Chapter 3: Medical, Legal, and Ethical Issues for the EMT

Flashcards covering the medical, legal, and ethical issues for EMTs, including consent types, legal definitions of death, negligence factors, and confidentiality standards based on lecture notes.

Decision-making capacity

The ability of a patient to understand the information being provided, coupled with the ability to process that information and make an informed choice regarding medical care.

Autonomy

The right of patients who have decision-making capacity to make decisions concerning their own health.

Competence

A legal term referencing a determination regarding a person's ability to make decisions, typically made by a court of law.

Expressed consent

Also known as actual consent, this is given when a patient specifically acknowledges, verbally or nonverbally, that they want an EMT to provide care or transport.

Informed consent

Consent given by a patient after an EMT has explained the nature of the treatment, potential risks, benefits, alternatives, and the consequences of refusing treatment.

Implied consent

The legal principle that assumes an unconscious or incapable person would consent to care and transport for a serious medical condition; also known as the emergency doctrine.

Involuntary consent

Consent for emergency care obtained from a guardian or conservator for patients who are mentally ill, developmentally delayed, or in a behavioral crisis.

Emancipated minor

A person under the legal age (usually 18) who can be legally treated as an adult because they are married, members of the armed services, parents, or living independently from parents.

In loco parentis

A legal principle meaning "in the position or place of a parent," allowing school or camp officials to give consent for a minor if a parent or guardian is unavailable.

Mature minor doctrine

A principle that provides minors who have chronic or severe illnesses greater empowerment to consent to or refuse interventions, even if they conflict with parental wishes.

Forcible restraint

The act of physically subduing a patient who is combative and presents a significant physical risk of danger to themselves, rescuers, or others.

Shared decision making

A collaborative process in which the clinician works with the patient to determine the optimal health care approach based on the patient's unique concerns and values.

Compassionate persuasion

An approach involving guiding a person to accept treatment they initially resisted through deeper exploration of their resistance and offering creative solutions.

Confidentiality

The principle that communication between a patient and the EMT generally cannot be disclosed without patient permission or a court order.

HIPAA

The Health Insurance Portability and Accountability Act of 1996; a federal law designed to protect sensitive health care information and safeguard patient confidentiality.

Protected Health Information (PHI)

Any information obtained during medical treatment that can be used to identify the patient, including medical history and assessment findings.

Advance directive

A written document, often referred to as a living will or health care directive, that specifies medical treatment for a patient should they become unable to make decisions.

DNAR order

Do Not Attempt Resuscitation order; a written document signed by a physician giving permission not to attempt resuscitation on a patient.

POLST / MOLST

Physician Orders for Life-Sustaining Treatment and Medical Orders for Life-Sustaining Treatment; forms that explicitly describe acceptable medical orders for terminally ill patients.

Durable power of attorney for health care

A legal designation (also called a health care proxy) that names a surrogate to make health care decisions for a patient if they become incapacitated.

Palliative care

A treatment approach focused on decreasing pain and symptoms rather than curing a disease or prolonging life.

Dependent lividity

A definitive sign of death where blood settles to the lowest point of the body, causing skin discoloration.

Rigor mortis

The stiffening of body muscles caused by chemical changes within muscle tissue, occurring between 2 and 12 hours after death.

Putrefaction

The decomposition of body tissues, typically occurring between 40 and 96 hours after death.

Algor mortis

The cooling of the body after death until it matches the ambient temperature.

Scope of practice

Legally defined care an EMT is able to provide, most commonly set by state law and further defined by the medical director.

Standard of care

The manner in which an EMT must act or behave; based on how a reasonably prudent person with similar training would act under similar circumstances.

Duty to act

An individual's responsibility to provide patient care, arising from statute, department policy, or by beginning treatment.

Negligence

Failure to provide the same care that a person with similar training would provide, involving duty, breach of duty, damages, and causation.

Proximate causation

A reasonable cause-and-effect relationship between an EMT's breach of duty and the damages suffered by a patient.

Res ipsa loquitur

A legal theory where an EMT is inferred to be liable because an injury occurred while in the EMT's control that generally does not occur without negligence.

