Chapter 4, Legal and Ethical Considerations of Providing Care, Wednesday, May 27th

Introduction

• Understanding medical, legal, and ethical issues is an essential foundation for all emergency care.

• You will learn information to reduce or prevent the legal liability you may face as a result of calls. 

  • Lawsuits are commonplace (providers are RARELY sued)

    • Much of EMS work takes place in the public eye

    • Choices and actions influence risk of being sued

    • Know how the law affects EMS providers

Scope of Practice

• The collective set of regulations and ethical considerations that define the extent and limits of an EMT’s job.

  • Defined by 

    • national standards

    • state legislation

    • medical direction

  • Communicated in protocols, standing orders

  • Rules and guidelines differ from state to state and region to region.

Adult and Pediatric Scope of Practice

Airway Respiratory Management

1. Oxygen AdministrationWhat it is:

Providing supplemental oxygen via nasal cannula or non-rebreather mask.

When to use:

• Shortness of breath

• Asthma

• COPD exacerbation

• Pneumonia

• Pulmonary edema

• Chest pain with hypoxia

• Trauma with low oxygen saturation

• Carbon monoxide exposure

Signs you should act:

• SpO₂ < 94% (or per protocol)

• Cyanosis

• Increased work of breathing

• Altered mental status from hypoxia

Example:

70-year-old with pneumonia:

• RR 32

• SpO₂ 87%

→ Administer oxygen immediately.

---

2. Pulse OximetryWhat it is:

Measures oxygen saturation.

When to use:

Almost every respiratory complaint.

Example:

Patient says:

"I feel fine."

But pulse ox shows:

• SpO₂ = 82%

This tells you the patient is actually hypoxic.

---

3. Nasopharyngeal Airway (NPA)What it is:

Soft rubber tube inserted through the nose.

Purpose:

Keeps airway open.

Use when:

Patient has:

• Decreased LOC

• Intact gag reflex

Example:

Overdose patient:

• Breathing spontaneously

• Semi-conscious

• Gag reflex present

→ NPA is appropriate.

Do NOT use if:

• Severe facial trauma

• Suspected basilar skull fracture

---

4. Oropharyngeal Airway (OPA)What it is:

Rigid airway inserted into mouth.

Purpose:

Prevents tongue from blocking airway.

Use when:

Patient:

• Unresponsive

• No gag reflex

Example:

Cardiac arrest patient

• Unresponsive

• No gag

→ Insert OPA.

Never use:

Awake patient.

They will gag and potentially vomit.

---

5. Oral SuctioningPurpose:

Removes secretions, blood, vomit.

Use when:

Airway is obstructed by:

• Vomit

• Blood

• Secretions

Example:

Seizure patient with vomit in airway.

Suction first before ventilation.

Airway always comes before oxygen.

---

6. BVM (Bag-Valve Mask)What it is:

Provides positive pressure ventilations.

Use when:

Patient is not breathing adequately.

Signs:

Adult:

• RR < 8

• RR > 30 with poor tidal volume

Child:

• Severe respiratory failure

Example:

Opioid overdose:

• RR 4

• Cyanotic

→ Begin BVM ventilations immediately.

---

7. CPAPPurpose:

Pushes air into lungs using continuous pressure.

Best for:

• CHF/Pulmonary edema

• COPD exacerbation

• Severe respiratory distress

Patient must:

• Be awake

• Follow commands

• Maintain own airway

Example:

CHF patient:

• Pink frothy sputum

• Crackles

• SpO₂ 84%

→ CPAP can dramatically improve oxygenation.

Do NOT use:

• Vomiting patient

• Unconscious patient

• Significant hypotension

---

8. Nebulized AlbuterolPurpose:

Bronchodilator

Opens constricted airways.Use for:

• Asthma

• Wheezing

• COPD

Example:

16-year-old asthma patient:

• Audible wheezing

• Difficulty speaking

→ Nebulized albuterol.

---

9. Supraglottic Airway (EMT Assist)Purpose:

Advanced airway placed above vocal cords.

