Medical, Legal, & Ethical Issues Flashcards
1
Q
A basic medical, legal, and ethical principle of emergency care is to first ___
A
Do no further harm
2
Q
EMTs are better positioned to avoid professional legal problems when they ___
A
Act in good faith, follow an appropriate standard of care, and provide compassionate care
3
Q
Immediate care or treatment
A
Emergency medical care
4
Q
Typically, ___ is required from every conscious adult before care can be started
A
Consent
5
Q
An adult who is ___ has the legal right to refuse care
A
Conscious, rational, and capable of making informed decisions
6
Q
Consent can be expressed or ___
A
Implied
7
Q
The foundation of consent is ___
A
Decision-making capacity
8
Q
The ability of a patient to understand the information you are providing, coupled with the ability to process that information and make an informed choice regarding medical care
A
Decision-making capacity
9
Q
The right of a patient to make decisions concerning their health
A
Patient autonomy
10
Q
Generally regarded as a legal term and determinations regarding it are made by a court of law
A
Competence
11
Q
The term more commonly used in health care to determine whether or not a patient is capable of making health care decisions
A
Decision-making competence
12
Q
Factors to be considered when determining a patient’s decision-making competence
A
- Mental limitation/dementia
- Are they of legal age?
- Impaired by alcohol, drugs, or serious injury/illness
- Experiencing significant pain
- Have a significant injury that could distract from a more serious injury
- Hearing or visual problems
- Language barrier
- Do they understand you/ask rational questions?
13
Q
The type of consent given when the patient specifically acknowledges that they want you to provide care or transport
A
Expressed consent
14
Q
Expressed consent is also called ___
A
Actual consent
15
Q
Expressed consent may be ___
A
Verbal or nonverbal
16
Q
To be valid, the consent the patient provides must be ___
A
Informed consent
17
Q
You explained the nature of the treatment being offered, along with the potential risks, benefits, and alternatives to treatment, as well as potential consequences of refusing treatment
A
Informed consent
18
Q
Always document consent in your ___
A
Run report
19
Q
A patient may agree to certain types of emergency medical care but ___
A
Not to others
20
Q
When a person is unconscious or otherwise incapable of making a rational, informed decision about care and unable to give consent, the law assumes that the patient would consent to care and transport to a medical facility if they were able to do so
A
Implied consent
21
Q
Implied consent applies only when ___
A
A serious medical condition exists and should never be used unless there is a threat to life or limb
22
Q
The principle of implied consent is known at the ___
A
Emergency doctrine
23
Q
Relating to medical jurisprudence or forensic medicine
A
Medicolegal
24
Q
In most instances, the law allows a ___ to give consent for an injured person who is unable to do so
A
Spouse, a close relative, or next of kin
25
If a patient is being treated based on implied consent and regains consciousness and appear capable of making an informed decision, the doctrine of implied consent ___
Would no longer apply
26
Under certain circumstances ___ are legally permitted to give consent for any individual who is incarcerated or has been placed under arrest
LE and prison officials
27
A prisoner who is conscious and capable of making decisions may ___
Refuse care
28
Involuntary consent is similar to ___ and consent should be obtained from ___
1. Those involving minors
2. Someone legally responsible for the patient, such as a guardian or conservator
29
Minors require a ___ to give consent for treatment and transport
Parent or legal guardian
30
In every state, when a parent cannot be reached to provide consent, health care providers are allowed to ___
Give emergency care to a child
31
In some states, a minor can consent to receive medical care, depending on ___
The minor's age and maturity
32
People who, despite being under the legal age in a given state, can be legally treated as adults based on certain circumstances
Emancipated minors
33
Many states consider minors to be emancipated if they are ___
Married, members of the armed forces, or if they are parents
Also if they are living away from and no longer relying on their parents for support
