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Medical/Medical/LegalLegaland Ethicaland EthicalIssuesIssues

Scope of PracticeScope of PracticeScope of PracticeScope of Practice

Legal Duties to the Patient, Medical

Director and Public

Legal Duties to the Patient, Medical

Director and Public

Scope of practice:Scope of practice:

Identifies duties and skills EMTs Identifies duties and skills EMTs are allowed and supposed to are allowed and supposed to perform when necessary.perform when necessary.

EMTs must function within minimum and maximum performance guidelines.

EMS personnel have

the responsibility to

know how state laws

and regulations apply

to them.

Standard of care:Standard of care:

The minimum acceptable The minimum acceptable

level of care normally level of care normally

provided in provided in

an area.an area.

Ethical Ethical ResponsibilitiesResponsibilities

Ethical Ethical ResponsibilitiesResponsibilities

There’s more to being an EMT...There’s more to being an EMT...

……than just driving around in than just driving around in an emergency vehicle with an emergency vehicle with

lights and siren!lights and siren!

Duty to ActDuty to ActDuty to ActDuty to Act

Duty to act:Duty to act:

A legal responsibility of EMS A legal responsibility of EMS

personnel to provide personnel to provide

emergency medical care when emergency medical care when

called upon or presented with called upon or presented with

the opportunity to do so.the opportunity to do so.

By being certified (or

licensed) as an EMT, you

may have an implied duty

to act.

Negligence:Negligence:

May occur when a patient May occur when a patient suffers damage or injury suffers damage or injury because an EMS provider fails because an EMS provider fails to perform to accepted to perform to accepted standards of care.standards of care.

Criteria for Negligence Criteria for Negligence Duty to actDuty to act

There was a responsibility to provide service.There was a responsibility to provide service.

Breach of dutyBreach of duty Failure to perform as well as a peer in same situation.Failure to perform as well as a peer in same situation.

Damage Damage Patient suffered a physical or psychological injury.Patient suffered a physical or psychological injury.

Proximate causeProximate cause Damage caused by EMS provider actions or inactions.Damage caused by EMS provider actions or inactions.

Once you accept responsibility for Once you accept responsibility for

taking action…taking action…

...an ...an implied contractimplied contract to to

provide service has been provide service has been

established between you and the established between you and the

patient.patient.

Abandonment:Abandonment:

Termination of care without Termination of care without the patient’s consent, and/or the patient’s consent, and/or without ensuring that care without ensuring that care would be continued at the would be continued at the same level or better.same level or better.

Care can be discontinued: Care can be discontinued:

If patient care is relinquished to someone with equal or greater qualificationsIf patient care is relinquished to someone with equal or greater qualifications

If patient is transported to a facility that can provide a better level of careIf patient is transported to a facility that can provide a better level of care

If personnel safety is threatened by uncontrolled hazards at the sceneIf personnel safety is threatened by uncontrolled hazards at the scene

If patient no longer needs or wants careIf patient no longer needs or wants care

Ethical Ethical ConsiderationsConsiderations

Ethical Ethical ConsiderationsConsiderations

Moral Moral andand Ethical Ethical

issuesissues are inherent in are inherent in

EMS, and cannot be EMS, and cannot be

ignored!ignored!

Consent for Treatment Consent for Treatment and Transportand TransportConsent for Treatment Consent for Treatment and Transportand Transport

Consent:Consent:

Permission from the patient or Permission from the patient or legal guardian for EMS legal guardian for EMS personnel to provide treatment, personnel to provide treatment, procedures and transportation. procedures and transportation.

Laws concerning consent vary from state to state.

Expressed consent:Expressed consent:

Patient directly agrees to Patient directly agrees to accept treatment, and gives accept treatment, and gives permission to proceed.permission to proceed.

Must be of legal age and able to make a rational decision.

Must be an informed decision

Implied consent:Implied consent:

Assumes that patients who are Assumes that patients who are

unable to express consent would unable to express consent would

do so if they could.do so if they could.

Applies to patients who are mentally, physically or emotionally impaired.

Children and Children and Mentally Mentally

Incompetent AdultsIncompetent Adults

Children and Children and Mentally Mentally

Incompetent AdultsIncompetent Adults

With children, With children,

consent for careconsent for care

must be obtained must be obtained

from a parent or from a parent or

legal guardian...legal guardian...

