Ch. 3: Medical, Legal, and Ethical Issues

Types of advanced directives.

1. Living will

2. Durable health care power of attorney (DHCPOA)

3. DNR

4. Physician orders for life-sustaining treatment (POLST)

When is a DNR invalid?

1. Accidental or suspicious death

2. Unnatural death

3. Patient is pregnant

Signs that resuscitation is not necessary/possible.

Decapitation, dead for long period of time, injury incompatible with life

What is an EMT required to report to PD?

1. Criminal conduct

2. Child/elder/spousal abuse

3. Anything EMS moves in potential crime scene to provide medical care

When can you treat a patient whose guardian isn’t present, and under what type of consent?

1. Child: Emancipated, armed forces, living apart from parents, wanting treatment for infectious disease, unwed/pregnant and want to be treated for pregnancy issues (but not abortion), drug problem/seeking shelter from violence

2. For child: Parent, grandparent, adult sibling, adult aunt/uncle, any adult with written auth (like field trip teacher)

Patient cannot consent if…

Patient is danger to themselves, patient is under arrest or protective custody, or involuntary consent

How do you evaluate mental capacity?

Based on orientation (name/age/location/time), decision making (cognition/judgement), and AVPU.

Special considerations when entering a crime scene.

1. Scene safety

2. Your job is patient care

3. Preserve evidence as much as possible

How to prove negligence.

Duty to act, breach of duty, noted injury/damage to patient, proximate cause of injury/damage

Good Samaritan law

protects off-duty EMT when providing emergency care unless there is gross negligence or you’re the cause of injury

Scope of practice

defines actions and care that an EMT can perform per state

Standard of care

care expected from any EMT with similar training

False imprisonment/kidnapping

transporting patients against their will (need PD if under influence or a minor)

Abandonment

failure to provide care to patient once contact has been initiated

Assault

any verbal threat that would cause serious fear/harm if acted on

Battery

touching someone without their consent, even if you believe action is necessary

HIPPA

Health insurance portability and accountability act

Living will

patient has health issues at time of death, and signals what long-term life support they want

Durable health care power of attorney (DHCPOA)

designates a person to make medical decisions if the signer becomes unable to do so

DNR

must be original/copy/bracelet/necklace, must be with patient, must be signed by a physician. Can do all aspects of life-saving care except for when pulseless/apneic. Can only be revoked by patient/guardian/physician.

Physician orders for life-sustaining treatment (POLST)

allows terminal patient to choose/refuse specific life-sustaining treatments

Libel

injury to a person’s character by false/malicious writing

Slander

injury to a person’s character by false/malicious speech

Informed consent

tell patient potential care, any risks/consequences. Patient needs to have understanding and rational decision making

Expressed consent

patient is conscious, informed, and have decision making capacity. Basically we approach them as EMS and they take our help.

Implied consent

Emergency doctrine; patient unresponsive/altered or is a child.

Involuntary consent

third party (family/PD) gives consent. Patient must be competent or in custody

Right to consent/refuse

patient is informed, have legal capacity, and have rational decision capacity; patient has to sign and need witness signatures

Nonfeasance

negligence; failure to perform required act or duty

Misfeasance

simple negligence; performance of legal act in harmful manner

Malfeasance

gross negligence; performance of a wrongful act

Duty to act

formal legal obligation to provide care

Breach of duty

deviation from standard of care

Noted injury/damage to patient

cannot be trivial, must be real/provable by law

Proximate cause of the injury/damage

the action of the medic caused the damages, and breach of duty led to this