34
A minor who is a parent may also give consent for ___
Their own child
35
If a minor is injured and requires medical treatment in a school or camp setting, teachers and school officials may act ___
In loco parentis
36
In the position or place of a parent, and can legally give consent for treatment of the minor if the parent or guardian is not available
In loco parentis
37
Even if acting in loco parentis, you should still attempt to ___
Obtain consent from a parent or legal guardian whenever possible
38
If a parent or legal guardian is not present and a true emergency exists, the consent to treat the minor is ___
Implied
39
___ is sometimes necessary when you are confronted with a patient who is in need of medical treatment and transportation but is combative and presents a significant physical risk of danger to themselves or others
Forcible restraint
40
Typically you should consult ___ for authorization to restrain or ___
1. Medical control
2. Contact LE personnel who have the authority to restrain people
41
___ should always be attempted prior to considering physical restraints
Verbal de-escalation
42
After restraints are applied, they should not be removed en route unless ___
They pose a risk to the patient, even if the patient promises to behave
43
While restrained, it is essential that you ___
Protect the patient's airway and monitor the patient's respiratory and circulatory status to avoid asphyxia, aspiration, and other complications
44
Consider calling for ALS backup to provide ___, as this may be safer than physical restraint, depending upon the situation
Pharmacologic restraint
45
Adults who are ___ have the right to refuse treatment or withdraw from treatment at any time
Conscious, alert, and appear to have decision-making capacity
46
Calls involving refusal of treatment pose a risk of ___
Litigation
47
In all such cases of refusal of treatment, you should involve ___
Online medical control and document this consultation
48
What information should be given to the patient to guide their decision to accept or refuse care?
1. What might be wrong with the patient
2. Description of the treatment believed necessary
3. Possible risks of treatment
4. Availability of alternative treatments
5. Possible consequences of refusing treatment
49
PCR
Patient Care Report
50
When treatment is refused, you must assess the patient's ability to make an ___
Informed decision
51
Patients who have attempted or conveyed ___ intent should not be regarded as having normal mental capacity
Suicidal
52
When in doubt, providing treatment is usually a much more ___ than failing to treat a patient
Defensible position
53
Before leaving the scene where a patient has refused care, you should again encourage the patient up to ___ times if the situation allows, to permit treatment
3
54
Do what before leaving a patient who has refused care?
1. Encourage them to change their mind
2. Remind them to call 911 if it changes or gets worse
3. Advise them to see their personal physician ASAP
4. Have them sign a refusal of treatment form (signature should be witnessed by a family member or police officer)
5. Notify medical control
55
Who must sign the refusal of care for for a child?
The individual who is refusing treatment
56
Communication between you and the patient is considered ___
Confidential
57
Disclosure of confidential information to anyone other than those providers directly involved in the care of the patient without proper authorization may result in liability for ___
Breach of confidentiality
58
Patient information may also be shared with ___
Third-party billing personnel
59
HIPAA considers all patient information that you obtain in the course of providing medical treatment to a patient to be ___
Protected health information
60
PHI
Protected health information
61
PHI includes not only medical information, but also any information that can ___
Be used to identify the patient
62
As an EMT, you have an obligation to guard all PHI from ___
Unlawful disclosure, either written or verbal
63
Safeguards to protect PHI include departmental ___
Security measures
64
When an EMT's role provides access to PHI of patients other than those for whom the EMT provided care, those records may be accessed only if there is a ___
Legitimate business reason to do so
65
What PHI records may the EMT not access without appropriate permission granted by the department privacy and security officer?
