our duty as EMTs

A

provide care

81
Q

what form is used in the state of MA to honor a DNR

A

comfort care(CC) or MOLST

82
Q

What is the comfort care protocol

A

verifies DNR orders, clarifies the role of EMS personnel at the scene and during transport of patients with a valid CC or DNR order

83
Q

What kind of care is acceptable under a DNR or CC

A

palliative or comfort care

84
Q

Can EMTs accept a copy of DNR or CC forms

A

Yes

85
Q

Why might a DNR have an expiration date

A

if a patient has a chronic illness and they were expected to die by X date but lived past it

86
Q

What must EMTs do if they encounter a DNR/CC form

A

confirm the identity of the patient with the CC form and ensure the form is current and valid(ie not expired)

87
Q

What can’t EMTs do if they encounter a DNR form

A
  1. Insert OPA
  2. Ventilate
  3. Utilize advanced airways
  4. Initiate CPR
  5. Administer chest compressions
  6. Administer cardiac resuscitation drugs
  7. Defibrillate
  8. Transport
88
Q

What CAN EMTs do in the case of an active DNR form

A
  1. Suction airway
  2. Administer oxygen
  3. Apply cardiac monitor
  4. Initiate an IV line
  5. Control bleeding
  6. Splint
  7. Provide emotional support
  8. Position the patient comfortably
  9. Contact medication control
89
Q

What should an EMT do in the case of a DNR but emergency is not related to respiratory or cardiac issues

A

provide full treatment

90
Q

If resuscitation efforts are initiated prior to a valid DNR being located, what must be discontinued after verification

A

CPR, ventilation, cardiac medications, and advanced airway measures

91
Q

What should be held in place if resuscitation efforts were started prior to a valid DNR being located

A

IVs and advanced airways

92
Q

What should be documented by EMS providers in the case of a call where a valid DNR was present

A

the DNR, showing that it was present, current, and blind, the expiration date, and care that was provided to the patient given the circumstances

93
Q

If there is an question regarding the validity of a DNR, but the patient is conscious, what should be done

A

the patient should be asked, and medical control should be contacted

94
Q

If there is any question regarding the validity of a DNR, but the patient is unconscious what should EMS personnel do

A

resuscitate

95
Q

Under what circumstance should EMS consider a DNR not valid

A

the patient revokes it themselves, the patient orders the destruction of it, or it is present partially destroyed

96
Q

Who else can revoke a DNR order

A

patients legal guardian or healthcare proxy

97
Q

What should be done upon the revoking of a DNR order

A

documentation should be filled out that shows it was revoked

98
Q

What does HIPAA stand for and what year was it established

A

Health Insurance Portability and Accountability Act; 1996

99
Q

What does HIPAA do

A

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

100
Q

What will happen if HIPAA is violated

A

civil or criminal action

101
Q

What is considered confidential information

A

patient history, assessment findings, and treatment rendered

102
Q

What are the exceptions for release of information protected by HIPAA

A

subpoena, other health care personnel treating patient, mandatory reporting, and insurance billing

103
Q

With whom can you share your treatment plan for a given patient

A

other health care provider taking over treatment

104
Q

why would you share patient information with insurance

A

for billing and claims

105
Q

why would you share patient information with healthcare operations

A

for quality improvement and research

106
Q

Under what other circumstances can patient information be released

A

if the patient signs off on its release or a legal subpoena is presented

107
Q

Why might EMS personnel not begin resuscitation efforts

A

the patient has trauma inconsistent with life

108
Q

Can EMTs pronounce a patient dead, if not, what do we do

A

no, we cannot. in this situation we must transport to the nearest hospital and the patient will be pronounced dead.

109
Q

What are some examples of trauma inconsistent with life

A

decapitation, transaction of the torso, complete destruction of the brain or heart, incineration, or cardiac arrest clearly caused by blunt or penetrating trauma

110
Q

What is the physician responsible for when a patient has died

A
  1. pronounce death(officially)
  2. determine cause of death
111
Q

What are definitive signs of death

A

Complete decomposition or putrefaction, dependent lividity, rigor mortis, algor mortis

112
Q

What is dependent lividity

A

blood settling to the lowest point of the body, causing discoloration of the skin

113
Q

What is rigor mortis

A

stiffening of the body, occurs within 2-12 hours after death

114
Q

What is algor mortis

A

cooling of the body until it matches the ambient environment

115
Q

Why is it essential to provide care to a decreased patient in the case of organ donations

A

maintenance of vital organs and tissues

116
Q

Some people have bracelets, necklaces, keychains or cards indicating what about their medical history

A

presence of DNR order, allergies, diabetes, epilepsy, or other serious condition

117
Q

Why is it so important to keep reports of all patient cases

A

courts considered an action not recorded an action that was not performed and untidy or incomplete reports are evidence of poor emergency medical care

118
Q

Why is the Good Samaritan law so important

A

protects those not receiving compensation from any civil action due to errors or omissions if they were trying to aid in an emergency situation

119
Q

What are the requirements for the Good Samaritan law to apply

A

acting within scope of practice, acting in good faith, and acting without compensation

120
Q

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?

A

Yes residents are required to report emergencies but they don’t have to intervene

121
Q

What should EMTs do when working in a crime scene

A

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

122
Q

In the case of a hanging, are ems allowed to untie the knot

A

No

123
Q

What might EMTs be asked to do if they moved objects in a crime scene

A

return to the scene and in detail address their movements, as well as point out where they stepped

124
Q

In documentation situations, what must EMTs keep in mind

A

avoid opinions, use objective statements, and place others words in quotes

125
Q

What situations must be reported by EMTs

A

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

126
Q

To report in MA how long should it take for one to call the hotline and report incident of abuse

A

24 hours

127
Q

How long is allotted for a person reporting abuse to submit the designated form

A

48 hours

128
Q

How can EMS personal act in court

A

They can be a witness or a defendant

129
Q

If you are subpoenaed as an EMT who should you notify

A

your service director and legal counsel

130
Q

What might you be required to do as an EMT witness in court

A

review the run report as evidence

131
Q

If you are the defendant in a count case, what can you utilize as an EMT

A

statues of limitations, governmental immunity, and contributory negligence

132
Q

What are interrogatories

A

written requests or questions

133
Q

What are depositions

A

orals requests or questions

134
Q

What can be done to allow both sides to gain more information in the instance of a lawsuit against EMS personnel

A

interrogatories and depositions

135
Q

Do medical cases normally go to trial

A

No

136
Q

What are statues of limitation

A

limits on amount of time that passes between incident and lawsuit

137
Q

What is contributory negligence

A

the patient is partially to blame for injury or damage

EMT (5 decks)

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