Usually placed by ALS.

EMT may assist.

Use when:

• Cardiac arrest

• Severe airway compromise

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Airway Decision Making

Think:

Is the airway open?

No:

• Jaw thrust

• Head tilt chin lift

• OPA/NPA

Is the airway dirty?

Yes:

• Suction

Is the patient oxygenating?

No:

• Oxygen

• CPAP

• BVM

Is the patient ventilating?

No:

• BVM immediately

Cardiac management

1. CPRUse when:

Patient:

• Unresponsive

• Not breathing normally

• Pulseless

Example:

You find:

• No pulse

• Agonal respirations

→ Start CPR immediately.

---

2. AEDPurpose:

Detects shockable rhythms.

Use:

Any cardiac arrest patient.

Example:

Patient collapses at mall.

• No pulse

• Not breathing

→ CPR
→ Attach AED ASAP

Follow prompts.

---

3. Temperature ManagementPurpose:

Prevent worsening injury.

Hyperthermia

Use:

• Cooling measures

Examples:

• Heat stroke

Hypothermia

Use:

• Blankets

• Warm environment

Examples:

• Cold-water drowning

---

4. 3-Lead ECG (Assist)Purpose:

Continuous cardiac monitoring.

Use:

• Chest pain

• Palpitations

• Syncope

Allows ALS to watch rhythm continuously.

---

5. 12-Lead ECG (Assist/Acquire)Purpose:

Detect STEMI.

Use:

Chest pain patients.

Example:

55-year-old:

• Crushing chest pain

• Diaphoresis

Acquire 12-lead early.

---

Cardiac Medications (AEMT Section)

Even if you're currently studying EMT, you'll likely be tested on these.

---

AspirinWhy:

Stops platelets from forming larger clots.

Use:

Suspected heart attack.

Example:

Patient:

• Crushing chest pain

• Pressure radiating to arm

→ Give aspirin if protocol allows.

Do NOT give:

• Allergy

• Active bleeding

---

NitroglycerinWhy:

Dilates coronary arteries.

Use:

Chest pain from suspected ACS.

Requirements:

• Adequate blood pressure

• Prescribed medication

Example:

Chest pain patient:
BP 150/90

→ Assist with nitro.

Avoid if:

BP low.

---

EpinephrineWhy:

Raises blood pressure and opens airways.

Use:

Anaphylaxis.

Example:

Bee sting:

• Wheezing

• Hives

• Swollen tongue

→ Epi immediately.

---

Naloxone (Narcan)Why:

Reverses opioid overdose.

Use:

Respiratory depression from opioids.

Example:

Patient:

• RR 4

• Pinpoint pupils

First:

• BVM

Then:

• Naloxone

Airway and breathing come first.

---

AlbuterolWhy:

Bronchodilator.

Use:

Asthma
COPD
Bronchospasm

Example:

Patient with wheezing and respiratory distress.

---

DextroseWhy:

Raises blood sugar.

Use:

Symptomatic hypoglycemia.

Example:

Diabetic patient:

• Altered mental status

• BGL = 35

→ Dextrose.

---

GlucagonUse:

Hypoglycemia when IV unavailable.

---

Ondansetron (Zofran)Use:

Nausea and vomiting.

Example:

Patient continuously vomiting and becoming dehydrated.

---

EMT Exam Tip

For almost every emergency, think:

1. Airway

• Open?

• Obstructed?

2. Breathing

• Oxygenating?

• Ventilating?

3. Circulation

• Pulse?

• Bleeding?

• Perfusion?

4. Determine the cause

• Asthma → Albuterol

• Opioid overdose → Narcan

• Anaphylaxis → Epinephrine

• ACS → Aspirin/Nitro

• Cardiac arrest → CPR + AED

Routes of Access/Medication Administration

1. Auto InjectorWhat it is

A preloaded device that automatically injects medication.

