Chapter 4: Medical, Legal, and Ethical Issues

Scope of Practice

What an EMT is legally allowed to do (defined by state law).

Standard of Care

How care should be provided (expected level of competence).

Expressed Consent

Verbal/written permission from a competent adult.

Implied Consent

Assumed (e.g., unresponsive patient).

Involuntary Consent

Court-ordered or for threats to self/others (e.g., psychiatric hold).

When can you treat a minor without parental consent?

• Life-threatening emergencies.

• Emancipated minors (married, military, parents).

• Check local laws for exceptions (e.g., STI treatment).

What steps must you take if a patient refuses care?

1. Ensure patient is alert, oriented, and informed of risks.

2. Document refusal (have patient/witness sign).

3. Consult medical direction if unsure.

4. Offer to call family/law enforcement if needed.

How do you handle a DNR (Do Not Resuscitate) order?

• Valid DNR/POLST must be present to withhold CPR.

• If unavailable/uncertain, begin resuscitation.

• Document thoroughly and notify hospital.

What are the 4 elements of negligence?

1. Duty to act (on-duty or initiated care).

2. Breach of duty (failed standard of care).

3. Proximate causation (harm resulted).

4. Damages (patient suffered injury/loss).

When does an EMT have a duty to act?

• On-duty: Always.

• Off-duty: Varies by state (Good Samaritan laws may apply).

• Abandonment: Stopping care before transferring to equal/higher-level provider.

What patient information is confidential?

• All medical history/treatment.

• Exceptions: Sharing with healthcare team, court order, or public safety (e.g., gunshot wounds).

How should EMTs handle evidence at a crime scene?

• Patient care first, but minimize disturbance.

• Note/don’t touch weapons, bullets, or fingerprints.

• Report observations to police.

What situations require mandatory reporting?

• Abuse (child, elder, domestic).

• Sexual assault.

• Gunshot/stab wounds.

• Dog bites (varies by state).

What are key ethical expectations for EMTs?

• Honesty in documentation.

• Non-maleficence (do no harm).

• Patient autonomy (respect refusals).

• Fair treatment (no discrimination).