Negligence per se

A theory of liability used when an EMT's conduct occurred in clear violation of a statute, such as performing a skill outside their scope of practice.

Tort

A civil wrong, such as defamation of character or invasion of privacy, that is not within the jurisdiction of criminal courts.

Abandonment

The unilateral termination of care by an EMT without the patient's consent and without transferring care to a provider of equal or higher competence.

Assault

Unlawfully placing a person in fear of immediate bodily harm, such as threatening to restrain a patient against their will.

Battery

Unlawfully touching a person, which includes providing emergency medical care or physical interventions without consent.

False imprisonment

The unauthorized confinement of a person that lasts for an appreciable period, such as refusing to let a patient out of an ambulance after they rescind consent.

Defamation

The communication of false information that damages a person's reputation; includes libel (written) and slander (spoken).

Good Samaritan laws

Statutes protecting individuals from liability for errors and omissions made while giving good-faith emergency care while off duty.

Gross negligence

Conduct that constitutes a willful or reckless disregard for a duty or a standard of care.

NEMSIS

The National EMS Information System; a database used to collect, store, and share standardized EMS data across the United States.

Discovery

The phase of a lawsuit where both sides obtain information through interrogatories (written questions) and depositions (oral questions under oath).

Ethics

A person's moral philosophy of right and wrong, and of ideal professional behavior; often referred to as the study of morality.

Applied ethics

The manner in which principles of ethics are incorporated into professional conduct.

Statute of limitations

The specific period of time within which a legal claim must be initiated.

Consent and Decision-Making

Consent is the permission granted by a patient for medical treatment. It is essential in decision-making as it reflects the patient's autonomy and capacity to make informed choices regarding their health care.

Express Consent vs. Implied Consent vs. Involuntary Consent

Express consent is when a patient explicitly agrees to treatment, either verbally or nonverbally. Implied consent assumes that an unconscious or incapable person would consent to necessary care. Involuntary consent is obtained from a guardian or conservator for patients unable to give consent due to mental illness or crisis.

Consent by Minors for Treatment or Transport

Minors may provide consent under certain doctrines, such as the mature minor doctrine, which allows them to make decisions for themselves in specific medical situations, or in cases where they are emancipated minors.

Conditions for Using Patient Restraints

Patient restraints may be indicated when a patient is combative and poses a significant risk of harm to themselves, rescuers, or others. Proper protocol requires that restraints are used only when necessary and proportional to the situation.

EMT’s Role When Patient Refuses Treatment

When a patient refuses treatment or transport, the EMT has the obligation to inform the patient of the risks associated with refusal, ensure they understand their decision, and document the refusal appropriately.

Patient Communication and HIPAA

The relationship emphasizes that patient communications are confidential and protected under HIPAA, which ensures sensitive health information is kept secure and not disclosed without consent.

Importance of Do Not Attempt Resuscitation (DNAR) Orders

DNAR orders provide clear instructions not to resuscitate a patient, respecting their wishes in end-of-life situations. EMS protocols must acknowledge and follow these orders to comply with legal and ethical standards.

Signs of Death

Presumptive signs of death may include unresponsiveness and absence of pulse, while definitive signs include rigor mortis, putrefaction, and dependent lividity.

Caring for Organ Donors

EMTs should ensure that organ donors receive proper care and support while preserving organ function until surgical teams can take over.

Medical Identification Devices Importance

Medical identification devices provide critical information about a patient’s health conditions or allergies, guiding EMTs in providing quick and accurate treatment.

Scope of Practice and Standards of Care

Scope of practice defines the level of medical services an EMT is authorized to perform, while standards of care pertain to how they are expected to perform those services based on reasonable and prudent practices.

EMT’s Legal Duty to Act

The EMT has a legal obligation to provide care once treatment is initiated, which arises from statutory laws and department policies.

Legal Issues for EMTs: Negligence and More

Negligence involves failing to provide adequate care, while abandonment refers to stopping care without patient consent. Assault and battery involve unlawful actions against a patient, and kidnapping can occur when a patient is detained unlawfully.

Reporting Requirements for Special Situations

EMTs must report specific situations, including suspected abuse, drug-related injuries, and crimes, as part of their legal obligations to ensure patient safety and public health.