Examples:

• Epinephrine auto-injector (EpiPen)

• DuoDote (special situations)

---

When EMTs use itAnaphylaxis

Patient has:

• Trouble breathing

• Wheezing

• Swollen tongue/lips

• Hives

• Low blood pressure

Example

Patient stung by bee:

• Respiratory distress

• Swollen airway

• Stridor

→ Use EpiPen IM through outer thigh.

Why?

Epinephrine:

• Opens airways

• Raises blood pressure

• Reduces swelling

---

2. InhalationWhat it is

Medication breathed directly into lungs.

Examples:

• Albuterol inhaler (MDI)

• Nebulized albuterol

---

When to useAsthma

Patient:

• Wheezing

• Tight chest

• Difficulty breathing

COPD

Patient:

• Wheezing

• Respiratory distress

---

Example

16-year-old asthma patient:

• Audible wheezing

• Speaking 2–3 words at a time

→ Assist with inhaler or nebulizer.

Why?

Gets medication directly into lungs quickly.

---

3. Intramuscular (IM)What it is

Medication injected into muscle.

Common site:

• Lateral thigh

---

When EMTs encounter itEpinephrine

Most common EMT IM medication.

Example

Patient with anaphylaxis.

→ Epi IM into thigh.

---

Why IM?

Muscle has excellent blood supply.

Medication works rapidly.

---

4. Oral (PO)What it is

Medication swallowed.

---

Common EMT examplesAspirin

Chest pain / suspected heart attack.

Glucose

Conscious diabetic patient.

---

Example

65-year-old:

• Crushing chest pain

• Alert and able to swallow

→ Give aspirin per protocol.

---

Do NOT give PO medication if:

• Unconscious

• Vomiting

• Cannot swallow safely

---

5. Intranasal (IN)What it is

Medication sprayed into the nose.

Absorbed through nasal mucosa.

---

Common EMT medicationNaloxone (Narcan)

---

When to use

Patient:

• Opioid overdose

• Respiratory depression

• Pinpoint pupils

---

Example

Patient found unconscious.

• RR 4

• Pinpoint pupils

First:

• Open airway

• BVM ventilate

Then:

• Administer Narcan IN.

---

Why IN?

• Fast

• Needle-free

• Easy to administer

---

6. Sublingual (SL)What it is

Medication placed under tongue.

---

Common EMT medicationNitroglycerin

---

When to use

Suspected acute coronary syndrome.

Patient:

• Chest pressure

• Crushing chest pain

---

Example

55-year-old male:

• Chest pain radiating to jaw

• BP 160/90

→ Assist with prescribed nitroglycerin.

---

Why under tongue?

Very rapid absorption.

Avoids digestive tract.

---

Do NOT use if:

• Hypotension

• Recent erectile dysfunction medication use (per protocol)

• Altered mental status

---

7. Rectal Administration

Mostly seen in pediatrics.

---

Example

Rectal diazepam for seizures.

EMTs may assist in some systems.

---

Scenario

Child actively seizing.

Caregiver has prescribed rectal medication.

→ Assist according to protocol.

---

Advanced Routes You'll See on Exams

Even though EMTs don't typically perform these, you should recognize them.

---

8. Intravenous (IV)What it is

Medication directly into a vein.

---

Why use it?

Fast medication delivery.

Immediate bloodstream access.

---

Common uses

• Dextrose

• Fluids

• Cardiac medications

• Pain medications

---

Example

Hypoglycemic patient:

• BGL = 25

AEMT/Paramedic:

→ IV Dextrose.

---

9. Intraosseous (IO)What it is

Needle placed into bone marrow.

Usually:

• Tibia

• Humerus

---

When used

Cannot obtain IV access.

Patient critically ill.

---

Example

Cardiac arrest patient.

No veins visible.

→ Establish IO access.

---

Why?

Bone marrow connects directly to vascular system.

Functions almost like an IV.

---

10. Peripheral Venous AccessWhat it is

Standard IV placement.

Common locations:

• Hand

• Forearm

• AC (antecubital vein)

---

When used

• Trauma

• Shock

• Cardiac emergencies

• Severe dehydration

---

11. Blood ProductsWhat it is

Administration of:

• Whole blood

• Packed red blood cells

• Plasma

---

When used

Massive hemorrhage.

