MedicalLegal and Ethical Issues

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Medical/Legal and Ethical Issues
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Scope of Practice

• A collective set of regulations which defines the
  scope, or extent and limits of the EMT Basic.

3
Legal Duties to the Patient

• Provide for the well-being of the patient by
  rendering necessary interventions outlined in the
  scope of practice.

4
Legal Duties to the Public

• Defined by state legislation.
• Enhanced by medical direction through the use of
  protocols and sanding orders.
• Referenced to the National Standard Curricula

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Legal Duties to Medical Director

• Legal right to function as an EMT-B may be
  contingent upon medical direction.
• Telephone/radio communications.
• Approved standing orders/protocol.
• Responsibility to medical direction.

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Ethical Responsibilities

• Make the physical/emotional needs of the patient
  a priority.
• Practice/maintenance of skills to the point of
  mastery.
• Attend continuing education/refresher programs.
• Critically review performances, seeking ways to
  improve response time, patient outcome, and
  communication.
• Honesty in reporting.

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Consent

• Permission from the patient, required for
  treatment by the EMT.

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Types of Consent

• Expressed Consent.
• Implied Consent
• Consent for children and Mentally Incompetent
  Adults

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Expressed Consent

• Patient must be of legal age and be able to make
  a rational decision.
• Patient must be informed of the steps of the
  procedures and all related risks.
• Must be obtained from every conscious, mentally
  competent adult before rendering treatment.

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Implied Consent

• Consent assumed from the unconscious patient
  requiring emergency intervention.
• Based on the assumption that the unconscious
  patient would consent to life-saving
  interventions.

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Children and Mentally Incompetent Adults

• Consent for treatment must be obtained from the
  parent or legal guardian..
• Emancipation issues.
• State regulations regarding age of minors.
• When life threatening situations exist and the
  parent or legal guardian is not available for
  consent, emergency treatment should be rendered
  based on implied consent.

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Patient Refusals

• The patient has the right to refuse treatment.
• The patient may withdraw from treatment at any
  time. (EXAMPLE - An unconscious patient who
  regains consciousness and refuses transport to
  the hospital.)
• Refusals must be made by mentally competent
  adults following the rules of expressed consent.

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Patient Refusals Cont..

• The patient must be informed of and fully
  understand all the risks and consequences
  associated with refusal of treatment/transport
  and must sign a release from liability form.
• When in doubt, err in favor of the patient.

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Patient Refusals Cont...

• Documentation is a key factor to protect the
  EMT-B in refusal.
• Competent adult patients have the right to refuse
  treatment.

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Before Leaving the Scene, the EMT-B Should

• Try again to persuade the patient to go to a
  hospital.
• Ensure that the patient is able to make a
  rational, informed decision and is not under the
  influence of alcohol,drugs, illness, or injury
  effects.
• Inform the patient why he should go and what may
  happen to him if he does not.
• Consult medical direction as directed by local
  protocol.
• Consider assistance of law enforcement.
• Document any assessment findings and emergency
  medical care given if the patient still refuses,
  then have the patient sign a refusal form
• The EMT-B should never make an independent
  decision not to transport.

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Assault

• Unlawfully touching a patient without his/her
  consent.

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Battery

• Providing emergency care when the patient does
  not consent to the treatment.

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Advanced Directives

• Do Not Resuscitate (DNR orders.)
• Patient has the right to refuse resuscitative
  efforts.
• In general, requires written order from
  physician.
• Review state and local protocol / legislation
  relative to DNR orders and advanced directives.
• When in doubt or when written orders are not
  present, the EMT-B should begin resuscitative
  efforts.

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Abandonment

• Termination of patient care without assuring the
  continuation of care at the same level or higher.
• Taking a patient to the hall of the E.R. and
  leaving him to respond to another call without
  assuring care by equal or higher trained
  personnel.

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Negligence

• Deviation from the accepted standard of care
  resulting in further injury to the patient.
• Four components for negligence to exist.
• Duty to act.
• Breach of duty.
• Injury / damages were inflicted.
• Physical
• Psychological
• The actions of the EMT-B caused the injury or
  damage.

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Duty to Act

• A contractual or legal obligation must exist.
• Implied
• Patient calls for an ambulance and the dispatcher
  confirms that an ambulance will be sent.
• Treatment is begun on a patient.
• Formal - ambulance service has a written contract
  with a municipality
• Specific clauses within the contract should
  indicate when service can be refused to a
  patient.

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Duty to Act Cont..

• Legal duty to act may not exist. May be moral or
  ethical considerations.
• In some states, while off duty, if an EMT-B comes
  upon an accident while driving.
• When driving the ambulance not in the companys
  service area and the EMT-B observes an accident.
• Moral / Ethical duty to act.
• Risk management.
• Documentation.
• Specific state regulations regarding duty to act.

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GOOD SAMARITAN LAWS

• Developed in most states to provide immunity to
  individuals trying to help people in emergencies.
• Will not stop a lawsuit from being filled.
• Will grant immunity from liability if rescuer
  acts in good faith to provide care to the level
  of his training.

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Confidentiality

• Confidential information.
• Patient history gained through interview.
• Assessment findings.
• Treatment rendered.

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Releasing Confidential Information

• Requires a written release form signed by the
  patient.
• Do not release on request, written or verbal,
  unless legal guardianship has been established.

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When a Release is Not Required

• Other health care providers need to know
  information to continue care.
• State law requires reporting incidents such as
  rape, abuse, or gunshot wounds.
• Third party payment billing forms.
• Legal subpoena.

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Special Situations

• Donor/organ harvesting consideration
• Requires a signed legal permission document
• Fig. 3-3 on p. 36
• A potential organ donor should not be treated
  differently from any other patient requesting
  treatment.

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EMT-B Role in Organ Harvesting

• Identify the patient as a potential donor.
• Establish communication with medical direction.
• Provide care to maintain viable organs.

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Medical Identification Insignia

• Bracelet, necklace, card.
• Indicates a serious medical condition of the
  patient.
• Allergies
• Diabetes
• Epilepsy
• Others

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Potential Crime Scene/Evidence Preservation

• Dispatch should notify police personnel.
• Responsibility of the EMT-B.
• Emergency care of the patient is EMT-Bs
  priority.
• Do not disturb any item at the scene unless
  emergency care requires it.
• Observe and document anything unusual at the
  scene.
• If possible, do not cut through holes in clothing
  fromgunshot wounds or stabbing.

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Special Reporting Situations

• Established by state legislation and may vary
  from state to state.

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Commonly Required Reporting Situations

• Abuse.
• Child.
• Elderly.
• Spouse.
• Crime.
• Wounds obtained by violent crime.
• Sexual assault.
• Infectious disease exposure.
• Dog bites.
• Patient restraint laws, e.g., forcing someone to
  be transported against their will.
• Mentally incompetent, e.g., intoxication with
  injuries.