2. SIDS, DNR, LEGAL Legal and Ethical issues

3. SIDS, DNR, LEGAL Know Your Reporting Responsibilities! this applies to you!

4. SIDS, DNR, LEGAL Special Reporting Requirements (1 of 2) F Abuse of children, elderly, and spouse F Injury during the commission of a felony F Drug-related injury F Childbirth

5. SIDS, DNR, LEGAL Special Reporting Requirements (2 of 2) F Infectious disease exposure F Crime scene F Deceased

6. SIDS, DNR, LEGAL Reporting F It is a misdemeanor to fail to report abuse. F report suspicion of child abuse, you do not need proof to report an incident.

7. SIDS, DNR, LEGAL What, When & Who WhatWhen F verbal report - immediately F written report- within 36 hours Who F law enforcement F protective services

8. SIDS, DNR, LEGAL Elder Abuse F Any person who takes advantage of person, property or emotional state F Victims are often hesitant or unable to report F Signs of abuse are often overlooked F Pt. often has multiple medical conditions and are dependent on others

9. SIDS, DNR, LEGAL Assessment of Elder Abuse (1 of 2) F Repeated visits to the emergency room F A history of being “accident-prone” F Soft-tissue injuries F Vague explanation of injuries F Psychosomatic complaints

10. SIDS, DNR, LEGAL Assessment of Elder Abuse (2 of 2) F Chronic pain F Self-destructive behavior F Eating and sleeping disorders F Depression or a lack of energy F Substance and/or sexual abuse

11. SIDS, DNR, LEGAL Signs of Physical Abuse F may be obvious or subtle. F Obvious signs include bruises, bites, and burns. F Look for injuries to the ears. F Consider injuries to the genitals or rectum as evidence of abuse.

12. SIDS, DNR, LEGAL Advance Directives F Specifies medical treatments desired if patient is unable to make decisions F Do not resuscitate (DNR) orders –Patients have the right to refuse resuscitative efforts.

13. SIDS, DNR, LEGAL Do Not Resuscitate F AKA - DNR or “no code” F supportive measures only - No CPR F family member can request resuscitation

14. SIDS, DNR, LEGAL Medical facility Vs. Home or Street There are different requirements

15. SIDS, DNR, LEGAL DNR- Nursing facilities F written order in patient's chart –no CPR –no code –DNR VERBAL ORDER FROM MD NOT VALID unless put in writing

16. SIDS, DNR, LEGAL

17. DNR - home/street F L.A. County “Prehospital DNR” Form F California “Prehospital DNR” Form** F MEDIC ALERT TAG bracelet or necklace F No other type of DNR may be honored in Los Angeles County

18. SIDS, DNR, LEGAL

20. Legal issues F Authority for patient care - most qualified at rendering emergency care F Physicians at the scene must show identification and agree to assume responsibility in order to direct care

21. SIDS, DNR, LEGAL Consent – three types F Expressed consent F Implied consent F Minors and mentally incompetent adults –“In loco parentis” –ALOC

22. SIDS, DNR, LEGAL Legal age of consent F Minor is under 18 years-old F Emancipated minor F Female - pregnancy related

23. SIDS, DNR, LEGAL Adults - Competence F Must be competent to refuse treatment or transport F hypotensive F hypoglycemic F under the influence F suicidal ideations or actions

24. SIDS, DNR, LEGAL Adults - Competence F Any EMT-B or EMT-P can deem a patient incompetent F This is NOT a 5150

25. SIDS, DNR, LEGAL Refusal of Treatment Against Medical Advice F when a patient refuses care or transport F do not need if you believe patient is OK without treatment.

26. SIDS, DNR, LEGAL Valid AMA F Patient Alert and Oriented X3 F Competent F EMT-B should obtain a witnessed signature MUST advise pt : F Of need for treatment F Of consequences of refusal F That they may re-contact 911

27. SIDS, DNR, LEGAL 5150 (72 hour hold) Patients may be placed on a hold if... –danger to self –danger to others –gravely disabled due to mental disorder

28. SIDS, DNR, LEGAL 5150 (72 hour hold) who may place hold –Law Enforcement –PET or PMRT member –County “designated” doctors

29. SIDS, DNR, LEGAL Limited Legal Authority F As an EMT-B, you have limited legal authority to require or force a patient to undergo care. F Police may put a patient in protective custody to allow you to provide care. F Know your local laws and protocols.

30. SIDS, DNR, LEGAL Assault and Battery F Know when to force TX F Assault –Unlawfully placing a person in fear of immediate bodily harm without consent F Battery –Unlawfully touching a person

31. SIDS, DNR, LEGAL Duty to Act F Individual’s responsibility to provide patient care F Begins once an ambulance responds to a call or treatment is initiated

32. SIDS, DNR, LEGAL Standard of Care F The minimum level of care that a person can expect F Imposed by local protocol F Imposed by the law F Professional or institutional standards

33. SIDS, DNR, LEGAL Negligence F Failure to apply the standard of care F Failure to provide the same care that a person with similar training would provide F Act or omission of an act F Good Samaritan Act does not apply to on-duty personnel

34. SIDS, DNR, LEGAL Negligence Determination F Duty F Breech of duty F Damages F Cause

35. SIDS, DNR, LEGAL Abandonment F Termination of care without patient’s consent F Termination of care without provisions for continued care F Care cannot stop unless someone of equal or higher training takes over

36. SIDS, DNR, LEGAL Ethical Responsibilities F Make physical/emotional needs a priority F Practice/maintain skills F Critically review performances F Attend continuing education/refresher programs F Be honest in reporting

37. SIDS, DNR, LEGAL Confidentiality F Information received from or about a patient is considered confidential. F Disclosing information without permission is considered a breach of confidentiality. F Generally, information can only be disclosed if the patient signs a written release.

38. SIDS, DNR, LEGAL Records and Reports F Complete documentation is a safeguard against legal complications F If an action or procedure is not recorded, it was not performed F An incomplete or untidy report is evidence of incompetence

39. SIDS, DNR, LEGAL Standards Imposed by States –Medical Practices Act u Exempts EMT-Bs from licensure requirements –Certification u Process of evaluating and recognizing that EMT-B has met certain predetermined standards

40. SIDS, DNR, LEGAL Regulation updates F EMT-1 or EMT-B designation only F Titles that no longer exist –EMT-1(AA) –EMT-1 (D)

41. SIDS, DNR, LEGAL Certification Application Requirements Be 18 years old or older. Have valid Course Completion Certificate. Apply within 2 years of course completion.

42. SIDS, DNR, LEGAL Certification requirements Submit application and fees. Pass a written certification examination. And..

43. SIDS, DNR, LEGAL Background Check Disqualifying convictions Violent crimes Sex related crimes Drug related crimes (including DUI)

44. SIDS, DNR, LEGAL Re-certification Requirements F Every two years –Complete refresher course Or –Obtain 24 hours of approved continuing education F Submit application and fees

45. SIDS, DNR, LEGAL Approved Continuing Education F BLS level F many methods to obtain CE F MANDATORY CPR & airway management course at least once every 2 years F YOU must find a CE Provider

46. SIDS, DNR, LEGAL End questions??