Medical/Legal and Ethical Issues CHAPTER 3 1

Legal Duties to the Patient, Medical Director and Public Scope of Practice Legal Duties to the Patient, Medical Director and Public 1

Scope of practice: Identifies duties and skills EMTs are allowed and supposed to perform when necessary. EMTs must function within minimum and maximum performance guidelines. 1

EMS personnel have the responsibility to know how state laws and regulations apply to them. 1

Standard of care: The minimum acceptable level of care normally provided in an area. 1

Ethical Responsibilities 1

There’s more to being an EMT... …than just driving around in an emergency vehicle with lights and siren! 1

Duty to Act 1

Duty to act: A legal responsibility of EMS personnel to provide emergency medical care when called upon or presented with the opportunity to do so. 1

By being certified (or licensed) as an EMT, you may have an implied duty to act. 1

Negligence: May occur when a patient suffers damage or injury because an EMS provider fails to perform to accepted standards of care. 1

Criteria for Negligence Duty to act There was a responsibility to provide service. Breach of duty Failure to perform as well as a peer in same situation. Damage Patient suffered a physical or psychological injury. Proximate cause Damage caused by EMS provider actions or inactions. 1

Once you accept responsibility for taking action… ...an implied contract to provide service has been established between you and the patient. 1

Abandonment: Termination of care without the patient’s consent, and/or without ensuring that care would be continued at the same level or better. 1

Care can be discontinued: If patient care is relinquished to someone with equal or greater qualifications If patient is transported to a facility that can provide a better level of care If personnel safety is threatened by uncontrolled hazards at the scene If patient no longer needs or wants care 1

Ethical Considerations 1

Moral and Ethical issues are inherent in EMS, and cannot be ignored! 1

Consent for Treatment and Transport 1

Consent: Permission from the patient or legal guardian for EMS personnel to provide treatment, procedures and transportation. Laws concerning consent vary from state to state. 1

Expressed consent: Patient directly agrees to accept treatment, and gives permission to proceed. Must be of legal age and able to make a rational decision. Must be an informed decision 1

Implied consent: Assumes that patients who are unable to express consent would do so if they could. Applies to patients who are mentally, physically or emotionally impaired. 1

Children and Mentally Incompetent Adults 1

With children, consent for care must be obtained from a parent or legal guardian... 1

...In the absence of a parent or guardian, consent is implied. 1

It is equally important to obtain consent for care for a mentally incompetent adult. 1

Refusal of Treatment & Transport 1

Adult patients of sound mind, who understand the consequences _ even though ill or injured _ have the legal right to refuse treatment. 1

Have the patient sign a “release from liability” form. 1

DOCUMENTATION IS CRUCIAL! Having the patient sign a “refusal form” is not enough SUPPORTING DOCUMENTATION IS CRUCIAL! 1

Assault and Battery 1

Assault: Threatened or attempted offensive physical contact, or causing fear of such contact. 1

Battery: Offensive physical contact without consent. 1

Advance Directives 1

Advance directive: A written document which some patients may use to state what treatment they want to receive, or refuse, should they become unable to state their wishes. Living Wills Durable Power of Attorney Do-Not-Resuscitate orders 1

DNR Bracelet 10

Do-Not- Resuscitate Order A DNR order is another form of advance directive. Do-Not- Resuscitate Order Attending Physician’s Order Authorized Decision- maker Patient’s Signature 1

Patient Confidentiality Confidential Information 1

Information obtained from a patient or other sources during the course of assessment and treatment is CONFIDENTIAL. 1

Releasing Confidential Information 1

A release may not be needed when: Patients are delivered to other healthcare providers Reporting required information to law enforcement Providing information to insurance companies or third-party payers Subpoenaed for release of information by a court order 1

Situations Requiring Special Reporting 1

Typical Reportable Cases Neglect or abuse of children Neglect or abuse of older adults Rape Gunshot wounds Stab wounds Animal bites Certain communicable diseases 1

Potential Organ Donors Special Situations Potential Organ Donors 1

An organ donor sticker may be on the back of a driver’s license. 10

Medical Condition Identification Insignia 1

A medical condition tag. ALERT 1

Medic Alert Tag 1

Considerations at Possible Crime Scenes 1

Do not disturb a crime scene unless absolutely necessary to provide patient care. 1

Crime Scenes Take note of crime scene appearance Avoid cutting or destroying clothing that may be needed as evidence Always wear gloves, and avoid unnecessary touching of objects at scene Be able to recall items you handle or move at the scene Document all actions and observations thoroughly 1

SUMMARY Scope of Practice Consent for Treatment and Transport Patient Confidentiality Special Situations SUMMARY 1