1. Medical/Legal
and Ethical
Issues
CHAPTER 3 1

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

3. 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

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

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

6. Ethical Responsibilities1

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

8. Duty to Act 1

9. 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

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

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

12. 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

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

14. 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

15. 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

16. Ethical Considerations1

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

18. Consent for Treatment and Transport1

19. 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

20. 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

21. 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

22. Children and Mentally Incompetent Adults1

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

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

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

26. Refusal of Treatment & Transport1

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

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

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

30. Assault and Battery 1

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

32. Battery:
Offensive physical contact
without consent. 1

33. Advance Directives 1

34. 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

35. DNR Bracelet 10

36. 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

37. Patient Confidentiality
Confidential Information 1

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

39. Releasing Confidential Information1

40. 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

41. Situations Requiring Special Reporting1

42. 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

43. Potential Organ Donors
Special Situations
Potential Organ Donors 1

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

45. Medical Condition Identification Insignia1

46. A medical condition tag.
ALERT 1

47. Medic Alert Tag 1

48. Considerations at Possible Crime Scenes1

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

50. 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

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