EMT Basics Text Book Notes Chapters 1 - 3

Chapter 1: EMS Systems

# 1. What is EMS?

EMS (Emergency Medical Services) = a team of people who respond to emergencies and get sick/hurt people the care and transport they need.

The 4 levels of EMS providers (lowest to highest training):

• EMR - (Emergency Medical Responder) | First on scene, basic life-saving care, limited equipment (~50-80 training hours).
• EMT - (Emergency Medical Technician) | Basic emergency care & transport, the "primary link" between scene and hospital (~150-200 hours).
• AEMT - (Advanced EMT) | Adds IV therapy, advanced airway, some medications (~200-400 hours)
• Paramedic - (Highest level) - heart rhythm interpretation, advanced meds, advanced airway (1,000–2,000+ hours) |

Simple rule: each level can do everything the level below it can do, plus more.

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# 2. Certification, Licensure, Credentialing (the 3 confusing C-words)

• Certification = you passed the exam proving you have the skills (usually through NREMT)
• Licensure = the STATE gives you legal permission to practice
• Credentialing = your local service/employer verifies you and lets you actually work there

Think of it like: Certification = you passed driver's ed. Licensure = the state gave you a license. Credentialing = your parents actually hand you the car keys.

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# 3. Quick History of EMS (just the highlights)

• 1966 — a report called "Accidental Death and Disability"exposed how bad emergency care was → Congress got involved
• 1970s - first official EMT textbook published ("Orange Book"), states started creating EMT training
• 1980s - more advanced skills got added (paramedics, AEMTs)
• 2019 - NHTSA updated the national guidelines (EMS Agenda 2050)

You don't need every date — just know: bad care in the 60s → government stepped in → training got standardized over time.

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# 4. Medical Direction — "Who's actually in charge of what an EMT can do?"

• Medical director = a physician who oversees your EMS service and approves what EMTs can do
• Standing orders = pre-approved instructions EMTs can follow WITHOUT calling anyone (like a recipe you already have permission to use)
• Online medical control = calling a doctor in real time for direction during a call
• Offline medical control = the training/protocols already given to you ahead of time (not real-time)

Easy way to remember: "Online" = on the phone right now. "Offline" = already-written rules you follow without calling.

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# 5. Components of the EMS System (the "big list")

Your book breaks the EMS system into pieces. Here's each one in one sentence:

• Regulation & Policy - laws/rules made at state and federal level
• Public Access - how people reach EMS (911, PSAP = public safety access point)
• Human Resources - who delivers care and how they're paid/trained
• Education Systems - how EMTs are trained and keep learning
• Public Health - preventing illness/injury before it happens (like seatbelt laws, vaccines)
• Communications - dispatchers relaying info (EMD = emergency medical dispatch)
• System Finance - how EMS gets funded (taxes, insurance billing, grants, etc.)
• Medical Direction - covered above
• Mobile Integrated Health Care (MIH) / Community Paramedicine - paramedics providing care IN the community, not just emergency transport
• EMS Research - using data/science to figure out what actually works best

You don't need to memorize this word-for-word — just recognize each term and know roughly what it means if it shows up on a question.

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# 6. Roles & Responsibilities of an EMT (short version)

- Keep equipment ready.

- Keep yourself, your partner, and the patient safe.

- Assess and treat the patient.

- Give emotional support.

- Maintain patient privacy (HIPAA!)

- Keep learning — never stop training.

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# 7. Professional Attributes (what makes a "good" EMT)

• Integrity - Honesty, always.
• Empathy - Caring about others' feelings
• Self-motivation - Solving problems without being told.
• Appearance/hygiene - Looking professional builds trust.
• Self-confidence - Knowing what you know AND knowing when to ask for help.
• Time management - Doing multiple things efficiently.
• Communication - Understanding others & being understood.
• Teamwork - Knowing your role in the group.
• Respect - Treating everyone with importance.
• Patient advocacy - Always putting the patient's needs first.
• Careful delivery of care - Paying attention to detail, staying safe.

Test tip: If a question asks "what should an EMT do in X situation," the answer is almost always tied back to ONE of these attributes (usually patient advocacy or safety).

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# 8. Patient Confidentiality / HIPAA

• HIPAA = the law protecting patient privacy

- Don't discuss patient info with anyone except those directly involved in their care

- No gossiping about calls — not even at home with family

- This will 100% show up on tests — it's an easy point if you remember: "protect patient privacy, always."

