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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 errors8 th 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 lawsuitsEMTs 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 EMTs Responsibility Appropriate, timely, compassionate care Reporting of crimes –Child abuse –Elder abuse Ethical dilemmascommon

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 –Good Samaritan laws Gross negligence –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 patients 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 Limited to TRUE EMERGENCY situationsLimited to TRUE EMERGENCY situations –Unconscious –Delusional –Unresponsive –Physically unable to express consent –Minors Expressed/actual Consent must be informed - Consent must be informed –permission for care of her/himself

21 Refusal Competencylegal status Decision-making capacityclinical 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 patients 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 A 3 E 3 P 3 Guidelines –3 As Assess Advise Avoid

27 Refusal A 3 E 3 P 3 Guidelines –3 Es Ensure Explain Exploit (uncertainty)

28 Refusal A 3 E 3 P 3 Guidelines –3 Ps Persist Protocols Protect –Refusal signed –Documentation

29 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 equallyinsisted 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 Advance directives –Living wills –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 individuallimited 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 RestraintsWhen 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 –System

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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