Legal and Ethical Issues

1
Legal and Ethical Issues

• Lesson 3

2
Introduction

• Lawsuits against First Responders are rare
• Adhere to basic legal principles regarding
  emergency care
• State laws vary

3
Regulations

• Federal, state, and local laws/regulations govern
  practice of emergency medicine
• Requirements vary for registering/becoming
  certified First Responder
• Laws state what First Responders can/cant do

4
Scope of Practice

• Level of care healthcare professional provides
  with specified level of training
• Defined by the U.S. DOTs First Responder
  National Standard Curriculum
• State laws may modify scope of practice
• Further defined through medical oversight,
  including protocols, standing orders, direct
  oversight

5
Standard of Care

• How you provide care and what specific care you
  give
• Same care as First Responder with similar
  training would give patient in similar
  circumstances
• National standard of care based on DOT National
  Standard Curriculum
• What you are taught in First Responder training
  standard of care
• Give care as you have been taught, and you cannot
  be held legally liable for a negative patient
  outcome
• Neglecting to follow standard of care may make
  you liable for negligence

6
Ethical Responsibilities

• To provide the best patient care possible
• Make patients physical and emotional needs your
  highest priority
• Practice care giving skills until mastered
• Regularly attend continuing education/refresher
  programs
• Review your performances after each patient care
  episode
• Be honest in reporting and documentation

7
Consent

• Patients have right to decide emergency care they
  will accept
• Obtain persons consent before providing care
• Consent based on information you provide
• A competent adult has right to refuse care

8
Competence

• Determine whether adult victim is competent to
  consent
• Competent person can understand what is happening
  and implications of receiving/refusing care
• Victim may not be competent because of
  intoxication, drug use or altered mental status
  caused by severe injury
• Parent or legal guardian gives consent for
  children or mentally incompetent adults
• If parent or guardian cannot be reached , consent
  is implied

9
Expressed Consent

• Patient explicitly grants permission for care
• Usually a verbal agreement or a nod
• Must be obtained from every responsive, competent
  adult before giving care

10
To Obtain Expressed Consent

• Identify yourself to patient
• 2. State your level of training
• 3. Explain what you think may be wrong
• 4. Describe care you will give and its benefits
• 5. Explain any risks related to care

11
Implied Consent

• Unresponsive victim assumed to give consent
• Consent assumed for child needing first aid if
  parent/guardian not present

12
Refusal of Consent

• Competent adult victims have right to refuse
  medical care
• You must honor their wishes
• May be verbal or indicated by shaking head or
  pulling away
• Person should fully understand all risks and
  consequences of refusing care
• After treatment begins, patient still has right
  to withdraw

13
When a Victim Refuses Consent

• When in doubt, err in favor of providing care
• Do not argue with victim or question victims
  personal beliefs
• Allow responding EMS units to evaluate situation
• Have victim sign refusal form or have witness
  hear victims refusal

14
While Awaiting Additional EMS Resources

• Try again to persuade victim to accept care
• Determine whether victim is competent
• Inform victim again why care is needed and what
  may happen if care is refused
• Consult medical oversight as directed by local
  protocol
• Consider calling for assistance from law
  enforcement
• Report assessment findings and emergency medical
  care you have provided

15
Assault and Battery

• Assault crime of verbally or physically
  threatening to touch another person without
  consent
• Battery crime of touching another person
  without consent
• Caring for a competent victim who refuses care
  may make you guilty of assault or battery
• Victim may file lawsuit against you

16
Advance Directives

• Legal document
• Signed while the person is competent
• Durable power of attorney for healthcare
• Do Not Resuscitate (DNR) order
• Generally must be signed and witnessed, and may
  require a physicians signature

17
If You Encounter an Advance Directive

• Follow local protocol
• DNR refers only to resuscitative care for victim
  whose heart has stoppednot other treatment
• If any doubt, or if written directive is not
  present, give care as usual
• Other adults/family members cannot refuse care
  for victim without formal advance directive
• If family members ask you to provide care, even
  when DNR order is present, give care until
  responding EMS professionals arrive

18
Abandonment

• Once you have begun emergency care, you have
  legal obligation to continue
• Obligation to render care ends when EMTs take
  over
• Failing to continue care before EMTs take over
  makes you guilty of abandonment, a form of
  negligence
• Assessing also is considered care
• If you assess and release patient and patient
  later dies or suffers, you are guilty of
  abandonment
• Leaving a victim who refuses care, without
  waiting for EMTs to arrive and assess victim, may
  also be abandonment

19
Abandonment Failure to Attempt Resuscitation

• If you believe person is dead and do not attempt
  resuscitation, you may be guilty of abandonment
• Conditions in which death can be assumed include
  decapitation, rigor mortis, tissue decomposition
• If unsure what to do in any situation, call
  medical control for advice

20
Negligence

• Failing to give care following the accepted
  standard of care
• Includes not giving care and giving improper or
  poor-quality care
• If the patient suffers further injury or
  disability, you may be sued for negligence

21
Negligence Continued

• May be negligent if
• You have a duty to act
• You breach that duty
• Your actions (or inactions) cause injury or damage

22
Good Samaritan Laws

• Protect you
• When acting in an emergency, voluntarily and
  without compensation
• When acting as a reasonable, prudent person with
  the same training would act
• When performing emergency care as trained

23
Confidentiality

• When gathering patients history, you may learn
  private information
• Assessment findings and emergency care provided
  are confidential
• You have ethical responsibility to respect
  patients right to privacy
• Never share patient information with others,
  including family members and coworkers

24
Health Insurance Portability and Accountability
Act (HIPAA)

• Confidentiality of all patient information
  legally protected
• You must not disclose any patient information
  except to others providing treatment, law
  enforcement personnel, or when subpoenaed by a
  court
• Violations may lead to civil or criminal
  penalties
• Follow the policies of your EMS system
• When in doubt, consider everything you know about
  a patient to be confidential
• A written release form signed by patient is
  required to share information

25
Special Situations

• Legal considerations are involved in other
  situations such as
• Medical identifications
• Crime scenes
• Reportable events
• Documentation

26
Medical Identification Insignia

• Include necklaces, bracelets, cards worn or
  carried
• Used by patients with certain medical conditions
  such as allergies, diabetes, epilepsy, and heart
  conditions
• Not looking for such insignia during patient
  assessment may be negligence

27
Crime Scenes

• At potential crime scene, take precautions to
  preserve evidence
• Make sure scene is safe before entering
• Ensure that law enforcement personnel are
  responding
• Do not disturb any item at scene unless emergency
  care requires it

28
Crime Scenes Continued

• Emergency care is top priority
• Observe and document anything unusual at scene
• When removing clothing to expose injury, do not
  cut through holes from gunshot or stabbing wounds
• Follow directions of law enforcement personnel,
  and explain what is necessary to provide
  essential patient care

29
Reportable Events

• First Responders are obligated to report
• Child, elder, and spouse abuse or domestic
  violence
• Crimes, such as gunshot and knife wounds,
  suspicious burns, rape and sexual assault
• Vehicle crashes
• Certain infectious diseases
• Exposure to a patients body fluids

30
Documentation

• Documenting patient assessment and care is very
  important
• Helps other EMS professionals assess and treat
  patient.
• Because patients condition often changes, report
  of early assessments provides key information
• Your record is a legal document that helps
  support what you saw, heard, and did at scene
• Complete the record as soon as possible after the
  emergency
• State and local EMS requirements for
  documentation vary
• Many EMS systems have printed forms used by First
  Responders