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# 9. Continuous Quality Improvement (CQI) & Call Review

• CQI = an ongoing system of reviewing EMS calls to improve care over time (looking at the whole system, not just one person)
• Quality control = the medical director specifically checking that EMTs are meeting the right standards

- Reviewing a call is NOT about punishment — it's a learning tool. EMTs are expected to be open to feedback.

- Common ways errors happen: communication mistakes (info not passed along clearly), unfamiliarity with protocols, chaotic scenes

- Fix: talk in clear, simple language and repeat back orders/directions to confirm you heard them correctly ("read-back")

Test tip: If a question describes an EMT getting feedback after a call, the right answer is almost always "this is a normal, healthy part of learning," not something to be defensive about.

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## 10. Vital Vocabulary (Glossary) — Chapter 1 Key Terms

• EMS - The overall multi-agency system providing prehospital emergency care.
• EMR - First trained responder on scene (police, firefighter, etc.) with basic skills.
• EMT - Trained in basic life support, AED use, and assisting with some medications.
• AEMT - EMT + IV therapy and some emergency medications.
• Paramedic - Highest level — advanced airway, cardiac monitoring, medications.
• ALS (Advanced Life Support) - The more advanced life-saving procedures (used by AEMT/Paramedic).
• Certification - Proof you passed the exam/met the standard.
• Licensure - Legal permission from the STATE to practice.
• Credentialing - Local/employer-level verification of your qualifications.
• Medical director - The physician who authorizes what EMTs in a service are allowed to do.
• Medical control - Physician instructions — either online (real-time radio/phone) or offline (protocols already given).
• National EMS Scope of Practice Model - NHTSA's document outlining skills for each EMS level.
• Public safety access point - The call center (often 911) that routes police/fire/EMS.
• EMD (Emergency Medical Dispatch) - System that helps dispatchers pick the right response + gives callers instructions before EMS arrives.
• Primary service area - The specific zone an EMS agency is responsible for.
• Public health - The branch of medicine focused on preventing health problems across whole populations.
• Primary prevention - Stopping an injury/illness from ever happening (e.g., vaccines).
• Secondary prevention - Reducing the effects of something that already happened/can't be fully prevented (e.g., seatbelts, helmets).
• Evidence-based medicine (EBM) - Making medical decisions based on solid research, not just tradition.
• Mobile integrated health care (MIH) - Delivering care in the community instead of only hospital/office settings.
• Community paramedicine - Paramedics with extra training providing ongoing community health services.
• CQI (Continuous Quality Improvement) - System-wide review process to improve EMS care over time.
• ADA (Americans With Disabilities Act) - Law protecting people with disabilities from discrimination.
• AED - Device that detects deadly heart rhythms and delivers a shock if needed.
• HIPAA - 1996 law protecting patient health information/privacy.
• IV Therapy - Delivering medication directly into a vein.

This table alone probably covers 20-30% of likely test questions — matching terms to definitions is a classic EMT exam format.

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# 11. Chapter Review Summary (from the book's "Ready for Review")

Quick-fire recap of the chapter's biggest points:

- State law + a state office of EMS regulate prehospital care standards.

- Ambulances are staffed by EMTs/AEMTs/paramedics trained to national standards and licensed by their state.

- EMRs (police, firefighters, etc.) often arrive before EMTs and provide basic care until EMTs take over.

- Once on scene, EMTs size up the situation, assess the patient, and give care/transport based on their protocols or online medical direction.

- The National EMS Scope of Practice Model (from NHTSA) sets the overarching guidelines for what each EMS level can do.

- EMS Agenda 2050 = the national vision document pushing for more people-centered EMS care.

- As an EMT, you'll often be the FIRST health care professional to assess/treat a patient — that comes with real responsibility and expected professional attributes (see Section 7 above).

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# 12. Sample Scenario Walkthrough — "You Are the Provider" (good example of how a real question set works)

The scenario: 48-year-old woman, lower back pain for about a month, no injury, no past medical history, called 911 because pain worsened. Vitals stable throughout (BP ~120/60s, pulse 70-90, breathing normal, O2 sats 97-99%).

The 6 questions asked about this scenario (and the short-version answers):

1. How do EMT roles compare to other EMS levels? — All levels share the same core job (safe care + transport), but higher levels (AEMT, paramedic) can do more advanced assessment/treatment for sicker patients.

2. How does the Scope of Practice Model affect what an EMT can do? — It's the national framework that each state builds its own rules from, defining what EMTs are allowed to assess/treat.

