Medical Direction, Legal and Ethical Concepts

Off-line medical direction

A physician directs training courses, helps set medical policies and procedures, and ensures quality management of EMS system so EMS can act and make medical decisions effectively without direct contact during emergencies.

On-line medical direction

A process where EMS providers receive immediate guidance and authorization from a physician via a wireless telephone or by two-way radio during an emergency response. This is used in cases where large numbers of people are injured or in cases of prolonged entrapment.

What is the purpose of Advance Directives and their role in patient care?

A document that specifies what the patient would like to be done if they’re unable to make their own medical decisions. 

Name all 3 Advance Directives

1. Living will: A written document that states the type of medical care the patient wants or wants withheld if the person becomes unable to make their own decisions. (often written when patient has a terminal condition)

2. Durable power of attorney for health care: Allows patient to designate another person to make decisions about their medical care. (representative if often a family member)

3. DNR (Do Not Resuscitate): Written request giving permission to medical personnel to withhold resuscitation in the event of cardiac arrest. (additional terms for these type of orders include MOLST and POLST)

Duty to Act

The first legal principle to consider. If you are employed by an agency that has designated you as an EMR and you are dispatched to the scene of an injury or illness. You must proceed quickly to the scene and provide emergency medical care within the limits of your training and available equipment.

Scope of practice

The specific pre-hospital healthcare services licensed providers are legally authorized to perform

Standard of care

The manner in which you must act or behave.

1. You must treat your patient to the best of your ability 

2. You must provide care that a reasonable, prudent person with similar training would provide under similar circumstances

How does the Good Samaritan Law protect providers giving care?

The law protects citizens from liability from errors or omissions in giving good faith emergency medical care.

Steps for approaching a crash scene? (Including obtaining patient consent)

1. Conduct a scene size-up: A visual overview of the incident and its surroundings. Determine the extent of the incident, estimate the number of patients, and try to locate any hazards that may be present

2. Stabilization of the scene and any hazards: Keep a lookout for hazards like infectious diseases, traffic, bystanders, spilled fuel, downed electrical wires, unstable vehicles, and vehicle fires.

3. Gain access to the patients: Try and gain access through the doors first, if this doesn’t work, try through a window

4. Initial emergency care: After you gain access, immediately begin emergency care, conduct a patient assessment on every patient, monitor the ABC’s, control bleeding, check for shock, stabilize the cervical spine, and provide emotional support. (DURING PATIENT ASSESSMENT, ASK FOR CONSENT TO TREAT).

5. Patient disentanglement: This process usually requires tools and specialized equipment to extract the patient from the vehicle.

6. Preparation for patient removal: As disentanglement proceeds, help prepare the patient for removal from the vehicle by applying dressing, bandages, and splints as needed, and keep maintaining stabilization of the head and cervical spine.

7. Patient removal: Patient is removed and placed onto stretcher of transporting ambulance.

What are the 3 different types of consent?

1. Expressed Consent: The patient verbally or non-verbally lets you know that they are willing to accept treatment.

2. Informed Consent: Permission for treatment given by a competent patient after potential risks, benefits, and alternatives have been explained.

3. Implied Consent: Assumed consent because the patient is unconscious, underage, or so badly injured that they cannot respond.

What are the 4 elements of negligence?

1. Duty to act

2. Breach of duty

3. Resulting injuries

4. Proximate cause

Ethics in EMS decision making

A moral responsibility that the community expects you to follow the established codes of what is right and wrong. Treat a patient in a manner that conforms to the accepted professional standards of conduct. That includes to stay up to date in your skills and knowledge to provide good patient care.