chapter 3 medical/legal and ethical issues. scope of practice legal duties to the patient, medical...
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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
MM
AR
YS
UM
MA
RY Scope of PracticeScope of Practice
Consent for Treatment Consent for Treatment
and Transportand Transport
Patient ConfidentialityPatient Confidentiality
Special SituationsSpecial Situations
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