3. Does this patient need EMT-level treatment? — Not every call is a dramatic emergency — sometimes it's reassurance, comfort positioning, and safe transport. You still treat every call seriously until proven non-emergent.

4. How is care integrated with the hospital? — You pass along your findings (verbal + written report) so the hospital can continue care smoothly — this is called continuity of care.

5. What safety concerns apply? — Safe driving, proper seatbelt/restraint use, and proper lifting technique to protect both patient and crew.

6. What's the purpose of reviewing an EMS call afterward? — To learn and improve — NOT to punish. This is basically CQI in action (see Section 9).

This format — a patient scenario followed by "what would you do" questions — is very likely how your actual exam questions will be structured. Practicing this pattern is high-value.

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# 13. Reading a Patient Care Report (PCR) — What the Form Looks Like

You'll eventually need to know how to read/fill these out. Key sections:

- Call times: Dispatched → En Route → At Scene → Transport → At Hospital → In Service (tracks the whole call timeline)

- Patient info: age, sex, weight, allergies, medications, past medical history, chief complaint

- Vital signs: taken MULTIPLE times throughout the call (shows if patient is stable, improving, or worsening)

- EMS treatment: checklist of what was done (oxygen, bandaging, splinting, CPR, "other" like comfort care, etc.)

Chapter 2: Workforce Safety & Wellness

#1. Pathogens, Infection & Immunity

Pathogen Protection & Host Definitions

• Host: The organism or individual that is attacked by an infecting agent.
• Immunity: Resistance to specific pathogens. Exposure to germs does not guarantee infection if the host is immune.

#2. Types of Immunity

• Lifelong Immunity: Protects against reinfection for life. Infection or vaccination provides permanent protection (e.g., Measles, Mumps, Polio, Rubella, Hepatitis A, Hepatitis B).
• Partial Immunity: Protects against new infections, but pathogens remaining in the body can reactivate and cause illness during stress or immune impairment (e.g., Chickenpox reactivating as Shingles, Tuberculosis).
• No Immunity: Repeated infections are common because exposure confers no lasting protection (e.g., Gonorrhea, Syphilis, HIV).
• Other / Unknown: Viruses that change yearly or newer strains where immunity duration is still under study (e.g., Influenza, COVID-19).

#3. Diseases Without Effective Immune Response

• HIV / AIDS: The human body is unable to mount an effective immune response to HIV, which can progress to AIDS.

#4. Immunizations & OSHA Standards

OSHA Requirements for Healthcare Workers

• Hepatitis B Vaccination: Employers are legally required to offer the Hepatitis B vaccine at no cost to employees exposed to bloodborne pathogens. Employees who decline must sign a formal waiver.
• Infection Control Plan: Employers must establish a written plan to minimize occupational exposure to bloodborne pathogens and needlesticks.

CDC Recommended Vaccinations

• Hepatitis B: Required by OSHA.
• Influenza: Recommended annually.
• MMR: Measles, mumps, and rubella (typically a one-time series).
• Varicella: Chickenpox vaccine (or verified history of having chickenpox).
• Tdap: Tetanus, diphtheria, pertussis (booster required every 10 years).
• Meningococcal Vaccine: Recommended for personnel routinely exposed in institutional settings.

Tuberculosis (TB) Testing

• EMTs must undergo a baseline tuberculin skin test before beginning work, followed by regular annual testing.

Postexposure Management & Prophylaxis

Immediate Actions Following Exposure

• Clean the Area: Wash exposed skin thoroughly with soap and water immediately. If eyes are exposed, rinse with water for at least 20 minutes.
• Notify Supervisor: Immediately contact your supervisor or department Infection Control Officer (ICO).
• Complete an Exposure Report: Document when the event happened, what you were doing, what PPE was worn, details of the exposure, and actions taken afterward.

Postexposure Treatment (Prophylaxis)

• HIV: Treatment involves a specific combination of antiviral medications.
• Hepatitis B: Blood is tested for antibodies. If antibodies are absent, an injection of Hepatitis B Immune Globulin (HBIG) is administered for temporary protection.
• Hepatitis C: There is currently no postexposure treatment available to prevent Hepatitis C infection.
• Tuberculosis: If a tuberculin skin test turns positive during postexposure monitoring, a long-term course of oral antituberculin medication is initiated.

#5. Scene Safety & Vehicle Operations

Priorities on Scene

• Personal safety (Yourself)
• Partner / Crew safety
• Patient safety

Transit & Ambulance Safety

• Wear seat belts (both lap and shoulder harness) at all times during transit.
• Put on appropriate Personal Protective Equipment (PPE) before departing the ambulance.
• Drive cautiously and position the vehicle to shield the scene when arriving first at a crash.

