chapter 3

Flashcards from EMS Lecture Notes

SOP

Stands for Standard Operating Procedure. Dictated by the state and established by local customs, laws, statutes, ordinances, administration, regulation within your agency, as well as case law.

Consent

Permission in order to render care. A patient has to consent to your treatment, to your touch, to what you're gonna do.

Patient Decision Capability Questions

Questions to determine if a patient is alert and oriented before they can refuse any actions; Examples include: How many quarters are in a dollar? What year is it? Who's the president? Person, place, time, and thing.

Patient Refusals

The most litigated calls in EMS realm, requiring thorough documentation to avoid lawsuits.

Emancipated Minor (North Carolina)

A minor deemed emancipated in North Carolina if they are having a child, being married, or serving in the armed forces.

Patient Impairment and Refusal

If a patient is impaired by alcohol, drugs, or a serious injury, they generally cannot refuse care unless they can prove, without a shadow of a doubt, they understand the consequences of their decisions.

What every EMS provider should tell their patient when regarding them refusing care.

You are welcome to refuse because you've answered all my questions appropriately. If you choose to do so, you are taking responsibility for your health, any potential worsening of it, that is up to and including death. Do you understand?

Importance of Advocating for the Patient

If a patient needs to go to the hospital, it's our job to advocate for them, which can shut down any argument or dispute from ALS.

Language Barrier

If you cannot understand your patient, call for an interpreter through your dispatch center, as North Carolina law requires them to keep an interpreter on the payroll 24/7.

Expressed Consent

Whenever a patient acknowledges that they want treatment, like verbally telling you, 'Please, God, help me.'

Implied Consent

Applies to patients that are unable to make an informed decision and that there is a threat to their life or a limb. Also applies to children and unconscious patients primarily.

Legal Guardian and Consent

For a child, express consent doesn't just have to be parents, can be anyone that is deemed to be their legal guardian, this can be teachers, a school nurse, a family relative. A babysitter can give permission to treat a child, but on the flip side, a babysitter can also refuse care.

Cessation of Care

At any point, care can be ceased per the patients request.

Split Parental Consent

In situations where parents are split on consent, with no definitive consent, go with your gut and prioritize the child's well-being.

Involuntary Consent

Applies to mentally ill patients in behavioral crisis, but EMS cannot involuntarily commit; law enforcement can.

Physical Restraint and Suicidal Patients

If a patient admits to you that they're going to physically harm themselves or others and they are not going to the hospital, then you are responsible, and you will be tried as such, if something were to happen.

Forcible Restraint

Consult with the hospital or medical control for additional orders to tie down a patient to cover your butt, push that off on someone that makes a lot more money as an EMT.

Restraining a Patient; when is it legal?

Restraining is only legal in certain situations, such as behaviorial or mental health crisis, or if the patient is an inminent danger to themselves and/or to others.

Prone Position

On your stomach, face down.

Supine Position

On your back, face up. How you should transport a physically restrained patient

Restraints

Once a patient has been put in restraints, they can not be removed or loosened unless there is a life-threatening reasons.

HIPAA

Health Insurance Portability and Accountability Act. Whoever you see in EMS, you keep it a secret. HIPAA covers patient history, assessment findings, treatments that were provided, and anything else that if it's disclosed, their identity could be identified.

HIPAA Disclosure

In order to disclose HIPAA, you can be put in a situation where you can disclose. They have to either verbally tell you on a scene that you can let them know, or after the fact/legal subpoena.

Good advice regarding breaching HIPAA

Your agency can also terminate you based off of social media. Please, God, don't let it get you in trouble.

Freedom of Speech

Does not protect first responders in any way, expected to be professional in all situations and held to a higher standard.

DNR

Do Not Resuscitate. It does not mean do not treat.

POST/MOST Form

Physician Orders for Life-Sustaining Treatment/Medical Orders for Life-Sustaining Treatment. Break down specifics where this patient can receive treatments in the form of yes/no.

POA Form

Power of Attorney; meaning your patient's unconscious, and the daughter, is the power of attorney, and I can prove it; now they're the ones making the medical decisions.

Overruling Advanced Directives

DNR, POST, and/or MOST can be overruled if the immediate power of attorney (Spouse) is present.

Anoxic Brain Injury Timeline

Brain damage can begin after 4-6 minutes without oxygen/circulation. 10+ minutes of downtime, it's certain brain damage. Irreversible injury by ~20 minutes.

DNR

If someone has tattooed across their chest, DNR, it doesn't matter. It has to be the legal form.

Organs besides the brain

All other organs can continue working for hours as long as CPR is being performed and a patient's being ventilated.

Medical ID Insignias

Can be a bracelet or necklace with a pendant where, when you pull it out, it has a USB flash drive.

SOP

Outlines the care that you are able to provide per your medical director. If you act out of the SOP, it is considered negligence and a criminal offense.

Call Medical Control

If you are ever in a sticky situation and you just don't know exactly how to do it.

Negligence

Whenever there is failure to provide some care that another provider with a similar training would have performed.

Negligence Per Se

An EMT knowingly acted in a clear violation of their standard of operations or that SOP.

Torts

Legal term; civil wrongs that are occurring.

Gross Negligence

The conduct that constitutes the willful or reckless disregard of a patient's health and safety and wellness.

4 Instances That Have To Be Proven To Achieve Negligence

Duty, a Breach of Duty, Damages, or Causation

Abandonment

Whenever you terminate care without the consent or a provision of future care being established.

Assault

Unlawfully placing a person in fear of immediate bodily harm is considered assault.

Batteries

Providing care without consent. Remember, don't touch who don't wanna be touched.

False Imprisonment

Whenever you lock the patient in the truck.

Defamation

Communication over a false information that damages the reputation of a person. i.e. libel, slander.

Good Samaritan Laws

With proof that you were actually trying to better their situation, you're protected by a good Samaritan laws, even if there are errors or omissions to the care. Conditions to be met: good faith without the expectation of getting paid, within your scope of practice, and you did not grossly operate in a grossly negligent manner.

Jury Records

If it wasn't documented, it never happened. If it was documented wrong, you're wrong. If it was misspelled, you're an idiot.

Breaking HIPAA Law Conditions

If there is abuse, injury during the commission of a felony, drug related injuries, childbirth, attempted suicides, dog bites, communicable diseases, assaults, DV situations, sexual assault or rape, exposure to infectious disease, transport of a patient in restraints at the scene of a crime, or the deceased.

Bioethics

The philosophy of right and wrong. It is your moral duty and ideal professional behavior of an environment.