1. Celebrities
2. The EMTs own
3. The records of family members
66
PHI may be disclosed for purposes of ___
1. Treatment
2. Payment
3. Operations
67
A DNR is a type of ___
Advance directive
68
A ___ patient is able to make rational decisions about their well-being
Competent
69
A written document that specifies medical treatment for a competent patient, should they become unable to make decisions
Advance directive
70
An advance directive is often referred to as a ___ but may also be referred to as a ___
1. Living will
2. Health care directive
71
DNR orders give you permission not to ___
Attempt resuscitation
72
DNR requirements
1. Clear statement of the patient's medical problems
2. Signature of the patient or legal guardian
3. Signature of one or more physicians or other licensed health care providers
4. In some states it might have an expiration date. If they do they must be dated in the preceding 12 months to be valid
73
POLST
Physician Orders for Life-Sustaining Treatment
74
MOLST
Medical Orders for Life-Sustaining Treatment
75
You may encounter POLST and MOLST forms when caring for patients with ___
Terminal illnesses
76
A POLST or MOLST form will ___
Explicitly describe acceptable interventions for the patient and must be signed by a physician, physician assistant, or nurse practitioner
77
Some patients may have named surrogates to make decisions for them regarding their health care in the event that they are unable to make such decisions for themselves
Durable power of attorney for health care
or
health care proxy
78
When presented with a power of attorney at the scene of a medical emergency, you must ___
Read it carefully to ascertain its meaning and validity
79
If there is any question regarding a medical power of attorney, you should ___
Contact online medical control
80
___ emergency care while efforts to interpret the power of attorney are made
Do not delay
81
The person named in the power of attorney or health care proxy is only authorized to make decisions when ___
The patient is no longer capable of doing so
82
Even in the presence of a DNR order, you are still obligated to ___
Provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest
83
When you are in doubt or the written orders are not present for a DNR order, you have an obligation to ___
Resuscitate
84
Determination of the cause of death is the medical responsibility of a ___
Physician
85
There are both ___ and ___ signs of death
1. Definitive
2. Presumptive
86
In many states death is defined as ___. Many states have also adopted ___ provisions
1. The absence of circulatory and respiratory function
2. Brain death
87
Brain death provisions refer to is as ___
Irreversible cessation of all functions of the brain and brainstem
88
In questions of whether to begin BLS, the general rule is ___
If the body is still intact, and there are no definitive signs of death, initiate emergency medical care
89
More evidence of death will be needed in cases of ___
Sudden death due to hypothermia, acute poisoning, or cardiac arrest
90
Conclusive signs of death that are obvious and clear to even nonmedical people
Definitive signs of death
91
Most medicolegal authorities will consider the presumptive signs of death, particularly when they follow a ___
Severe trauma or occur at the end stages of a long-term illness
92
Presumptive signs of death
1. Unresponsiveness to painful stimuli
2. Lack of a carotid pulse or heartbeat
3. Absence of chest rise and fall
4. No deep tendon or corneal reflexes
5. Absence of pupillary reactivity
6. No systolic blood pressure
7. Profound cyanosis
8. Lowered or decreased body temperature
93
Definitive signs of death
1. Obvious mortal damage, such as decapitation
2. Dependent lividity
3. Rigor mortis
4. Algor mortis
5. Putrefaction
94
Blood settling to the lowest point of the body, causing discoloration of the skin
Dependent lividity
95
The stiffening of body muscles caused by chemical changes within the muscle tissure
Rigor mortis
96
Rigor mortis progression
Develops first in the face and jaw, gradually extending downward until the body is in full rigor
97
The rate of rigor mortis onset is affected by ___
The body's ability to lose heat to its surroundings
98
Rigor mortis occurs sometime between ___ after death
2 to 12 hours
99
Refers to the cooling of the body until it matches the ambient temperature
Algor mortis
100
Decomposition of body tissues
Putrefaction
101
How long for putrefaction to take place?