Traffic & Roadway Operations

• High-Visibility Clothing: Wear reflective vests or clothing meeting ANSI Class 2 or Class 3 standards when working on or near roadways (ANSI requires all EMS providers to wear high-visibility public safety vests on or near roadways).
• Scene Blocking: Use heavy vehicles (e.g., fire engines) to block traffic lanes protecting the work area.
• Warning Devices: Place warning signs, cones, or flares at a sufficient distance to alert oncoming traffic from both directions.
• Night Operations: Ensure proper lighting, as poor visibility increases collision and injury risks.

#6. Environmental & Scene Hazards

Hazardous Materials (HazMat)

• Look for diamond-shaped placards, labels, and UN identification numbers from a safe distance using binoculars.
• General HazMat Guidelines:
• Do not enter the scene if hazardous materials are present.
• Park and stay upwind and uphill.
• Keep your distance and request specialized HazMat resources via dispatch.
• Do not begin patient care until the scene is cleared and patients are decontaminated by trained HazMat personnel.
• Emergency Response Guidebook (ERG): A key reference publication by the U.S. DOT listing common hazardous materials, isolation distances, and emergency care procedures.

#7. Electrical & Power Line Hazards

• Treat all downed power lines as live and energized.
• Establish a danger zone extending beyond the distance between utility poles; keep all unauthorized personnel, equipment, and vehicles outside this perimeter.
• Do not touch downed wires or vehicles in contact with wires until qualified utility personnel confirm the power is shut off.
• Wear appropriate protective equipment, such as a helmet made of certified electrical nonconductive material with a secured chin strap.

Lightning Hazards

• Avoid high ground, metallic objects, tall isolated trees, and wet areas.
• If caught in the open: Minimize body contact with the ground (drop equipment, crouch low with feet close together, do not lie flat).
• Seek shelter inside a hard-topped vehicle or ambulance if possible.

#8. Fire Hazards

• 7 Primary Fire Hazards:
• Smoke
• Oxygen deficiency
• High temperatures
• Toxic gases
• Building collapse
• Equipment hazards
• Explosions
• Toxic Fire By-Products:
• Carbon Monoxide (CO): Colorless, odorless gas; binds to hemoglobin ~200 times more readily than oxygen, causing severe hypoxia.
• Cyanide: Inhaled combustion product that blocks cellular respiration.
• Carbon Dioxide (CO_2): Colorless, odorless gas; high concentrations (>10% to 12%) cause increased respiration, dizziness, sweating, and rapid death.
• Fire Safety: Do not enter burning structures without proper firefighting training, structural gear, and a Self-Contained Breathing Apparatus (SCBA). Avoid using medical oxygen near smoking, smoldering, or fuel-leaking environments.

# 9. Vehicle Crashes & Unstable Vehicles

• Ensure the vehicle is stabilized before attempting entry; turn off the ignition.
• Watch for undeployed airbags, hazardous fluids (gasoline, oil, battery acid), downed electrical wires, and alternative fuel systems (hybrid batteries, propane, EV systems).
• Wear heavy protective gear to guard against sharp glass and jagged metal edges.

#10. Violent Scenes & Violence Against Responders

Violent Scenes & Crime Scenes

• Staging: Request or wait to stage in a safe location until law enforcement secures the scene.
• Personal Safety First: You must attempt to understand the risks of each environment. Whenever in doubt, do not put yourself at risk.
• Projectiles & Cover: At scenes involving projectiles (bullets, bottles, rocks), find protection immediately.
• Cover: Tactical use of an impenetrable barrier for protection (e.g., concrete walls, vehicle engine blocks).
• Concealment: Use of objects to limit a person's ability to see you (does not stop bullets).
• Crime Scene Preservation: Maintain the chain of evidence. Do not disturb the scene unless absolutely necessary to care for the patient.

#11. Violence Against Responders

• Risk Rate: The rate of violence-related injuries with work loss for emergency responders is 22 times higher than the overall rate for other employees in the United States.
• Prevention Strategies:
• Training in identifying scenes of potential violence.
• Training in de-escalation strategies, techniques, and interpersonal communications.
• Continuous ongoing scene assessment.
• Dispatch identification and alerting of past or potential threats.
• Protection Recommendations:
• Training in self-defense and escape techniques.
• Physical and chemical restraint training.
• Fitting and use of body armor.
• Operations training with law enforcement personnel.
• Reporting: Physical or verbal violence must be reported on appropriate incident forms per state laws and department policies.

