Presentation on theme: "Legal and Ethical Principles of Emergency Care"— Presentation transcript:
1 Legal and Ethical Principles of Emergency Care 2Legal and Ethical Principles of Emergency Care
2 Define the following terms: ObjectivesDefine the following terms:AbandonmentAdvance directiveBatteryBreach of dutyCivil law (tort)Competence(continued)
3 Define the following terms ObjectivesDefine the following termsCompetentConfidentialityConsentCriminal lawDutyDuty to act(continued)
4 Define the following terms ObjectivesDefine the following termsEmancipated minorEthicsExpressed consentGood Samaritan lawHealth Insurance Portability Accountability Act (HIPAA)(continued)
5 Define the following terms ObjectivesDefine the following termsImplied consentInformed consentMandated reporterNegligenceStandard of careUnresponsiveValues(continued)
6 ObjectivesExplain the concepts of “duty” and “breach of duty” as they relate to the Emergency Medical Responder.Explain the term ethics and how it relates to the Emergency Medical Responder.Explain the term Good Samaritan law and how these laws relate to the Emergency Medical Responder.Explain the term mandated reporter and how it relates to the Emergency Medical Responder.(continued)
7 Differentiate the terms scope of practice and standard of care. ObjectivesDifferentiate the terms scope of practice and standard of care.Compare and contrast the various types of consent utilized by the Emergency Medical Responder.Explain the role of the Emergency Medical Responder for patients who refuse care.Differentiate civil and criminal litigation.Explain the common elements of an advance directive.(continued)
8 ObjectivesExplain the role of the Emergency Medical Responder when confronted with an advance directive.Explain the role of the Emergency Medical Responder with regards to patient confidentiality.Explain the role of the Emergency Medical Responder with respect to evidence preservation when working in or around an actual or potential crime scene.(continued)
9 ObjectivesConsistently model ethical behavior in all aspects of Emergency Medical Responder training and job performance.Demonstrate compassion and empathy toward all classmates, coworkers, and simulated patients.Participate willingly as a team member in all class/training activities.(continued)
10 Value the importance of maintaining patient confidentiality. ObjectivesValue the importance of maintaining patient confidentiality.Demonstrate a desire to always do what is right for the patient.
13 Legal Duties“Good Samaritan laws” minimize exposure to liability; encourage bystanders to provide emergency care.Requires individual providing care to do so without compensation and to remain within scope of practice.Duty: legal term that one is morally or legally obligated to provide care.Talking Point: EMRs may have a legal and/or ethical duty to assist those in need.
14 Legal Duties Scope of Practice What is legally permitted to be done by individuals trained or licensed at a particular levelDoes not define what must be done for patient or in a particular situationBased on EMS education standards
15 Legal Duties Standard of Care Based on what is expected of someone with training and experience working under similar conditionsVaries county to county, state to state, region to regionExpected to follow approved standing orders/protocols for your EMS system
17 Legal Duties Ethical Responsibilities Ethics: study of principles that define behavior as right, good, and proper.Patient's needs before own, so long as safe to do so.Patient receives appropriate medical care.Maintain open mind.Develop understanding of differences.Legally it is your responsibility to see that your patient receives the most appropriate medical care possible, even when he does not think he needs any care.(continued)
18 Legal Duties Ethical Responsibilities (continued) Treat all people equally.Provide highest standard of care.Maintain and practice skills and knowledge.Attend continuing education.Be honest in reporting care provided.Errors should be reported immediately.Values are core beliefs that you hold to be true.(continued)
19 Legal Duties Ethical Responsibilities (continued) EMS values Integrity CompassionAccountabilityRespectEmpathyValues – defined as the personal beliefs that determine how a person actually behaves
21 ConsentConsent: Legal term to give formal permission for something to happenEMRs must receive permission from patients before legally providing care
22 ConsentCompetenceBeing adequately or well qualified to make decisions both physically and intellectuallyAdult patients who demonstrate competence will know who they are, where they are, and; at a minimum, what day it is.Competence is the patient’s ability to understand what is going on around him, your questions, and the implications of the decisions he is making.
23 Consent Patient may not be competent to make medical decisions Being a minorIntoxicationDrug ingestionSerious injuryMental illness
24 Consent Expressed Consent (informed consent) Competent adult's informed decision to accept emergency care provided by an EMR.May come in the form of verbal answer or simply allowing you to continue your care.By law, only parent or guardian of child may give consent or refuse care.Expressed Consent does not need to be verbal. By NOT pulling away or stopping you, the patient is giving consent.(continued)
25 Consent Expressed Consent Advise patient of following: Your level of trainingWhy you think care may be necessaryWhat care you plan to provideAny consequences related to refusing careTalking Point: Keeping patients informed is not only part of your duty as an EMR; it also helps to alleviate patient anxiety.
26 Consent Implied Consent Legal position assumes that an unresponsive or incompetent adult patient would consent to receiving emergency care if he/she could.Law assumes parents would want care to be provided for their child.Since children are not legally allowed to provide consent or to refuse medical care, a form of implied consent is used in most states when parents or guardians are not on the scene and cannot be reached quickly.
27 Use implied consent to provide care to a minor when a parent or guardian is not available.
28 Consent Emancipated Minor Legally allowed to make their own decisions regarding medical care.MarriedPregnantParentMember of armed forcesFinancially independent; living away from homeProvide care as you would any other adult patient in the same situation.