---

Example

Motor vehicle crash.

Patient:

• BP 70/40

• Severe bleeding

ALS/critical care may administer blood products.

---

Putting It Together: EMT Scenario ThinkingChest Pain

Patient:

• Crushing chest pain

• Alert

Routes:

• PO → Aspirin

• SL → Nitroglycerin (assist)

---

Asthma Attack

Patient:

• Wheezing

• Respiratory distress

Routes:

• Inhalation → Albuterol

---

Anaphylaxis

Patient:

• Airway swelling

• Wheezing

• Hypotension

Routes:

• Auto-injector

• IM Epinephrine

---

Opioid Overdose

Patient:

• RR 4

• Pinpoint pupils

Routes:

• IN Naloxone

---

Diabetic Emergency

Patient:

• Low blood sugar

• Conscious

Route:

• Oral glucose

If unconscious:

• IV Dextrose (AEMT/Paramedic)

• IM/IN options depending on protocol

---

Quick EMT Exam Memory Table

Route	Medication	Typical Scenario
Oral (PO)	Aspirin, Glucose	Chest pain, hypoglycemia
Sublingual (SL)	Nitroglycerin	Suspected heart attack
Intranasal (IN)	Naloxone	Opioid overdose
Inhalation	Albuterol	Asthma/COPD
IM	Epinephrine	Anaphylaxis
Auto-Injector	Epinephrine	Severe allergic reaction
IV	Dextrose, fluids	Shock, hypoglycemia
IO	Emergency medications	Cardiac arrest/no IV access
Blood Products	Blood transfusion	Massive hemorrhage

Standard of Care

• Standards of care is the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation

• What EMTs should, and are expected to do, do 

• Prudent person criterion - public is going to expect you to do things as an EMT; provide care and get them to hospital for example

• Defined stakeholders

• Communicated in protocols, standing orders

• To be an effective EMT, you must maintain your skills and knowledge as well as participate in quality improvement

Exception Principle of the protocols

The Exception Principle allows EMTs to safely bend standard treatment rules in rare, unanticipated clinical situations. Because no rulebook can predict every medical emergency, it gives providers permission to do what is best for the patient’s immediate survival, provided they stay within their legal training and call a doctor first. [1, 2]

Here is exactly how the Exception Principle works, broken down step-by-step:

1. The "Rule-Bending" Rule

Standard protocols act as a step-by-step "recipe" for treating common emergencies. The Exception Principle acknowledges that sometimes a patient has a unique, unpredictable condition where following the standard recipe might actually cause harm. [1, 2, 3, 4]

2. The Four Strict Conditions

You cannot simply use the Exception Principle to do whatever you want. It only applies if all of the following conditions are met: [1, 2]

• The patient's life is in immediate danger and standard care isn't working.

• The action you want to take is within your legal training level (e.g., an EMT basic cannot suddenly perform a paramedic-level surgery).

• You must get approval from Medical Control (a doctor you speak with over the radio or phone) before making the move.

• It is used for a single specific patient, not as a permanent shortcut to bypass standard paperwork or operational rules. [1, 2, 3, 4, 5]

3. Why It Exists

It essentially acts as a legal safety net. It protects the EMT and Medical Control doctor when they step outside the standard box to perform a life-saving intervention for a uniquely complex emergency. [1, 2]

4. What Happens After

After the emergency is over, the provider must file highly detailed paperwork. They have to document exactly what they did, why they did it, and the verbal approval they got from the doctor

Here is a realistic scenario where an Advanced EMT (AEMT) would use the Exception Principle:

The Situation

An AEMT is called to a remote hiking trail for a 50-year-old male experiencing an extreme, life-threatening asthma attack. Standard treatment protocols dictate giving the patient inhaled nebulizer medications (like albuterol) and a continuous flow of oxygen.