#12. Protective Clothing & Personal Gear

General Principles

• Protective gear is critical to safety; inspect equipment before reaching the scene to avoid delays.
• Rescue Clothing: Must fit the activity and environment. Turnout gear is too restrictive for confined space rescue.
• Fluid Barrier: EMS coats purchased after 1998 should provide a liquid barrier against body fluids.

#13. Cold Weather Clothing

Layering provides flexibility and better temperature control:

• Inner Layer (Transfer Layer): Wicks moisture away from skin (polypropylene, polyester, or wool). Avoid cotton in cold/wet weather as it absorbs moisture and causes chilling.
• Middle Layer (Thermal): Bulky insulation (wool or polyester fleece).
• Outer Layer: Wind- and water-resistant layer with zippers for venting (e.g., nylon). Avoid flammable or meltable synthetic outer fabrics if fire is possible.

#14. Specialty Protective Gear

• Turnout / Bunker Gear: Structural firefighting gear designed for heat, fire, water, and impact/cuts. Provides minimal protection from electrical shock and adds weight/restricts range of motion.
• Gloves:
• Firefighting gloves protect against heat, cold, cuts, but reduce dexterity and do not protect against electrical hazards.
• Leather puncture-proof gloves worn over latex/nitrile gloves are used for extrication and rescue tools.
• Contaminated Gear: Gloves/gear contaminated with body fluids can cross-contaminate equipment, patients, and responders.
• Helmets:
• Must be worn in "fall zones" (where objects may fall) and near high-voltage/electrical hazards.
• Must have top/side impact protection and a secure, non-stretching chin strap with a face shield.
• Construction helmets are not suited for rescue work (lack side protection and adequate chin straps).
• Boots:
• Should cover and protect ankles, be water-resistant, flexible, and puncture-resistant. Steel-toed boots are preferred.
• Socks: Wearing two pairs of socks (thin inner, thick outer) helps wick moisture and prevent blisters.
• Eye & Face Protection:
• Wear face shields or goggles during extrication or tool use (prescription glasses do not offer adequate protection).
• Wear eye protection in helicopter landing zones due to airborne dirt and debris.
• Use UV-blocking eyewear in snow or high altitudes.
• Ear Protection: Use industrial soft foam earplugs for high-noise environments (helicopters, extrication tools, sirens) to prevent permanent hearing loss.
• Skin Protection: Use sunscreen with a minimum SPF of 15 to protect against sunburn and long-term skin cancer risks.
• Hair, Rings & Jewelry: Tie back long hair; avoid loose rings and neckwear to prevent entangling in machinery.
• Body Armor: Bullet- and stab-resistant vests vary from light/concealable daily-wear vests to heavy tactical body armor used for violent scenes.

#15. Patient Care, Communication & Stress

Caring for Critically Ill and Injured Patients

• Immediate Communication: Let the patient know who you are and what you are doing as soon as possible.
• Avoid Grim Comments: Never make negative remarks about a patient's condition (e.g., "This is a bad one," "He's going to lose it"). Patients can hear even when apparently unresponsive.
• Orient the Patient: Reassure and orient disoriented patients using brief, clear statements (e.g., name, location, safety status).

#16. Wellness & Stress Management

• Foundations of Wellness: Physical, mental, and social health are essential for an EMT career.
• Types of Stress Reactions:
• Acute Stress Reaction: Immediate reaction occurring during a traumatic event.
• Delayed Stress Reaction: Manifests after the stressful event (e.g., PTSD).
• Cumulative Stress Reaction: Prolonged, excessive stress leading to burnout over time.
• Critical Incident Stress Management (CISM): A structured process used to confront critical incident stress and defuse emotional trauma in responders.

