Chapter 4 - Medical, Legal, and Ethical Issues

Scope of Practice

Set of regulations and ethical considerations that define the extent of and limits of an EMTs job

Standard of Care

Defined as the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation

Expressed Consent

consent given by patients who are of legal age and are mentally competent to make a rational decision with regard to their medical well-being

in loco parentis

a person who may give consent for care of a child when a parent is not present or able to give consent

implied consent

Consent that is presumed in cases when a patient is unable to make their own medical decisions due to things such as level of consciousness or in the event a parent is unable to be reached when care for a child is needed.

Reasons a person may be transported against their will

Court Orders or poses a threat of harm to themselves or others

Reasons patients refuse care

Denial, fear, failure to understand the seriousness of the situation, intoxication, and many other reasons

Factors needed for patients to refuse care/transport

able to legally consent, A&Ox4, and must be fully informed

Liability

able to be held legally responsible

When convincing a patient to be transported, you should…

talk with the patient, listen carefully to determine reason of refusal, inform the patients of the consequences of refusal of care/transport, consult medical direction, and call law enforcement if necessary

If a patient refuses transport, you should…

have them sign the refusal form used by your agency, document all attempts made and witnesses, let patient know that they can call back at any time, and may recommend to call someone to stay with them in case problems occur

Assault

Placing a person in fear of bodily harm

Battery

Causing bodily harm to or restraining a person

DNR

Legal document, which is signed by patient and their physician, that states that the patient has a terminal illness and does not wish to prolong life through resuscative efforts

Advance directive

A DNR order; instructions written in advance of an event

POLST

Physician’s Order for Life-Sustaining Treatment; states patient’s wishes regarding resuscitation attempts, artificial nutrition administration, and other medical interventions.

Medical proxy

A person whom the signer of the document names to make health care decisions in case the signer is unable to make those decisions

negligence

Finding that an EMT had a failure to act properly, did not meet standard of care, and that harm was caused to the patient as a result

Tort

a civil offense; an action or injury caused by negligence from which a lawsuit may arise

res ipsa loquitur

“Thing speaks for itself”; foundational concept in negligence as it allows a finding of negligence even when there is not specific evidence for a negligent act

Two most common and significant causes of lawsuits against EMTs

Refusal and ambulance collisions

abandonment

leaving a patient after has been initiated and before the patient has been transferred to someone with equal or greater medical training

morals

personal standards or principals of right and wrong

ethics

social system or social or professional expectations for applying principals for right or wrong

Good Samaritan Laws

A series of laws, varying by state, designed to provide limited legal protection for citizens and some health care personnel when they are administering emergency care.

confidentiality

Obligation not to reveal information obtained about a patient except to other health care professionals involved in the patient’s care or subpoena or in a court of law or when the patient has signed a release of confidentiality

Duty to Act

Certain situations in which EMTs have an obligation to provide emergency care

HIPAA

Health Insurance Portability and Accountability Act; protects the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed

Libel

False or injurious information in written form

Slander

False or injurious information stated verbally

Medical Identification Devices

a device that provides information about certain medical information or health conditions; may even be a tattoo, necklace, bracelet, or a card

File/Vile of Life

Stored in a patient’s residents and often used for senior citizens, it allows medical professionals to locate important medical information

Organ Donor

A person who has completed a legal document that allows for donation of organs and tissues in the event of death; often found on licenses and state IDs

Safe Haven Laws

A law that permits a person to drop off an infant or child at a police, fire, or EMS station or to deliver the infant/child to any available public safety personnel.

Crime scene

Location where a crime has been committed or any place that evidence relation to a crime may be found

Does care of a patient differ if they are or aren’t an organ donor?

No.

What should an EMT’s first priority be when on a crime scene?

Patient care

Things that should be taken note of or preserved when at the scene of a crime

Condition of scene, the patient (incl. clothes), finger and footprints, and microscopic evidence

Actions that will be helpful to police when at a crime scene

Remember what you touch, minimize impact on the scene, and work with the police

Incidents that may require reporting

Abuse, suspicion of human trafficking, violence (ex. GSWs, stabbings, or SA). Note that you may have to notify law enforcement for cases in which restraint may be necessary, an intoxicated person is found with injuries, or a mentally incompetent person has been injured.

Other ethical responsibilities are…

Honest reporting, refrain from actions that may cause harm to a patient, working to help the patient, respecting the rights of others treating all patients fairly, assisting others (as appropriate) to learn our profession, reporting misconduct, and making sure that research is approved by the appropriate authorities