EMT Ch. 3- Medical, Legal, & Ethical Issues

factors to be considered when determining a pt’s decision-making capacity

• impaired by mental limitations/dementia

• legal age (18+)

• impaired by alcohol/drugs or serious injury/illness

• experiencing significant pain

• significant injury distracting from more serious injury

• apparent hearing/vision problems

• language barriers present

• appearing to understand info given to them

expressed/actual consent

type of consent given when pt specifically acknowledges they want care/transport; may be verbal/nonverbal

informed consent

makes consent valid; consent given after nature of treatment is explained with potential risks, benefits, & alternatives to treatment; valid if given verbally

implied consent

legal principle that allows consent when pt is intoxicated, mentally impaired; used only when pt is incapable of making a rational, informed decision about care & unable to give consent

involuntary consent

pt has no decision in care/transport; applies pts who are mentally ill, developmentally delayed, in behavioral crisis

emancipated minors

minors who are

• married

• members of armed services

• parents

• living independently

in loco parentis

“in position/place of parents”; usually occurring in schools/camps where parents are not present

protected health info (PHI)

medical & any info that can be used to identify pt

DNRs must have

• clear statement of pt’s medical problem(s)

• signature of pt/legal guardian & physicians/providers

• possibly an expiration date (12 months)

Physician Orders for Life-Sustaining Treatment (POLST) & Medical Orders for Life-Sustaining Treatment (MOLST)

explicitly describe acceptable interventions for pt; must be signed by authorized provider; contact medical control for guidance

presumptive signs of death

• unresponsiveness to painful stimuli

• lack of carotid pulse/heartbeat

• absence of chest rise/fall

• no deep tendon/corneal reflexes

• absence of pupillary reactivity

• no systolic blood pressure

• profound cyanosis

• lowered/decreased body temperature

definitive signs of death

• obvious mortal damage

• dependent lividity

• rigor mortis

• algor mortis

• putrefaction

dependent lividity

blood settling to the lowest point of body; causes discoloration of skin

rigor mortis

stiffening of body muscles occurring between 2-12 hours after death; develops top down; depends on rate of heat loss

algor mortis

cooling of dead body until it matches ambient temperature

putrefaction

decomposition; depending on temperature conditions, may occur between 40-90 hours after death

notify medical examiner if:

• person is DOA

• death without previous medical care or unable to state COD

• suicide

• violent death

• suspected/known poisoning

• resulting from unintentional injuries

• suspicion of criminal act

• infant/child deaths

standard of care

manner in which an EMT must act/behave; established by local customs, statutes, ordinances, protocols, medical literature/textbooks, administrative regulations, & case law

negligence

failure to provide same level of care another with similar training would provide

determination of negligence

1. duty- obligation to provide consistent care

2. breach of duty- does not act within expected/reasonable standard of care

3. damages- physical/psychological harm on pt

4. causation- reasonable cause/effect relationship between breach of duty & damages suffered by pt

all four must be present for a lawsuit to occur

res ipsa loquitur

EMT is held liable for damages even when plaintiff is unable to clearly demonstrate how injuries were obtained

negligence per se

should have done ___ but didn’t

torts

civil wrongs

abandonment

unilateral termination of care without pt’s consent or provisions for continuing care

assault

verbal threat of immediate bodily harm

battery

physical; unlawful touching of another person

defamation

any communication of false information that damages the reputation of a person

libel

written defamation

slander

spoken defamation

to be protected by Good Samaritan Laws:

1. you acted in good faith in rendering care

2. you rendered care w/o expectation of compensation

3. you acted within scope of training

4. you did not act in grossly negligent manner

gross negligence

conduct that constitutes a willful/reckless disregard for duty/standard of care

general rules regarding reports & records:

• if an action or procedure is not recorded on the written report, it was not performed

• an incomplete/untidy report is evidence of incomplete/incompetent medical care

requires special mandatory reporting

• abuse of children, elderly, & others

• injury during commission of a felony

• drug-related injuries

• childbirth

possibly requires mandatory reporting

• burns in children under a certain age

• attempted suicide

• dog bites

• exposure to certain communicable diseases

• domestic violence

• sexual assault/rape

statute of limitations

time within which a claim must be initiated

contributory negligence

legal defense that may be raised when defendant thinks the conduct of the plaintiff somehow contributed to any injuries/damages sustained by plaintiff

Which of the following scenarios is an example of informed consent?

An EMT advises a patient of the risks of receiving treatment

You arrive at the scene of a motor vehicle-versus-pedestrian accident. The patient, a 13-year-old male, is unconscious & has multiple injuries. As you are treating the child, a law enforcement officer advises you that the child's parents will be at the scene in approximately 15 minutes. What should you do?

Transport the child immediately & have the parents meet you at the hospital

You suspect that a 6-year-old girl has broken her leg after falling from a swing at a playground. Shortly after you arrive, the child's mother appears & refuses to allow you to continue treatment. You should:

try to persuade the mother that treatment is needed

Which of the following most accurately defines negligence?

Deviation from the standard of care that might result in further injury

Maintaining the chain of evidence at the scene of a crime should include:

not cutting through holes in clothing that were caused by weapons