MEDICAL / LEGAL & ETHICAL ISSUES

Medical / Legal & Ethical Issues are a vital element of the EMT’s daily life. Should an EMT stop and treat an automobile crash victim when off duty? Should patient information be released to an attorney on the telephone? Can a child with a broken arm be treated even though his parents are not at home? These and many other Medical / Legal & Ethical questions face the EMT every day.

SCOPE OF PRACTICE

• Key Term
• Scope of Practice
• A Collective Set of Rules and Duties That Define Your Role as an EMT-B.

SCOPE OF PRACTICE

• List of Skills & Interventions That Can Be Performed
• Gives the EMT Legal Duties
• To Patient
• To Medical Director
• To Public

SCOPE OF PRACTICE

• Defined By State Legislation
• Enhanced By Medical Direction
• Protocols
• Standing Orders
• Legal Right to Function
• Must Have Medical Direction
• Phone or Radio
• Protocols or Standing Orders

ETHICAL RESPONSIBILITIES

• Make Patient’s Needs a Priority
• Practice & Maintain Skills
• Attend Con-Ed
• Critically Review Performance
• QA / QI Audits
• Improve Response Time, Patient Outcomes, & Communications
• Honesty in Reporting

ADVANCED DIRECTIVES & LIVING WILLS

• Do Not Resuscitate Orders (DNR)
• Patient has Right to Refuse Resuscitation
• Generally, Requires Dr’s Written Order
• Contact Medical Command
• When In Doubt Start Resuscitation Efforts

CONSENT

• Are You Allowed to Treat or Not?
• Expressed
• Implied
• Child or Mentally Incompetent Adult

CONSENT

• Expressed
• Patient Must be of Legal Age
• Able to Make Rational Decision
• You Must Inform Patient of Procedures & Risks
• Must be Obtained Before Treatment
• Conscious
• Mentally Competent

CONSENT

• Implied
• Consent Assumed From Unconscious Patient

CONSENT

• Children & Mentally Incompetent Adults
• Consent Must be Obtained by Parent or Legal Guardian
• Emancipation Issues
• Emergency / Life-Threatening Situations
• Parent / Legal Guardian Not Available
• Render Care Based On Implied Consent

ASSAULT / BATTERY

• Unlawfully Touching a Patient Without Consent
• Providing Emergency Care When Patient Does NOT Consent

REFUSALS

• Patient Has the Right to Refuse Treatment
• Patient Can Withdraw From Treatment Anytime
• Unconscious Pt Regains Consciousness Then Refuses
• Must Be Mentally Competent Adult
• Head Injury?
• Under the Influence of Alcohol or Drugs?

REFUSALS

• Patient Must be Informed & Understand Risks
• Right Up to the Point of Death
• Patient Should Sign "Release From Liability"
• Might Help
• Probably won’t
• Have Witness
• Before Signing – Try, Try, & Try Again to Convince Patient to Consent
• When In Doubt Provide Care

REFUSALS

• Consult Medical Direction
• Consider Law Enforcement Assistance
• Never Make an Independent Decision Not to Transport

REFUSALS

• DOCUMENTATION
• Key Factor to Legal Protection
• Assessment Findings
• Care Given
• Risk Factors Told to Patient
• Patient Quotes
• Witnesses

ABANDONMENT

• Key Term
• Abandonment
• Termination of care of the patient without assuring the continuation of care at the same or higher level of training.

NEGLIGENCE

• Key Term
• Negligence
• Deviation from the accepted standard of care resulting in further injury to the patient

NEGLIGENCE

• Components of Negligence
• You Had a Duty to Act
• There Was a Breach of the Duty
• Injury or Damages Were Inflicted
• Physical
• Psychological
• Actions of the EMT Caused the Injury or Damage

DUTY TO ACT

• A Contractual or Legal Obligation Must Exist
• Implied
• Patient Calls EMS, Dispatcher Confirms Ambulance Will be Sent
• Treatment Has Begun
• Formal
• Service Has Written Contract

DUTY TO ACT

• Legal Duty to Act May Not Exist
• May Be a Moral or Ethical Issue
• EMT Off Duty – See a MVA
• Do You Have to Render Treatment?
• In an Ambulance, But Not In Your Service Area
• Moral / Ethical Duty to Act
• Risk Management
• Documentation

CONFIDENTIALITY

• Confidential Information
• Patient History Gained Thru Interview
• Assessment Findings
• Treatment Rendered

CONFIDENTIALITY

• Releasing Confidential Information
• Requires Written Release by Patient
• No Verbal Request
• Establish Legal Guardianship
• Release Not Required
• Other Healthcare Pros Need to Continue Care
• Law Requires Reporting Violent Crime
• Third Party Billing Contracts
• Legal Subpoena

CONFIDENTIALITY

• Medical ID Insignia ("Medic Alert")
• Bracelet, Necklace, Card
• Indicates Medical Condition
• Allergies
• Diabetes
• Epilepsy
• Other

CONFIDENTIALITY

• HIPAA
• Health Insurance Portability and Accountability Act
• Mandates Increased Privacy of Patient-Specific Medical Information and Their:
• Recordkeeping
• Storage
• Access
• Discussion

CRIME SCENE

• Potential Crime Scene & Evidence Preservation
• Dispatch Should Notify Police
• Your Safety FIRST
• Emergency Care of the Patient is a Priority
• Do Not Disturb Items Unless Necessary
• Observe & Document What You See or Move
• Clothing is Evidence – Watch What You Cut!!!

SPECIAL REPORTING

• Varies From State to State
• Common Reporting Situations
• Abuse
• Child, Elderly, Spouse
• Crime
• Violent
• Sexual
• Certain Infectious Diseases

ORGAN DONATION

• Requires Signed Donor Form
• Driver’s License Shows Intent

ORGAN DONATION

• EMT’s Role in Organ Donation
• Treat as Any Other Patient
• Identify Potential Donors
• Notify Medical Direction
• Provide Care to Maintain Vital Organs