The Problem

The patient’s airways are completely closed up. Because no air is moving in or out of his lungs, the inhaled nebulizer medication cannot actually reach his airways to work. He is rapidly losing consciousness from a lack of oxygen.

The Protocol Conflict

The standard protocol for this specific medical service states that only Paramedics—not AEMTs—are allowed to inject epinephrine intramuscularly (an EpiPen-style shot) for severe asthma. The AEMT is fully trained and certified to inject epinephrine, but their local protocol restricts them from doing it for asthma (it is normally reserved for severe allergic reactions).

The nearest Paramedic unit is 30 minutes away. If the AEMT waits or sticks strictly to the standard asthma protocol, the patient will experience cardiac arrest and die.

Applying the Exception Principle

1. Immediate Danger: The patient's life is at risk and standard treatment is failing.

2. Within Training: The AEMT is legally certified to give epinephrine injections.

3. Medical Control Approval: The AEMT calls the hospital doctor on the radio, explains that the patient is dying because no air is moving, and asks for an exception to give the epinephrine injection. The doctor grants verbal approval.

4. Action Taken: The AEMT gives the shot, the airways open up, and the patient's life is saved.

The Follow-Up

Once the patient is safely at the hospital, the AEMT writes a detailed narrative report. They document the patient's critical condition, the failure of the standard protocol, the exact time they received verbal permission from the doctor, and the successful outcome.

For an asthma attack or severe bronchospasm, a Massachusetts EMT's standing orders restrict them to administering inhaled bronchodilators (like Albuterol) via a nebulizer or CPAP machine. They cannot give a shot of epinephrine for asthma. [1, 2]

The rules handle epinephrine for asthma differently based on certification level:

• EMT-Basics & Advanced EMTs (AEMTs): They carry epinephrine (either an auto-injector or a "Check and Inject" syringe kit), but they are legally limited to using it for anaphylaxis. They are completely locked out of using it for standard asthma flare-ups under standing orders. [1, 2, 3, 4]

Medical Direction

EMTs are extensions of medical director

Physicals and medical director required for all EMS systems 

• Oversees all aspects of patient care

• Continuous quality improvement 

We have a medical director for the EMT and Paramedicine Programs

• Zachary Kramer, MD

There is also a state medical director, Jonathan Burstein, MD, as well as regional medical directors and affiliate hospital medical directors within a region

Medical Director Oversight

Indirect

• Respondeat-superior

• MD is responsible for EMTs actions vicariously

• This principle also applies to employers

Direct

• CQI Monitoring/Validation

• Supervision

• Protocol development

Medical director oversight is the legal and clinical safety net for Emergency Medical Technicians (EMTs). It ensures safe, standardized patient care. [1, 2, 3, 4, 5]

The specific terms in your query break down as follows:

Medical Director Oversight Categories

• Indirect Oversight: The behind-the-scenes administrative duties performed by the Medical Director, such as developing standing orders, policies, and educational requirements. [1, 2, 3, 4]

• Direct Oversight: Real-time, two-way communication between the Medical Director and the EMT, such as calling a doctor on the radio for specific treatment instructions on a live scene. [1, 2]

Legal & Employer Liability

• Respondeat Superior: A Latin legal doctrine meaning "let the master answer". It holds that employers are vicariously (indirectly) responsible for the negligent acts of their employees, provided those acts occurred within the normal scope of their job duties. [1, 2, 3]

• MD Vicarious Liability: Because EMTs practice medicine under the medical director’s license, the MD assumes responsibility for the system's clinical performance. [1, 2]

Clinical Supervision & Quality Management

• Protocol Development: The Medical Director is responsible for writing the strict, evidence-based rules, algorithms, and standing orders that dictate exactly how EMTs assess and treat patients. [1, 2]

• CQI (Continuous Quality Improvement): A structured system used to review and validate patient care. It involves auditing call reports, reviewing patient outcomes, and monitoring medical data to spot errors, improve system performance, and provide targeted training to EMTs

