1. Medical/Legal and Ethical Issues
CHAPTER 3
Medical/Legal and Ethical Issues

2. Scope of Practice
A collective set of rules and duties that define your role as an EMT–B

3. Legal Duties of the EMT-B
Providing patient care within the scope of practice
State Legislation – further defined by medical direction through the use of protocols and standing orders
Medical Direction – scope of practice may be contingent upon telephone/radio communications and approved standing orders/protocols

4. Ethical Responsibilities
Make patient's needs a priority (physical/emotional).
Maintain skills and knowledge to the point of mastery.
Critically review performance, seeking ways to improve response time, patient outcome, communication. (Quality Improvement)
Prepare honest reports.
Maintain confidentiality

5. Advance Directives

6. Advance Directives: DNR Orders
Patient has the right to refuse resuscitative efforts.
Usually requires written physician order on a NYS DOH form – you need to make sure you see this, and it is only valid for six months

7. Advance Directives: DNR Orders
Become familiar with protocols related to DNR orders and advance directives
Prehospital DNRs honored
Health Care Proxy not honored in the prehospital setting (only in the hospital setting)
When in doubt, resuscitate.

8. Do Not Resuscitate (DNR) Order

9. Types of Consent

10. Consent: Expressed/Informed
Patient of legal age and able to make a rational decision
Must be informed of the steps of the procedures and all related risks
Must be obtained from conscious, mentally competent adults before treatment

11. Consent: Implied
Consent implied for unconscious patient requiring emergency intervention
Based on the assumption the unconscious patient would consent if conscious

12. Consent: Children and Incompetent Adults
Consent required from parent/guardian
Emancipation Issues (those who are married or of a certain age)
State regulations regarding age of minors
Consent implied in life-threatening emergency

13. Patient Refusal Patients have the right to refuse treatment if they:
are legally able to refuse
are mentally competent following the rules of informed consent
are fully informed of risks
sign a “release of liability” form
if an unconscious patient regains consciousness, and refuses transport

14. Patient Refusal
When in doubt, err in favor of providing care!

15. Documenting Patient Refusal
Leading cause of lawsuits
Documentation is key to protection.
Note all assessment findings and emergency medical care given.
Attempt to persuade patient to accept care.
Ensure the patient is able to make a rational, informed decision
Outline risks & consequences as explained.

16. Options for Patient Refusal
Utilize others to help:
Family members may help convince patient.
Medical control may assist.
Law enforcement may have legal options.
THE EMT-BASIC SHOULD NEVER MAKE AN INDEPENDENT DECISION NOT TO TRANSPORT

17. Patient Refusal Checklist

18. Assault/Battery
Unlawfully touching patient without consent can be considered battery.
Providing care when the patient does not consent to the treatment

19. Ethical, Medical,
Legal Issues

20. Key Term
Abandonment
Termination of care of a patient without assuring continuation of care at the same level or higher (we must hand over care to an EMT-I or Paramedic/at the hospital)

21. Key Term
Negligence
Deviation from accepted standard of care, resulting in further injury to a patient
“Something that should have been done but was not, or was done incorrectly”

22. Negligence: Components
Duty to act
Breach of that duty (may include failure to act/did not provide standard of care)
Injury or damages inflicted (physical or psychological)
The actions of the EMT-B caused the injury/damage

23. Duty to Act An obligation to provide emergency care to a patient
Formal Duty: Contractual obligation between agency and municipality (specific clauses within the contract should indicate when service can be refused to a patient)
Implied Duty:
Patient call to and dispatcher confirms that an ambulance will be sent
Treatment is begun on patient

24. Duty to Act: Ethical/ Moral
There are no NYS laws regarding duty to act:
Off duty
Out of your EMS system, but in an ambulance
Good Samaritan laws

25. Confidential Information
Patient history gained through interview
Assessment findings
Treatment rendered
Written release required to release information signed by the patient. Do not release on request, written or verbal, unless legal guardianship has been established

26. Confidential Information
Exceptions to written release:
Legal Subpoena
Other health care personnel treating patient need to know information to continue care
Mandatory reporting (rape, abuse)
Insurance – 3rd party payment billing forms
Statewide data collection system (PCRs)

27. HIPAA Health Insurance Portability and
Accountability Act mandates increased
privacy of patient-specific medical
information and their:
Record keeping
Storage
Access
Discussion – when medically necessary

28. Organ Donation Requires a separate signed donor form.
Driver's license shows intent to be a donor on reverse side.

29. Organ Donor Form

30. EMT–B Role in Organ Donation
Organ donor patients are treated the same as other patients.
Identify potential donors.
Notify medical direction.
Provide care to maintain vital organs.

31. Medical Identification Devices
Alert EMT–B
to patient’s
medical
condition
Heart conditions
Diabetes
Allergies (bees, medicines, foods, etc…)
Epilepsy
Other information

32. Medical Identification Device (front)

33. Medical Identification Device (back)

34. Crime Scenes
Do not enter the crime scene until it is safe – scene is “RED” until secured by police.
Patient care is the priority.
If possible, do not cut through holes in clothing from gunshot wounds or stabbing wounds
Remain alert for evidence and try not to disturb it unless you need to, to provide emergency care.
Evidence deals with condition of the scene, the patient, fingerprints/footprints, and microscopic evidence

35. Crime Scenes Be observant and document anything unusual at the scene.
Minimize your impact on the scene.
Remember what you touch and report it to police.
Plan and communicate with the police.

36. Special Reporting Situations
Abuse (child, spouse, elderly) (physical, sexual, emotional)
Sexual assault/Rape
Gunshot wound
Infectious disease exposure

37. Special Reporting Situations
Restraint
MCI
Other unusual situations
Mandatory reporting laws vary from state to state.