Depending upon temperature conditions, sometime between 40 and 96 hours after death
102
Once you have adequately determined death based on local protocols, ___
Remove yourself from the scene
103
Outlines the care you are legally able to provide for the patient
Scope of practice
104
Your medical director further defines the scope of practice by developing ___
Protocols and standing orders
105
The manner in which you must act or behave as an EMT
Standard of care
106
Your conduct must be judged in the light of the emergency situation, taking into account ___
1. Scene safety
2. General confusion at the scene of the emergency
3. The needs of other patients
4. The type of equipment available
107
A serious situation, such as an injury or illness that arises suddenly, threatens the life or welfare of a person or group of people, and requires immediate intervention
Emergency
108
In addition to standards imposed by law, professional or institutional standards may be admitted as evidence in determining the adequacy of an ___
EMTs conduct
109
State health department regulations usually govern the ___
Scope and level of training
110
Court decisions have resulted in case law defining standards of ___
Care
111
An individual's responsibility to provide patient care
Duty to act
112
Responsibility comes from either ___
Statute or function
113
The failure to provide the same care that a person with similar training would provide in the same or a similar situation
Negligence
114
Deviation from the accepted standard of care that may result in further injury to the patient
Negligence
115
Negligence is based on ___
1. Duty
2. Breach of duty
3. Damages
4. Causation
116
It is possible to be held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred
Theory of res ipsa loquitur
117
Theory of res ipsa loquitur can apply if ___
It can be shown that an injury occurred, that the cause of the injury was in the control of the EMT, and that such injuries generally do not occur unless there is negligence
118
A theory that may be used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute
Negligence per se
119
Civil wrongs
Torts
120
All forms of negligence come under the general category known as ___
Torts
121
The unilateral termination of care by the EMT without the patient's consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient
Abandonment
122
Once care is started, you have assumed a duty that must not stop until ___
An equally competent medical provider assumes responsibility
123
Unlawfully placing a person in fear of immediate bodily harm
Assault
124
Threatening to restrain a patient who does not want to be transported could be considered ___
Assault
125
Unlawfully touching a person
Battery
126
___ lawsuits for battery are common in health care
Civil
127
To sustain a criminal case of assault or battery, it is generally necessary to prove ___
The intent to cause harm
128
Seizing, confining, abducting, or carrying away of a person by force
Kidnapping
129
It is more likely for an EMT to be the target of a civil lawsuit for ___ rather than kidnapping since they are acting in good-faith to provide care for the patient
False imprisonment
130
The unauthorized confinement of a person that lasts for an appreciable period of time
False imprisonment
131
Communication of false information that damages the reputation of a person
Defamation
132
Defamation in writing
Libel
133
Defamation that is spoken
Slander
134
Based on the common law principle that when you reasonably help another person, you should not be liable for errors and omissions that are made in giving good-faith emergency care
Good Samaritan Laws
135
Good Samaritan laws are not intended to apply to ___
People who are at work being compensated for doing a job
136
Good Samaritan laws apply when you are ___
Off-duty
137
Conditions for the Good Samaritan law
1. You acted in good faith rendering care
2. You rendered care without expectation of compensation
3. You acted within the scope of your training
4. You did not act in a grossly negligent manner
138
Conduct that constitutes a willful or reckless disregard for a duty or standard of care
Gross negligence
139
Immunity statutes apply to EMS systems that are considered governmental agencies
Sovereign immunity
140
___ could provide early warning of a disease outbreak
NEMSIS
141
The philosophy of right and wrong, of moral principles, and of ideal professional behavior
Ethics
142
The study of morality
Ethics
143
A code of conduct that cen be defined by society, religion, or a person, affecting character and conscience and the definition of right versus wrong
Morality
144
Field of ethics that addresses issues that arise in the practice of health care
Bioethics
145
The manner in which principles of ethics are incorporated into professional conduct
Applied ethics
146
A civil lawsuit begins with the service of a ___ and ___
Summons
Complaint
147
Sets forth the details of the plaintiff's case and provides the theory on which the plaintiff is relying to recover a judgement against you and your service
Complaint
148
The response to the complaint is called an ___
Answer
149
Time within which a claim must be initiated
Statute of limitations
150
Generally applies only to EMS systems that are operated by municipalities or other governmental agencies
Governmental immunity
151
Legal defense that may be raised when the defendant thinks that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff
Contributory negligence
152
The next phase of a trial after the answer to the summons
Discovery
153
An opportunity for both sides to obtain information that will enable the attorneys to have a better understanding of the case and assist in negotiating a possible settlement or in preparing for a trial
Discovery
154
Written questions that each side sends to the other
Interrogatories
155
Oral questions asked of parties and witnesses under oath
Depositions
156
These damages are intended to compensate the plaintiff for the injuries they sustained
Compensatory damages
157
Not commonly awarded in negligence cases and are reserved for those cases where the defendant has acted intentionally or with a reckless disregard for the safety of the public
Punitive damages
