EMT CHAPTER 3 - Medical, Legal, and Ethical Issues

scope of practice

The specific actions and medical interventions an EMT is legally authorized to perform under state law, certification, and local protocols.

standard of care

The level and quality of care a reasonably prudent EMT with similar training would provide under similar circumstances.

relationship between scope of practice and standard of care

Scope defines what you may do; standard defines how well you must do it. Acting outside scope is illegal; falling below standard is negligent.

duty to act

A legal obligation to respond and render care when on duty and a patient needs and accepts help.

off‑duty EMT duty to act

When the EMT voluntarily begins to assess, treat, or otherwise represent themselves as a caregiver at the scene.

negligence

Failure to provide expected standard of care, resulting in harm, without intent to injure.

four elements required to prove negligence

Duty to act, breach of duty, damages (injury), proximate cause.

proximate cause

A direct, legally recognizable link between the EMT's breach of duty and the patient's injury.

gross negligence

Willful, wanton, or reckless disregard for patient safety far beyond simple carelessness.

res ipsa loquitur

"The thing speaks for itself" — negligence is obvious because the injury could not occur without someone's breach of duty.

negligence per se

An act automatically considered negligent because it violates a statute, rule, or protocol.

contributory negligence

A legal finding that the patient's own actions helped cause or worsen the injury.

statute of limitations in EMS lawsuits

The legally defined time period during which a patient may file a civil claim for negligence.

sovereign (governmental) immunity

Protection that shields government‑owned EMS agencies from certain civil lawsuits unless gross negligence is proven.

Good Samaritan law

State law granting limited legal immunity to unpaid rescuers who render aid in good faith without gross negligence.

Good Samaritan law and lawsuits

It only provides a defense; a suit can still be filed and must be defended in court.

informed consent

Permission for care given after full disclosure of nature, benefits, risks, and consequences.

expressed consent

Clear verbal or nonverbal agreement by a competent adult to treatment.

implied consent (Emergency Doctrine)

Assumed permission for care when a patient is unresponsive, incapacitated, or a minor in a true emergency.

minor consent

Consent provided by a parent/guardian for someone under the age defined by state law unless emergency doctrine applies.

emancipated minor

A person under legal adult age who possesses the legal rights of an adult (e.g., married, pregnant, military, court‑emancipated).

involuntary consent

Consent obtained from a third‑party authority (court order, law enforcement, legal guardian) for mentally incompetent or custodial patients.

advance directive

Written instructions for medical care if the patient loses decision‑making capacity.

living will

Document directing end‑of‑life decisions (ventilation, feeding tubes) for terminal or permanently unconscious patients.

durable power of attorney for health care

Legal instrument naming a proxy authorized to make medical decisions when the patient cannot.

DNR order

Physician‑signed document instructing providers not to begin CPR if patient is pulseless and apneic.

POLST/MOLST

Physician Orders for Life‑Sustaining Treatment — detailed orders covering acceptable treatments before and during arrest for seriously ill patients.

honor a DNR/POLST in the field

A valid, signed, unaltered document or approved bracelet/card physically at the scene.

Valid document

A valid, signed, unaltered document or approved bracelet/card physically at the scene.

DNR action

Action if a DNR is questionable or absent. Initiate full resuscitative measures and contact medical direction for clarification.

Steps for patient refusal of care

Assess capacity, explain diagnosis and risks, attempt to persuade, document thoroughly, obtain signed refusal with witness, consult medical direction if needed.

Capacity

Patient's ability to understand information, weigh risks/benefits, and make a rational decision.

Presumptive signs of death

No pulse, respirations, or blood pressure; unresponsive; fixed pupils; no reflexes.

Definitive signs of death

Decapitation, dependent lividity, rigor mortis, decomposition, incineration, body transection.

Hypothermia rule regarding death

No one is dead until they are warm and dead; initiate resuscitation unless valid DNR exists.

Abandonment

Stopping patient care or leaving the scene without transferring to an equal or higher‑level provider.

Assault in EMS

Intentional act that makes a patient fear harmful or offensive contact.

Battery in EMS

Actual unlawful touching or treatment without consent.

