1. Legal and Ethical Principles of Emergency Care2
Legal and Ethical Principles of Emergency Care

2. Define the following terms:
Objectives
Define the following terms:
Abandonment
Advance directive
Battery
Breach of duty
Civil law (tort)
Competence
(continued)

3. Define the following terms
Objectives
Define the following terms
Competent
Confidentiality
Consent
Criminal law
Duty
Duty to act
(continued)

4. Define the following terms
Objectives
Define the following terms
Emancipated minor
Ethics
Expressed consent
Good Samaritan law
Health Insurance Portability Accountability Act (HIPAA)
(continued)

5. Define the following terms
Objectives
Define the following terms
Implied consent
Informed consent
Mandated reporter
Negligence
Standard of care
Unresponsive
Values
(continued)

6. Objectives
Explain 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.
Objectives
Differentiate 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. Objectives
Explain 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. Objectives
Consistently 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.
Objectives
Value the importance of maintaining patient confidentiality.
Demonstrate a desire to always do what is right for the patient.

11. Topics Legal Duties Consent Advance Directives Negligence Abandonment
Confidentiality
Reportable Events
Special Situations

12. LEGAL DUTIES

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 level
Does not define what must be done for patient or in a particular situation
Based on EMS education standards

15. Legal Duties Standard of Care
Based on what is expected of someone with training and experience working under similar conditions
Varies county to county, state to state, region to region
Expected to follow approved standing orders/protocols for your EMS system

16. Different emergency personnel may be assisting during an emergency, including police, firefighters, and EMTs. Each must practice the standard of care expected of his own level of training. (© Mark C. Ide)

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
Compassion
Accountability
Respect
Empathy
Values – defined as the personal beliefs that determine how a person actually behaves

20. CONSENT

21. Consent
Consent: Legal term to give formal permission for something to happen
EMRs must receive permission from patients before legally providing care

22. Consent
Competence
Being adequately or well qualified to make decisions both physically and intellectually
Adult 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 minor
Intoxication
Drug ingestion
Serious injury
Mental 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 training
Why you think care may be necessary
What care you plan to provide
Any consequences related to refusing care
Talking 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.
Married
Pregnant
Parent
Member of armed forces
Financially independent; living away from home
Provide 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).

31. ADVANCE DIRECTIVES

32. Advance Directives
Advance 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 Directives
Designation of agent to make decisions on your behalf
Do Not Resuscitate (DNR) order
Choice to prolong or not prolong life
Pain relief options
Donation 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.

35. NEGLIGENCE

36. Negligence Negligence: Failure to provide expected standard of care.
Four elements to determine if negligent:
Duty to act
Breach of duty
Damages
Causation

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.

39. ABANDONMENT

40. Abandonment
Abandonment: 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 It
You 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?

42. CONFIDENTIALITY

43. Confidentiality
Treatment 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. Confidentiality
Authorization 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 It
You 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?

47. REPORTABLE EVENTS

48. Reportable Events
All 50 states have laws that define mandatory reporters and what types of events they must report.
May include:
Exposures to infectious diseases
Suspicious burns
Vehicle crashes
Drug-related injuries

49. Reportable Events May include:
Crimes that result in knife or gunshot wounds
Child and elder abuse
Domestic violence
Rape

50. SPECIAL SITUATIONS

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.

57. SUMMARY

58. Summary
Legal 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. Summary
Must 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. Summary
Could 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.

61. REVIEW QUESTIONS

62. Explain the concepts of:
Review Questions
Explain the concepts of:
duty to act
breach of duty
ethics
What 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 Questions
What are the different types of consent?
Explain the role of the EMR with regard to:
Refusal of care
Advance directives
Patient confidentiality
Mandated reporting
Crime scene preservation

64. Please visit www. bradybooks
Please visit and follow the Resource Central links to access content for this text.