3 Avenues of Authority for EMTs

• LICENSING/CERTIFICATION AGENCY 

  • MA OEMS

  • NREMT

• EMPLOYMENT 

  • PUBLIC or PRIVATE

    • Union CBA

    • Rules and Regs

    • Policy Handbook

• MEDICAL DIRECTOR

  • Grants authorization to practice

Ethical Responsibilities

• Study of morals and moral choices; rules of right and wrong conduct

• Ethical issues can pose dilemmas

• EMT Code of Ethics

  • Provide care based on need without regard to nationality, race, creed, color, or religion

  • Protect patient confidentiality

  • Respect patient dignity

  • Promote high standard of care

  • Take responsibility for actions and conduct

  • Uphold standards of practice and education

Quality training promotes a high standard of care for your patients.

Core Values

• People act and decide according to values and beliefs

• Core values

  • Integrity

  • Compassion

  • Accountability

  • Responsibility

  • Empathy

Legal Aspects of Providing Care

Licensure vs Certification

Authority to Practice

Certification

• a process, often voluntary, by which individuals who have demonstrated the level of knowledge and skill required in the profession, occupation, role, or skill are identified to the public and other stakeholders

  • voluntary process;

  • by a private organization;

  • for the purpose of providing the public information on those individuals who have successfully completed the certification process (usually entailing successful completion of educational and testing requirements) and demonstrated their ability to perform their profession competently.
    

• Licensure

  • State’s grant of legal authority, pursuant to the state’s police powers, to practice a profession within a designated scope of practice

•  The use of certification is used by some states as a basis for granting individuals the right to practice

• an occupation has a statutorily or regulatorily defined scope of practice and only individuals authorized by the state can perform those functions and activities, the authorized individuals are licensed

An EMT certification validates that you have met specific educational standards and passed competency exams, usually issued by a private or national organization like the National Registry of Emergency Medical Technicians. [1, 2]

An EMT license is the mandatory, legal permission granted by a government or state authority (such as a state EMS office) that actually allows you to work and practice in the field

Duty to Act

• Implied or contractual

  • Off-duty responders generally do not have duty to act

    • However, once care is begun, a duty is created

    • Failure to continue care until patient care is transferred can result in claims of negligence or abandonment

  • A.    In certain situations an EMT has a duty to act, or an obligation to provide emergency care to a patient.

  • B.    An EMT who is on an ambulance and is dispatched to a call has a duty to act.

  • C.    If an EMT initiates care and then leaves the patient without ensuring that the patient has been turned over to someone with equal or greater medical training, this is considered abandonment.

  • D.    A duty to act is not always clear.

  • 1.     In many states, an off-duty EMT has no legal obligation to provide care.

  • 2.     If you are off-duty but begin care and then leave before other trained personnel arrive, this could still be considered abandonment.

  • Always follow local protocols and laws

Good Samaritan laws

• Intended to protect passersby from liability if they stop to render aid

• Applies to those responding in good faith and without compensation

• Prudent person standard applies

• Does not cover gross negligence

Consent

Expressed Consent

• Patient must be alert, competent adult

• Verbal, nonverbal, written

• Must determine: competence, capacity

Consent

• EMTs must have consent before treating patients

• Several forms of consent

• Patient can withdraw consent at any time

Implied Consent

• Patients who are unresponsive can be cared for on implied consent 

• Consent is assumed when someone cannot consent

• Minors - implied consent always; cannot get refusal from parents over the phone. Parents need to be seen. If minor has a baby, they are not a minor anymore (female)

• Unresponsive

• Mentally incompetent; if they can answer questions appropriately, they have the right to refuse because they are mentally competent. If they can’t answer simple questions, then they are mentally incompetent.

• Includes intoxication

• Includes law enforcement if needed 

Refusal of Care

Obtaining Patient Refusal

• Patients who refuse care

• Competent adults have the right to refuse care

• Legal guardian or parent can refuse care for dependents 

• Patients can withdraw consent; cannot be over the phone in massachusetts 

• When a patient refuses care: 

• Try to convince patient to allow care; explain risks and consequences

• Determine patients understanding of information

• Try to convince patient to allow care;explain risks and consequences

• Determine the patient's understanding of information

• If conditions of protocols are met, have patient sign a release

• If a patient refuses to sign, have a witness. 

