Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Chapter 3 Medical, Legal, and Ethical Issues Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 1.Define key terms introduced in this chapter Explain the importance to EMRs of understanding the legal and ethical aspects of emergency medical care Differentiate between actions that are within the EMR’s scope of practice and those that are not Explain the importance of only providing emergency medical care that is within your scope of practice Explain the importance of medical oversight in EMS systems Give examples of off-line and on-line medical oversight

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 7.Explain the components required in order to obtain expressed consent Predict potential consequences of failing to obtain the proper type of consent to provide emergency medical care Given a patient care scenario, identify the type of consent that applies to the situation Describe the actions that you should and should not take when a patient refuses your care Differentiate between situations in which you can and cannot share a patient’s protected health information with someone else

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 12.Explain the EMR’s obligations with respect to advance directives Given a scenario involving a health care provider’s interactions with a patient, identify potential ethical issues in the situation Give examples of actions or inactions that can lead to specific types of tort claims Describe how EMRs can provide patient care while minimizing disruption of crime scenes and destruction of evidence

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer OBJECTIVES DIRECTORY 16.Give examples of situations in which EMRs may be required to make a mandatory report to law enforcement or other authorities. 3535

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer TOPICS Providing Legal and Ethical Care Advance Directives Ethics Liability and Negligence EMS at the Crime Scene

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer INTRODUCTION Encountering legal and ethical issues

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Call Environment –Residence Dispatch –Man feeling weak and nauseous for two hours

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Providing Legal and Ethical Care Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Providing Legal and Ethical Care Do you need permission to help someone? Can you treat a minor without the consent of the parents? Can you let someone die? Can you discuss details of a call with others? Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Scope of Practice Definition Who sets scope of practice Protocols Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Medical Oversight Off-line medical direction On-line medical direction Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Consent Expressed consent Implied consent Emancipated minors Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Refusal of Care Must meet specific criteria Must make an informed decision Documentation

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Refusal of Care When should a patient not be allowed to refuse –Altered mental status –Under the influence of drugs or alcohol –Impaired judgment due to medical conditions Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Confidentiality Health Insurance Portability and Accountability Act (HIPAA)

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Confidentiality Times when it is acceptable to disclose PHI –Transferring relevant and pertinent information to others directly involved in patient care –Upon patient approval to insurers and those responsible for payment –Operational reasons within EMS agencies including quality improvement and research –Mandatory reporting situations such as crimes of violence, abuse, or public health situations

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Confidentiality Times when it is acceptable to disclose PHI –When required to do so by legal subpoena Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Advance Directives Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Advance Directives Do not resuscitate order (DNR) Living will Durable power of attorney Health care proxy Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response You arrive to find the scene is safe Patient has vomited, so you don gloves and safety glasses Man states that “My wife called for you…I didn’t. I don’t want to go to the hospital.” He is in distress and having difficulty breathing He agrees to let you assess him while waiting for EMS CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: The Response, continued His skin is pale, cool, and moist You place him on oxygen You begin to get a history and vital signs while waiting for EMS

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Ethics Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Ethics Define things that an EMR should not do Based on morals –Honesty –Kindness and compassion –Advocacy Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Liability and Negligence Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Liability and Negligence Tort Assault/battery Abandonment Negligence

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Four Components of Negligence Duty to act Breach of duty Harm was caused Proximate causation Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer EMS at the Crime Scene Back to Topics

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Photo: © Craig Jackson/ In the Dark Photography

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Evidence Identification and Preservation Fingerprints Blood and body fluids Wounds Conditions at the scene Statements made at the scene Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Mandated Reporting Child abuse or neglect Domestic violence Elder abuse Sexual assault Gunshot wounds or other violence Infectious diseases Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Case Study: Transition EMS arrives, and patient doesn’t want to go to the hospital. After discussing transport more, the patient still refuses. You report your treatment and vitals to the ambulance crew. The wife is able to finally convince the patient to go. The patient was having a heart attack.

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Scope of practice –Protocols –Off-line medical direction –On-line medical direction –Expressed consent –Implied consent –Emancipated minor –Refusal of care CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –HIPAA –Advance directives –DNR –Health care proxy –Ethics –Tort –Assault –Battery CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Define the following terms –Abandonment –Negligence –Duty to act –Breach of duty –Proximate causation Back to Objectives

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER Rules and regulations that are set to designate how an emergency responder can legally function are called a)on-line medical direction. b)off-line medical direction. c)protocols. d)scope of practice. CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER An unconscious patient involved in a motor vehicle collision is able to be treated under a)expressed consent. b)implied consent. c)emancipated consent. d)written consent. CONTINUED

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer STOP, REVIEW, REMEMBER PHI may be disclosed to all of the following except a)transporting ambulance. b)QA/QI research forms. c)finance department for billing. d)various agency members.

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer REVIEW Discussion 1.What are the EMR’s obligations with respect to advance directives? 2.What are some examples of actions or inactions that can lead to specific tort claims? 3.What are the components required in order to obtain expressed consent? 4.What is the importance of medical direction in EMS?

Copyright ©2011 by Pearson Education, Inc. All rights reserved. EMR Complete: A Worktext Daniel Limmer Please visit and click on the mykit links to access content for this text. REINFORCE AND REVIEW