Exam 1: Patient refusal/transport, HIPAA, Ethics/Morality, Negligence/Abandonment/Assault, Consent

Patient Refusal of Treatment/Transport

Patients have the right to refuse if they have:

• Decision-making capacity

• Are of legal age (usually 18)

• Understand the risks

• Can communicate a decision

This right is called:

Autonomy

Before Accepting a Refusal

You must determine the patient has decision-making capacity.

The patient must be able to:

• Understand information

• Process information

• Make an informed decision

• Communicate that decision

Assess Capacity

Ask yourself:

• Is the patient intoxicated?

• Is the patient alert?

• Is the patient confused?

• Is there severe pain?

• Is there a language barrier?

• Does the patient understand what I'm explaining?

• Is the patient asking logical questions?

• Is the patient oriented?

Explain

The patient must understand:

• Condition

• Risks

• Benefits

• Alternatives

• Consequences of refusing

This is called:

Informed refusal

Documentation

Always document:

• Assessment findings

• Decision-making capacity

• Risks explained

• Benefits explained

• Alternatives discussed

• Patient responses

• Medical direction consultation

• Patient signature

• Witness signature

If You're Unsure

Contact:

Medical direction

Remember:

When in doubt, treating is generally safer than not treating.

HIPAA

HIPAA =

Health Insurance Portability and Accountability Act

Purpose:

Protects:

Protected Health Information (PHI)

PHI Includes

Anything identifying the patient:

• Name

• Address

• Birthday

• Photos

• Medical history

• Assessment

• Treatment

• Reports

May Share PHI For

• Treatment

• Payment

• Health care operations

Never

• Post on social media

• Discuss with friends

• Leave reports lying around

• Photograph patients with personal phone

Recording Fact

The public may legally record EMS in public.

EMTs usually cannot force people to stop recording.

Ethics vs Morality

Ethics

Professional standards of right and wrong.

Guide EMT behavior.

Morality

Personal beliefs about right and wrong.

As an EMT

Professional ethics come before personal opinions.

Applied Ethics

Applying ethical principles while caring for patients.

Ethical Decision Checklist

Ask:

• Is this best for the patient?

• Is my decision logical?

• Does it respect patient rights?

• Would another EMT agree?

• Can I defend this decision?

Negligence

Failure to provide expected standard of care causing harm.

Four Elements of Negligence

All four must exist.

Duty

You had a responsibility to care.

Breach of Duty

You failed to meet the standard.

Damages

Patient was harmed.

Causation

Your actions caused the injury.

Gross Negligence

Reckless disregard for patient safety.

Much more serious.

Negligence Per Se

Violation of a law automatically establishes negligence.

 Abandonment

Stopping care without patient consent before transferring care to an equal or higher provider.

Examples:

• Leaving patient

• No hospital report

• Walking away

Avoid by:

• Giving verbal report

• Proper transfer of care

Assault

Definition:

Threatening unwanted touching.

No physical contact needed.

Example:

Threatening to restrain someone.

 Battery

Touching or treating without consent.

Examples:

• Splinting after refusal

• Giving medication after refusal

• Transporting against patient's wishes

Expressed Consent

Patient gives permission.

Can be:

Verbal

"Yes."

Nonverbal

Nods.
Holds out arm.

Informed Consent

Patient understands:

• Risks

• Benefits

• Alternatives

• Consequences

Implied Consent

Patient cannot consent because:

• Unconscious

• Altered mental status

• Cardiac arrest

• Serious emergency

Law assumes they would consent.

Also called:

Emergency Doctrine

Involuntary Consent

Patient legally cannot decide because of:

• Mental illness

• Psychiatric emergency

• Developmental disability

Guardian or legal authority may consent.

Decision-Making Capacity

Medical determination.

EMT assesses it.

Competence

Legal determination.

Court decides.

Autonomy

Patient's legal right to make healthcare decisions.

Surrogate Decision Maker

May decide when patient cannot.

Examples:

• Spouse

• Parent

• Guardian

• Health care proxy

Duty to Act

Legal obligation to provide care.

Scope of Practice

What you're legally allowed to do.

Standard of Care

How well you're expected to perform.

Confidentiality

Keeping patient information private.

PHI

Protected Health Information.

Autonomy

Patient chooses own medical care.