Legal and Ethical issues

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Legal and Ethical issues
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Know Your Reporting Responsibilities!

• this applies to you!

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Special Reporting Requirements (1 of 2)

• Abuse of children, elderly, and spouse
• Injury during the commission of a felony
• Drug-related injury
• Childbirth

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Special Reporting Requirements (2 of 2)

• Infectious disease exposure
• Crime scene
• Deceased

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Reporting

• It is a misdemeanor to fail to report abuse.
• report suspicion of child abuse, you do not need
  proof to report an incident.

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What, When Who

• What When
• verbal report - immediately
• written report - within 36 hours
• Who
• law enforcement
• protective services

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Elder Abuse

• Any person who takes advantage of person,
  property or emotional state
• Victims are often hesitant or unable to report
• Signs of abuse are often overlooked
• Pt. often has multiple medical conditions and are
  dependent on others

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Assessment of Elder Abuse (1 of 2)

• Repeated visits to the emergency room
• A history of being accident-prone
• Soft-tissue injuries
• Vague explanation of injuries
• Psychosomatic complaints

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Assessment of Elder Abuse (2 of 2)

• Chronic pain
• Self-destructive behavior
• Eating and sleeping disorders
• Depression or a lack of energy
• Substance and/or sexual abuse

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Signs of Physical Abuse

• may be obvious or subtle.
• Obvious signs include bruises, bites, and burns.
• Look for injuries to the ears.
• Consider injuries to the genitals or rectum as
  evidence of abuse.

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Advance Directives

• Specifies medical treatments desired if patient
  is unable to make decisions
• Do not resuscitate (DNR) orders
• Patients have the right to refuse resuscitative
  efforts.

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Do Not Resuscitate

• AKA - DNR or no code
• supportive measures only - No CPR
• family member can request resuscitation

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Medical facility Vs. Home or Street

• There are different requirements

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DNR- Nursing facilities

• written order in patient's chart
• no CPR
• no code
• DNR
• VERBAL ORDER FROM MD NOT VALID unless put in
  writing

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DNR - home/street

• L.A. County Prehospital DNR Form
• California Prehospital DNR Form
• MEDIC ALERT TAG bracelet or necklace
• no other type of DNR may be honored in Los
  Angeles County

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Legal issues

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

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Consent three types

• Expressed consent
• Implied consent
• Minors and mentally incompetent adults
• In loco parentis
• ALOC

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Legal age of consent

• Minor is under 18 years-old
• Emancipated minor
• Female - pregnancy related

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Adults - Competence

• Must be competent to refuse treatment or
  transport
• hypotensive
• hypoglycemic
• under the influence
• suicidal ideations or actions

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Adults - Competence

• Any EMT-1 or EMT-P can deem a patient incompetent
• This is NOT a 5150

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Refusal of Treatment

• Against Medical Advice
• when a patient refuses care or transport
• do not need if you believe patient is OK without
  treatment.

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Valid AMA

• Patient Alert and Oriented X3
• Competent
• EMT-B should obtain a witnessed signature
• MUST advise pt
• Of need for treatment
• Of consequences of refusal
• That they may re-contact 911

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5150 (72 hour hold)

• Patients may be placed on a hold if...
• danger to self
• danger to others
• gravely disabled due to mental disorder

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5150 (72 hour hold)

• who may place hold
• Law Enforcement
• PET or PMRT member
• County designated doctors

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Limited Legal Authority

• As an EMT-B, you have limited legal authority to
  require or force a patient to undergo care.
• Police may put a patient in protective custody to
  allow you to provide care.
• Know your local laws and protocols.

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Assault and Battery

• Know when to force TX
• Assault
• Unlawfully placing a person in fear of immediate
  bodily harm without consent
• Battery
• Unlawfully touching a person

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Duty to Act

• Individuals responsibility to provide patient
  care
• Begins once an ambulance responds to a call or
  treatment is initiated

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Standard of Care

• The minimum level of care that a person can
  expect
• Imposed by local protocol
• Imposed by the law
• Professional or institutional standards

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Negligence

• Failure to apply the standard of care
• Failure to provide the same care that a person
  with similar training would provide
• Act or omission of an act
• Good Samaritan Act does not apply to on-duty
  personnel

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Negligence Determination

• Duty
• Breech of duty
• Damages
• Cause

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Abandonment

• Termination of care without patients consent
• Termination of care without provisions for
  continued care
• Care cannot stop unless someone of equal or
  higher training takes over

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Ethical Responsibilities

• Make physical/emotional needs a priority
• Practice/maintain skills
• Critically review performances
• Attend continuing education/refresher programs
• Be honest in reporting

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Confidentiality

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

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Records and Reports

• Complete documentation is a safeguard against
  legal complications
• If an action or procedure is not recorded, it
  was not performed
• An incomplete or untidy report is evidence of
  incompetence

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Standards Imposed by States

• Medical Practices Act
• Exempts EMT-Bs from licensure requirements
• Certification
• Process of evaluating and recognizing that EMT-B
  has met certain predetermined standards

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Regulation updates

• EMT-1 or EMT-B designation only
• Titles that no longer exist
• EMT-1(AA)
• EMT-1 (D)

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Certification Application Requirements

• Be 18 years old or older.
• Have valid Course Completion Certificate.
• Apply within 2 years of course completion.

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Certification requirements

• Submit application and fees.
• Pass a written certification examination.
• And ..

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Background Check

• Disqualifying convictions
• Violent crimes
• Sex related crimes
• Drug related crimes (including DUI)

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Re-certification Requirements

• Every two years
• Complete refresher course
• Or
• Obtain 24 hours of approved continuing education
• Submit application and fees

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Approved Continuing Education

• BLS level
• many methods to obtain CE
• MANDATORY CPR airway management course at least
  once every 2 years
• YOU must find a CE Provider

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End

• questions??