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Legal and Ethical Aspects of Emergency Medical Services

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Presentation on theme: "Legal and Ethical Aspects of Emergency Medical Services"— Presentation transcript:


2 Legal and Ethical Aspects of Emergency Medical Services

3 Lesson Goal Outline potential ethical dilemmas & provide simple approach to resolving those dilemmas Identify & define legal implications of working in EMS

4 Introduction Many laws & ethical principles apply to EMS work
Be aware of how these issues relate to decisions

5 Scope of Potential Liability
Medical errors—8th leading cause of death 50, ,000 Americans die each year because of medical errors

6 Scope of Potential Liability
EMTs operate in unique environment Most lawsuits in EMS arise from vehicle accidents Root cause of many lawsuits—EMT’s attitude & behavior

7 Key Areas of EMS Law Levels of certification Training requirements
Scope of practice Standard of care Requirements for certification Complaints against providers Disciplinary actions Legal protection Patients’ rights Emergency vehicle operations Workplace safety

8 EMT’s Responsibility Appropriate, timely, compassionate care
Reporting of crimes Child abuse Elder abuse Ethical dilemmas—common

9 Duty to Act & Standard of Care
Primary ethical responsibility Provide appropriate care On call Good Samaritan Standard of Care Clinical & technical standards trained to perform

10 Guiding Ethical Principles
Patients’ autonomy Patients’ best interests First, do no harm Fairness

11 Ethical Issues What is a “good quality of life”? Organ donation

12 Handling Unethical Situations
Consider your own beliefs Promote workplace culture of honesty, integrity, & communication

13 Negligence Ordinary negligence 4 elements Duty to act Breach of duty
Causation Harm

14 Negligence Immunity defense Gross negligence Good Samaritan laws
Always act in good faith

15 Negligence Personal risk management Be well educated Be well rested
Know & follow protocols Maintain skills & knowledge

16 Attitudes & Communication
Create a positive impression Well rested & alert Professional appearance Confidence Empathy Communication skills

17 Attitudes & Communication
Get on patient’s level Introduce yourself Explain what you are doing Reassure patient Do not make false promises Provide basic comfort Communicate with family

18 Attitudes & Communication
Smile Use comforting tone Avoid extraneous chatter Be efficient Say goodbye at end of call

19 ABANDONMENT Terminating care without legal excuse.
Turning pt. over to lesser qualified personnel

20 Consent Must be obtained Implied Expressed/actual
Limited to TRUE EMERGENCY situations Unconscious Delusional Unresponsive Physically unable to express consent Minors Expressed/actual -Consent must be “informed” permission for care of her/himself

21 Refusal Competency—legal status
Decision-making capacity—clinical determination

22 Refusal Ethics Patient must be informed of meaning & consequences of refusal The time informed refusal takes is worthwhile

23 Refusal Make sure patient understands Treatment Risks Alternatives
Consequences of not being treated

24 Refusal Considerations Make sure patient understands
Make reasonable attempts to persuade patient Make sure decision is not coerced Document discussion Know who can refuse on patient’s behalf Err on side of treatment

25 Refusal Legally Patients’ rights to self-determination
Assessing decision-making capacity Patients can refuse some or all interventions

26 Refusal A3E3P3 Guidelines 3 As Assess Advise Avoid

27 Refusal A3E3P3 Guidelines 3 Es Ensure Explain Exploit (uncertainty)

28 Refusal A3E3P3 Guidelines 3 Ps Persist Protocols Protect
Refusal signed Documentation

29 “Law enforcement on scene on our arrival. Pt
“Law enforcement on scene on our arrival. Pt. had been unresponsive prior to EMS arrival per Sgt. Ulrickson. On EMS arrival Pt. was awake, agitated and refused assessment, treatment or transport. No injuries noted on visual assessment. Pt. denied injury. Stated he laid down on sidewalk to ‘take a power nap’. Pt. able to move all extremities equally—insisted on standing up. Gait unsteady. Alert to time, place, date. Refusal signed. Pt. advised he could call EMS or seek further medical assistance at any time. Pt. escorted home by friends.”

30 Living Wills & Advance Directives
Durable power of attorney DNR orders

31 Advance Directives in Montana EMS
Comfort One POLST

32 Scope of Practice Issues
Definition: procedures, actions, and processes that are permitted for the licensed individual—limited to that which the law allows for education, experience, and competency. EMS providers must always act within their scopes of practice

33 Documentation The patient care report (PCR) Has many purposes
Is a reflection on YOU Includes written and verbal

34 Patients’ Rights Confidentiality & privacy are both legal and ethical issues

35 Patients’ Rights HIPAA Policies for release of PCRs Superprotection

36 Patients’ Rights Restraints—When and How
When patient is physical threat to himself or others. Contact medical control, if possible. Restrain as little as possible. Involve Law Enforcement, if necessary. Circa 1752

37 Incident Reports Unusual occurrences Prevent recurrences Individuals

38 Future of EMS Law Anticipate regulations as profession matures
Reduce potential for litigation Professional approach Reduce errors Maintain training Team work

39 Summary EMTs act within an ethical & legal context Common issues
Certification/licensure Scope of practice Consent & refusal Negligence Resuscitation decisions

40 Summary Lawsuits Vehicle collisions Breech of confidentiality
EMTs’ behavior & attitudes Personal responsibility & risk reduction


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