When a patient refuses care

• CONTACT MEDICAL CONTROL FOR HIGH RISK REFUSALS

• When in doubt, on the side of treatment

• Involve law enforcement in extreme cases

• Use detailed documentation 

Additional Legal Concepts

Statue of limitations

• Amount of time after an event that legal proceedings can be initiated

Contributory negligence

• Any behavior on the patients part that may have led to the injury for which he is suing another party 

Sovereign immunity:

• Exemption from liability for government agencies 

1. Statute of Limitations

Think of this as the legal "expiration date" for your lawsuit. It is a law that sets a strict time limit (usually 2 to 3 years, depending on the state and type of case) after an event occurs to formally begin legal proceedings. If you wait too long and miss this deadline, you lose your right to sue and seek compensation. [1, 2, 3, 4]

2. Contributory (or Comparative) Negligence

This is a rule used to figure out who is to blame when both parties share some of the fault. If a patient ignores their doctor's instructions or lies about their medical history, this behavior can be used to argue the patient contributed to their own injury. In most states, your compensation is reduced by your percentage of fault. If your percentage of fault crosses a certain limit (usually 51% or more), you are completely barred from recovering any damages. [1, 2, 3, 4, 5]

3. Sovereign Immunity

This is a legal shield that largely protects government agencies (like cities, states, or federal branches) from being sued. The rule comes from the old idea that "the king can do no wrong." Today, it means the government is generally immune to lawsuits unless they have passed specific laws—such as the Federal Tort Claims Act—that waive this immunity, allowing citizens to sue under strict conditions. [1, 2, 3, 4, 5]

Advance Directives

• Legal statement of patient's wishes regarding health care

• Different types

  • Living will

  • Do not resuscitate order

  • Durable power of attorney for health care

  • Physician's orders for life-sustaining treatment

    • MOLST in MA

Negligence

• Criminal and civil laws apply to EMS providers

• Torts are civil cases based on wrongdoing by the defendant

• Negligence is an omission or neglect of reasonable care, precaution, or action
  

• Four elements necessary to prove negligence

  1. EMT had a duty to act

  2. EMT breached the duty to act by not living up to his legal obligations

  3. Patient suffered damages

  4. EMT's breach of duty was the cause of the patient's damages 

Abondement

• EMT with duty to act leaves a patient in need of care without turning care over to a person of equal or higher training

• Always formally turn over patient care with a verbal report and, usually, written patient care report

Assault and Battery

• Assault 

  • Threat of force against another person; including threatening physical contact against a patient's wishes

• Battery

  •  Carrying out the threat, including providing care a patient does not consent to

• Use of restraints

  • Can be legally risky

    • False imprisonment

    • Kidnapping

  • Use only when patient is imminent risk to self or others

  • Involve law enforcement if possible

  • Document all aspects of situation

Patient Transfers

• Emergency Medical Treatment and Active Labor Act (EMTALA)

• Issues with transporting patients and transferring care

  • Closest hospital is often best; follow protocols

  • For transfers, make sure patient's needs are in your scope of practice

  • Excellent communication needed to safely transfer care

Confidentiality and Privacy

• Health Care Insurance Portability and Accountability Act (HIPAA)

  • Restrictions on sharing patient information

• To maintain patient confidentiality, discuss your patient only with those who will be continuing patient care.

Mandated Reporting

Special Reporting Situations: State laws identify specific situations that EMS providers must report

• Issues include abuse and neglect

  • Elderly

  • Mentally handicapped

  • Children 

Lesson Summary

• Scope of practice and standard of care

• Ethical and moral obligations

• Patient confidentiality

• Legal issues

  • Duty to act

  • Advance directives

  • Assault, battery

  • Abandonment

  • Negligence

  • Organ donor status

  • Crime scenes

  • Mandatory reporting