False imprisonment/kidnapping in EMS

Transporting or restraining a competent patient against their wishes without legal authority.

Defamation

Communication of false information harming reputation — spoken (slander) or written (libel).

Patient confidentiality waiver

Continuity of care, mandatory reporting laws, third‑party billing, court subpoena, or patient's written release.

HIPAA requirements for EMTs

Discuss PHI only when medically necessary, safeguard written/electronic records, give patients the privacy notice and obtain acknowledgement.

COBRA's purpose in EMS

Guarantees public access to emergency care regardless of insurance status.

EMTALA's anti-dumping rule

Hospitals must provide medical screening and stabilize emergency conditions before transferring or discharging.

EMS responsibilities under EMTALA for interfacility transfers

Verify patient stability, ensure crew can manage required care, obtain consent and physician certification before transport.

Key points for safe interfacility transfer

Receive full report, confirm needed equipment/meds, obtain signed transfer papers, choose quickest route.

Organ donor considerations for EMTs

Treat as any patient; maintain oxygenation/CPR if appropriate; notify receiving ED and consider contacting donor network.

Medical ID locations

Bracelet, necklace, wallet card, smartphone lock screen, or medical alert tattoo.

Safe Haven law basics

Allows parent to surrender an unharmed infant at designated sites (fire/EMS/hospital) without prosecution; age limit varies by state.

Mandatory reporting situations in EMS

Child/elder abuse, domestic violence (varies), sexual assault, gunshot or stab wounds, suspicious burns, animal bites, certain communicable diseases, attempted suicide, patient restraints, infectious exposure.

Crime-scene evidence preservation rules for EMTs

Enter/exit one path, move only what's necessary, wear gloves, do not cut through bullet holes or knots, save removed clothing, document observations, confer with police.

Coroners/medical examiners notification

Violent, suspicious, unattended, or sudden deaths; suicides; homicides; SIDS; crashes; some DOAs (follow local protocol).

Ethics vs. morals

Ethics = professional rules of right conduct; morals = personal beliefs of right and wrong.

Key EMT ethical responsibilities

Patient welfare first, respect dignity, maintain competence, uphold confidentiality, act with honesty, collaborate professionally.

Common ethical dilemmas in EMS

Expired DNR, scarce resources (triage), family refusing care for minor, treating DNR patient who isn't in arrest, limited wilderness resuscitation capacity.

Expired DNR

A do-not-resuscitate order that is no longer valid.

Intentional tort

A deliberate civil wrong (e.g., assault, battery) done with knowledge of its nature.

False documentation liability

Falsifying or omitting info on a patient care report is both unethical and a legal offense that can constitute fraud or negligence.

Legal importance of equipment checks

Failure to inspect or maintain equipment can breach duty and create negligence liability if patient harm occurs.

Statute of limitations vs. discovery rule

Statute sets filing deadline from event; discovery rule starts clock when injury is discovered or should have been discovered.

Gross deviance from protocol

An intentional disregard or extreme departure from approved procedures—grounds for gross negligence claims.

Abandonment at hospital triage

Leaving patient on stretcher or in wheelchair without oral handoff to qualified staff equals abandonment.

Conditions for using patient restraints legally

Patient poses risk to self/others, least-restrictive device used, protocol followed, and continuous monitoring documented.

Role of EMT documentation in legal defense

Accurate, complete PCR is primary evidence showing care met standard and patient rights respected.

Steps if EMT discovers partner unfit for duty

Report to supervisor immediately; duty to partner, patient safety, and public welfare supersedes loyalty.

Contributory vs. comparative negligence

Contributory: any patient fault bars recovery; comparative: damages reduced by patient's percentage of fault (varies by state).

National EMS Scope of Practice Model

Sets minimum nationwide expectations for EMS provider skills but states retain authority to expand or limit scope.

National EMS Education Standards influence

Provide a nationwide benchmark for what competent EMTs should know and do, shaping protocols and court expectations.

Reasonable person standard in EMS

Jury compares EMT's actions to what a prudent EMT with similar training would have done.

Medical direction's legal role

Provides authority for EMT practice, approves protocols, offers real-time orders; deviating without permission may breach duty.