29 Consent Refusal of Care Alert and competent adults have the right to refuse care.Restraining or threatening to restrain patient against his/her wishes could result in violation of criminal law.Parent/legal guardian can refuse to let you care for a child.Refusal can be for variety of reasons (economic situation, religious views, lack of trust, etc.)(continued)
30 Consent Refusal of Care When care is refused: Stay calm and professional.Inform patient of potential dangers of refusal.Use aid of someone patient trusts.Carefully document refusal of care.Some situations require having a verbal refusal to a third party over the phone or radio. (use gunshot example).
32 Advance DirectivesAdvance Directive: Document that allows a patient to define in advance what his/her wishes are should he/she become incapacitated due to medical illness or severe injury.
33 Advance DirectivesDesignation of agent to make decisions on your behalfDo Not Resuscitate (DNR) orderChoice to prolong or not prolong lifePain relief optionsDonation of organs
34 Advance Directives Do Not Resuscitate (DNR) Orders Written legal document, signed by patient and physician.States patient has terminal illness and does not wish to prolong life through resuscitative efforts.Does not mean “do not care.”As an EMR, you have a duty to provide appropriate comfort and care within the bounds of the DNR.Patient’s also have the right to withdraw the DNR order any time.
36 Negligence Negligence: Failure to provide expected standard of care. Four elements to determine if negligent:Duty to actBreach of dutyDamagesCausation
37 Negligence EMRs have a legal duty to act. A legal duty to act has been established if care is offered and accepted by patient.Provide care according to agency's standard operating procedures.Laws vary from state to state.
38 Negligence General rule: advise patient to accept treatment by EMTs. State “Good Samaritan” laws may offer protection from civil liability; be familiar with your own state's laws.
40 AbandonmentAbandonment: To leave a sick or injured patient before equal or more highly trained personnel can assume responsibility for care.Could include failure to provide patient information during transfer to more highly trained personnel.Inform provider accepting care of facts gathered, assessment made, and care rendered.Once you begin to help someone who is sick or injured, you have established a legal duty and must continue to provide care until you transfer patient care to someone of equal or higher training.
41 Think About ItYou are on scene with an adult who has fallen and is complaining of only ankle pain. The ambulance has not arrived yet. A “child not breathing” call is dispatched in your immediate vicinity but the other EMR unit responding is across town. What do you do?
43 ConfidentialityTreatment of information that individual has disclosed in relationship of trust and with expectation that it will not be divulged to others.Protect patient's right to privacy.Information only released if patient has authorized to do so in writing.
44 ConfidentialityAuthorization not required for you to pass on patient information to other health-care providers.Health Insurance Portability and Accountability Act (HIPAA) gives patients more control over their healthcare information and limits ways that information is stored and shared.
45 During transfer, sharing of information with those involved in the care of the patient is a necessary and important part of good patient care.
46 Think About ItYou respond to a duplex where a 30-year-old male appears to have over-dosed. The EMTs arrive on scene and assume care. The patient's parents who live next door enter the room and ask you what happened. What do you tell them?
48 Reportable EventsAll 50 states have laws that define mandatory reporters and what types of events they must report.May include:Exposures to infectious diseasesSuspicious burnsVehicle crashesDrug-related injuries
49 Reportable Events May include: Crimes that result in knife or gunshot woundsChild and elder abuseDomestic violenceRape
51 Special Situations Organ Donors Patient completed legal document that allows for donation of organs and tissues in event of death.Care must not differ in any way from care of patient who is not a donor.Oxygen delivered to body cells by CPR will help preserve the organs.Talking Point: It is not always possible to know if a patient is an organ donor. Hospital staff will validate patient's wishes.
52 Special Situations Medical Identification Devices Necklace, arm/ankle bracelet, or card meant to alert EMS personnel that patient has particular medical condition (heart problem, allergies, diabetes, epilepsy).May provide important medical information.(continued)
53 Special Situations Medical Identification Devices Some areas use “Vial of Life” program.Special vial where important medical information is stored.Window sticker alerts EMS to vial kept in patient's refrigerator.
54 The Medic Alert bracelet is one example of a medical identification device (front shown).
55 The Medic Alert bracelet is one example of a medical identification device (back shown).
56 Special Situations Crime Scenes Location where crime has been committed or place where evidence relating to crime may be found.Do not enter scene until instructed to do so by law enforcement.Make as little impact on scene as possible to preserve evidence.
58 SummaryLegal duty to provide care and must do so within scope of practice.Must maintain high degree of integrity as well as ethical and moral standards when caring for patients.Have a responsibility to keep both knowledge and skills up-to-date.
59 SummaryMust obtain consent from every victim and be able to apply principles of expressed and implied consent.Properly manage and document all patients who refuse care and enlist law enforcement when necessary.
60 SummaryCould be accused of negligence if you do not provide acceptable level of care or if you abandon patient.Must respect privacy and confidentiality of all patients and refrain from sharing information about patients unless legally allowed or required to do so.
62 Explain the concepts of: Review QuestionsExplain the concepts of:duty to actbreach of dutyethicsWhat is the difference between scope of practice and standard of care?How does the Good Samaritan law in your area relate to the EMR?What is the difference between civil and criminal litigation?
63 What are the different types of consent? Review QuestionsWhat are the different types of consent?Explain the role of the EMR with regard to:Refusal of careAdvance directivesPatient confidentialityMandated reportingCrime scene preservation
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