...In the absence of a ...In the absence of a

parent or guardian, parent or guardian,

consent consent

is is implied.implied.

It is equally important It is equally important

to obtain consent for to obtain consent for

care for a care for a mentally mentally

incompetent adult.incompetent adult.

Refusal of Refusal of Treatment & Treatment &

TransportTransport

Refusal of Refusal of Treatment & Treatment &

TransportTransport

Adult patients of sound mind,

who understand the

consequences _ even though ill

or injured _ have the legal right

to refuse treatment.

Have the patient sign a “release from liability” form.

Having the patient sign Having the patient sign

a “refusal form” is a “refusal form” is notnot

enoughenough

SUPPORTINGDOCUMENTATION

IS CRUCIAL!

Assault and BatteryAssault and BatteryAssault and BatteryAssault and Battery

Assault:Assault:

Threatened or attempted Threatened or attempted offensive physical contact, or offensive physical contact, or causing fear of such contact.causing fear of such contact.

Battery:Battery:

Offensive physical contact Offensive physical contact without consent.without consent.

AdvanceAdvanceDirectivesDirectivesAdvanceAdvance

DirectivesDirectives

Advance directive:Advance directive:

A written document which some A written document which some patients may use to state what patients may use to state what treatment they want to receive, treatment they want to receive, or refuse, should they become or refuse, should they become unable to state their wishes.unable to state their wishes.

Living WillsDurable Power of AttorneyDo-Not-Resuscitate orders

DNR BraceletDNR Bracelet

A DNR order is another form of advance directive.

Do-Not- ResuscitateOrderAttending

Physician’s OrderAuthorized

Decision- makerPatient’s Signature

Patient ConfidentialityPatient ConfidentialityPatient ConfidentialityPatient Confidentiality

Confidential InformationConfidential Information

Information obtained from Information obtained from

a patient or other sources a patient or other sources

during the course of during the course of

assessment and treatment assessment and treatment

isis CONFIDENTIAL.CONFIDENTIAL.

Releasing Releasing Confidential Confidential InformationInformation

Releasing Releasing Confidential Confidential InformationInformation

A release may not be needed when: A release may not be needed when:

Patients are delivered to other healthcare providersPatients are delivered to other healthcare providers

Reporting required information to law enforcementReporting required information to law enforcement

Providing information to insurance companies or third-party payersProviding information to insurance companies or third-party payers

Subpoenaed for release of information Subpoenaed for release of information by a court orderby a court order

Situations Requiring Situations Requiring Special ReportingSpecial Reporting

Situations Requiring Situations Requiring Special ReportingSpecial Reporting

Typical Reportable Cases Typical Reportable Cases

Neglect or abuse of childrenNeglect or abuse of children

Neglect or abuse of older adultsNeglect or abuse of older adults

RapeRape

Gunshot woundsGunshot wounds

Stab woundsStab wounds

Animal bitesAnimal bites

Certain communicable diseasesCertain communicable diseases

Special SituationsSpecial SituationsSpecial SituationsSpecial Situations

Potential Organ DonorsPotential Organ Donors

An organ donor sticker An organ donor sticker may be on the back of a may be on the back of a driver’s license.driver’s license.

Medical Condition Medical Condition Identification Identification

InsigniaInsignia

Medical Condition Medical Condition Identification Identification

InsigniaInsignia

A medical condition tag.

MEDICALMEDICAL

ALERTALERT

Medic Alert Tag

Considerations at Considerations at Possible Crime Possible Crime

ScenesScenes

Considerations at Considerations at Possible Crime Possible Crime

ScenesScenes

Do not disturb a crime scene

unless absolutely necessary to

provide patient care.

Crime Scenes Crime Scenes Take note of crime scene appearance Take note of crime scene appearance

Avoid cutting or destroying clothing that may be needed as evidenceAvoid cutting or destroying clothing that may be needed as evidence

Always wear gloves, and avoid unnecessary touching of objects at sceneAlways wear gloves, and avoid unnecessary touching of objects at scene

Be able to recall items you handle or move Be able to recall items you handle or move at the sceneat the scene

Document all actions and observations thoroughlyDocument all actions and observations thoroughly

SU

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UM

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RY Scope of PracticeScope of Practice

Consent for Treatment Consent for Treatment

and Transportand Transport

Patient ConfidentialityPatient Confidentiality

Special SituationsSpecial Situations