Requirements to honor MOLST limiting airway management

Form must be valid; if patient deteriorates, EMT follows prescribed limitations (e.g., no intubation) while giving permitted comfort care.

MOLST vs. traditional DNR difference

MOLST can specify partial interventions (meds yes, shocks no); DNR focuses solely on CPR/ventilation after arrest.

Handling expired or ambiguous advance directive

Provide full care, contact medical direction; treat directive as invalid until clarity achieved.

Who can revoke an advance directive

The patient (if capable) at any time, verbally or in writing; EMT must honor revocation and document.

EMT actions if family demands CPR against valid DNR

Explain legal duty, involve medical direction, follow DNR unless revoked by patient; provide emotional support.

Comfort-care arrest (DNR-CC)

Directive allowing comfort treatments (oxygen, pain meds) but prohibiting resuscitative measures once arrest occurs.

Legal significance of patient's personal property

EMTs must safeguard belongings; loss or damage can result in civil liability.

HIPAA minimum necessary rule

Share only the least amount of PHI needed for the purpose of the disclosure.

Actions if you accidentally disclose PHI

Report to your agency's Privacy Officer immediately for mitigation and documentation per HIPAA policy.

HIPAA policy

Report to your agency's Privacy Officer immediately for mitigation and documentation.

Responsibilities when treating potential organ donor in cardiac arrest

Perform high‑quality CPR/ventilation to maintain organ perfusion, notify receiving facility, and document donor status.

National Association of EMTs Code of Ethics (1978)

Prioritize patient welfare, respect dignity, maintain skills, act with honesty, safeguard confidentiality, collaborate with healthcare team.

COBRA guarantee regarding emergency care

Requires hospitals that participate in Medicare to provide emergency medical screening and stabilization regardless of a patient's insurance or ability to pay.

EMTALA forbids hospitals from doing what?

'Patient dumping': refusing, delaying, or inappropriately transferring emergency patients based on financial status.

Documents or confirmations an EMT must obtain before interfacility transfer

Full patient report, signed informed-consent for transfer, physician certification of medical necessity/stability, destination facility acceptance.

EMT's three duties beyond patient care

Duty to self (maintain credentials, mental/physical fitness), duty to partner (ensure colleague fitness/safety), duty to equipment (inspect and maintain gear each shift).

When must EMS equipment checks be completed?

At the beginning of every shift; failure may create negligence if equipment malfunctions.

res ipsa loquitur in EMS context

A doctrine allowing negligence inference when the injury would not occur without EMT error (e.g., fractured arm from improper stretcher strap).

abandonment in the ED

Leaving a patient without verbal hand-off to a qualified nurse, physician, or provider at or above EMT level.

Assault vs battery in EMS

Assault is threatening harm; battery is physical contact or treatment without consent.

When are police or legal authority typically notified of death in the field?

Homicide, suicide, violent or suspicious deaths, crash fatalities, SIDS, burns, electrocution, or when local protocol mandates.

Exceptions allowing release of PHI without patient permission

Continuity of care, mandatory reporting, third-party billing, legal subpoena/court order, operations overseen by agency Privacy Officer.

HIPAA's "minimum necessary" rule

Share only the smallest amount of patient information needed for the intended purpose.

Privacy Officer in EMS agencies

Designated individual responsible for HIPAA compliance, breach reporting, and staff training.

What must an EMT do after accidental PHI disclosure?

Immediately notify the agency's Privacy Officer and document the incident per policy.

Medical alert tattoo

Permanent tattoo indicating a condition (e.g., 'Type 1 Diabetic'); assess wrists, arms, chest for such tattoos during exam.

Traditional medical ID locations

Bracelet, necklace, wallet card, smartphone lock screen, or personal health USB tags.

EMT actions upon finding a potential organ donor

Provide standard care, maintain oxygenation and perfusion, notify medical direction/receiving facility for donor network activation.

Safe-Haven laws age range

Varies by state—commonly newborn to 30 days, some up to one year; EMTs must know local statute.

Common Safe-Haven surrender sites

Hospital EDs, fire stations, EMS stations, or law-enforcement facilities as defined by state law.