Medical/Legal and Ethical Issues

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CHAPTER 3
Medical/Legal and Ethical Issues
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Scope of Practice
A collective set of rules and duties that define
your role as an EMTB
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Legal Duties of the EMT-B

• Providing patient care within the scope of
  practice
• State Legislation further defined by medical
  direction through the use of protocols and
  standing orders
• Medical Direction scope of practice may be
  contingent upon telephone/radio communications
  and approved standing orders/protocols

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Ethical Responsibilities

• Make patient's needs a priority
  (physical/emotional).
• Maintain skills and knowledge to the point of
  mastery.
• Critically review performance, seeking ways to
  improve response time, patient outcome,
  communication. (Quality Improvement)
• Prepare honest reports.
• Maintain confidentiality

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Advance Directives
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Advance Directives DNR Orders

• Patient has the right to refuse resuscitative
  efforts.
• Usually requires written physician order on a NYS
  DOH form you need to make sure you see this,
  and it is only valid for six months

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Advance Directives DNR Orders

• Become familiar with protocols related to DNR
  orders and advance directives
• Prehospital DNRs honored
• Health Care Proxy not honored in the prehospital
  setting (only in the hospital setting)
• When in doubt, resuscitate.

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Do Not Resuscitate (DNR) Order
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Types of Consent
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Consent Expressed/Informed

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

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Consent Implied

• Consent implied for unconscious patient requiring
  emergency intervention
• Based on the assumption the unconscious patient
  would consent if conscious

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Consent Children and Incompetent Adults

• Consent required from parent/guardian
• Emancipation Issues (those who are married or of
  a certain age)
• State regulations regarding age of minors
• Consent implied in life-threatening emergency

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Patient Refusal

• Patients have the right to refuse treatment if
  they
• are legally able to refuse
• are mentally competent following the rules of
  informed consent
• are fully informed of risks
• sign a release of liability form
• if an unconscious patient regains
  consciousness, and refuses transport

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Patient Refusal

• When in doubt, err in favor of providing care!

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Documenting Patient Refusal

• Leading cause of lawsuits
• Documentation is key to protection.
• Note all assessment findings and emergency
  medical care given.
• Attempt to persuade patient to accept care.
• Ensure the patient is able to make a rational,
  informed decision
• Outline risks consequences as explained.

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Options for Patient Refusal

• Utilize others to help
• Family members may help convince patient.
• Medical control may assist.
• Law enforcement may have legal options.
• THE EMT-BASIC SHOULD NEVER MAKE AN INDEPENDENT
  DECISION NOT TO TRANSPORT

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Patient Refusal Checklist
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Assault/Battery

• Unlawfully touching patient without consent can
  be considered battery.
• Providing care when the patient does not consent
  to the treatment

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Ethical, Medical, Legal Issues
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Key Term
Abandonment
Termination of care of a patient without assuring
continuation of care at the same level or higher
(we must hand over care to an EMT-I or
Paramedic/at the hospital)
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Key Term
Negligence
Deviation from accepted standard of care,
resulting in further injury to a
patient Something that should have been done
but was not, or was done incorrectly
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Negligence Components

• Duty to act
• Breach of that duty (may include failure to
  act/did not provide standard of care)
• Injury or damages inflicted (physical or
  psychological)
• The actions of the EMT-B caused the injury/damage

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Duty to Act

• An obligation to provide emergency care to a
  patient
• Formal Duty Contractual obligation between
  agency and municipality (specific clauses within
  the contract should indicate when service can be
  refused to a patient)
• Implied Duty
• Patient call to 9-1-1 and dispatcher confirms
  that an ambulance will be sent
• Treatment is begun on patient

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Duty to Act Ethical/ Moral

• There are no NYS laws regarding duty to act
• Off duty
• Out of your EMS system, but in an ambulance
• Good Samaritan laws

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Confidential Information

• Patient history gained through interview
• Assessment findings
• Treatment rendered
• Written release required to release information
  signed by the patient. Do not release on
  request, written or verbal, unless legal
  guardianship has been established

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Confidential Information

• Exceptions to written release
• Legal Subpoena
• Other health care personnel treating patient need
  to know information to continue care
• Mandatory reporting (rape, abuse)
• Insurance 3rd party payment billing forms
• Statewide data collection system (PCRs)

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HIPAA

• Health Insurance Portability and
• Accountability Act mandates increased
• privacy of patient-specific medical
• information and their
• Record keeping
• Storage
• Access
• Discussion when medically necessary

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Organ Donation

• Requires a separate signed donor form.
• Driver's license shows intent to be a donor on
  reverse side.

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Organ Donor Form
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EMTB Role in Organ Donation

• Organ donor patients are treated the same as
  other patients.
• Identify potential donors.
• Notify medical direction.
• Provide care to maintain vital organs.

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Medical Identification Devices

• Heart conditions
• Diabetes
• Allergies (bees, medicines, foods, etc)
• Epilepsy
• Other information

Alert EMTB to patients medical condition
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Medical Identification Device (front)
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Medical Identification Device (back)

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Crime Scenes

• Do not enter the crime scene until it is safe
  scene is RED until secured by police.
• Patient care is the priority.
• If possible, do not cut through holes in clothing
  from gunshot wounds or stabbing wounds
• Remain alert for evidence and try not to disturb
  it unless you need to, to provide emergency care.
• Evidence deals with condition of the scene, the
  patient, fingerprints/footprints, and microscopic
  evidence

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Crime Scenes

• Be observant and document anything unusual at the
  scene.
• Minimize your impact on the scene.
• Remember what you touch and report it to police.
• Plan and communicate with the police.

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Special Reporting Situations

• Abuse (child, spouse, elderly) (physical, sexual,
  emotional)
• Sexual assault/Rape
• Gunshot wound
• Infectious disease exposure

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Special Reporting Situations

• Restraint
• MCI
• Other unusual situations
• Mandatory reporting laws vary from state to state.