#17. Key Chapter 2 Vocabulary

• Acute Stress Reactions: Stress reactions occurring during a traumatic situation.
• Aerosol-Generating Procedure: Treatments that increase airborne transmission risks (e.g., CPR).
• Airborne Transmission: Spread of an organism via droplets or dust in the air.
• Bloodborne Pathogens: Microorganisms in human blood that cause disease (e.g., HBV, HIV).
• Burnout: Exhaustion, cynicism, and reduced performance from long-term job stress.
• Centers for Disease Control and Prevention (CDC): Federal agency managing public health and disease prevention.
• Communicable Disease: A disease that can spread from person to person or species to species.
• Compassion Fatigue: Lessening of compassion over time due to stress disorder.
• Concealment: Using objects to hide a person from view (does not stop bullets).
• Contamination: Presence of infectious organisms on objects or body surfaces.
• Cover: Tactical use of an impenetrable barrier for protection.
• Critical Incident Stress Management (CISM): Process to defuse stress after a critical incident.
• Cumulative Stress Reactions: Prolonged or excessive stress buildup over time.
• Delayed Stress Reactions: Reactions to stress occurring after a stressful event.
• Designated Officer: Department individual handling exposure and infection control issues.
• Direct Contact: Disease transmission via physical contact between infected person and host.
• Distress: Negative, harmful stress response.
• Eustress: Positive, beneficial stress response.
• Exposure: Situation where a person has been in contact with blood, body fluids, or airborne particles.
• Foodborne Transmission: Contamination of food or water causing disease.
• General Adaptation Syndrome: Body's response to stress (alarm, resistance, recovery/exhaustion).
• Hepatitis: Inflammation of the liver (often viral).
• Host: An organism attacked by an infecting agent.
• Human Immunodeficiency Virus (HIV): Virus causing AIDS by attacking the immune system.
• Immunity: Body's ability to protect itself from acquiring a disease.
• Indirect Contact: Disease transmission via a contaminated intermediate object.
• Infection: Invasion and growth of organisms in body tissues.
• Infection Control: Procedures to reduce risk of disease transmission.
• Infectious Disease: Illness caused by small, harmful organisms inside the body.
• Occupational Safety and Health Administration (OSHA): Federal regulatory agency enforcing workplace safety guidelines.
• Pathogen: A microorganism capable of causing disease in a susceptible host.
• Personal Protective Equipment (PPE): Gear blocking exposure to pathogens or hazards.
• Posttraumatic Stress Disorder (PTSD): Delayed stress reaction to a severe prior incident.
• Resilience: An individual's capacity to cope with and recover from distress.
• Standard Precautions: Protective measures traditionally developed by the CDC for handling body fluids.
• Transmission: The way an infectious disease spreads (contact, airborne, vector, foodborne).
• Vector-Borne Transmission: Use of an animal/insect to spread an organism.
• Wellness: Active pursuit of a state of good health.

Chapter 3: Medical, Legal, and Ethical Issues

Chapter Overview & Core Principle

• Basic principle: First, do no further harm.

- EMTs provide emergency medical care = immediate care/treatment; often the first link in prehospital care.

- As EMS becomes more complex, litigation involving EMS participants is increasing.

- Providing competent care that conforms to scope and standard of care helps you avoid civil AND criminal actions.

- You may also face administrative action (e.g., suspension of your state EMT license) brought by your state EMS agency.

- Ethical dilemmas EMTs face (know these examples):

- Patient wants to be let out of the ambulance mid-transport

- Suspected child abuse and a parent demands you stop

- Partner posts about a call on social media

# 1. CONSENT

• General Rule

- Consent required from every conscious, rational adult capable of making informed decisions before care can start.

- A capable adult has the legal right to refuse care, even if ill/injured.

- Patients may consent to some care and refuse other care.

- Providing care against refusal = grounds for criminal and civil action.

- Consent can be expressed (actual) or implied.

• Decision-Making Capacity

- Decision-making capacity = ability of a patient to understand the information you provide AND process it to make an informed choice.

- Law allows patients to make choices that seem medically unsound, even if dangerous — this is patient autonomy.

- Competence = legal term; determined by a court of law.

- Decision-making capacity = the term used in health care to determine if a patient can make health care decisions (often used interchangeably with competence, but technically different).

• Factors to assess decision-making capacity:

- Intellectual capacity impaired by mental limitation or dementia?

- Legal age (18 in most states)?

- Impaired by drug/alcohol intoxication or serious injury/illness?

- Experiencing significant pain?

- Has a significant injury that could distract from a more serious one?

- Hearing or visual problems?

- Language barrier?

- Does the patient understand what you're saying / ask rational questions?

• Informed Consent

- Must explain: nature of treatment offered, potential risks/benefits, alternatives, and consequences of refusing.

- Valid if given verbally, but hard to prove later — document consent in your run report.

- Have a witness if possible.

- A patient may consent to some care but refuse other care.

• Expressed (Actual) Consent

- The patient specifically acknowledges wanting care/transport.

- Can be verbal ("yes") or nonverbal (nodding, extending arm).

• Implied Consent

- Applies when a patient is unconscious or otherwise incapable of making a rational, informed decision.

- Law assumes the patient would consent if able to.

- Applies only when a serious medical condition exists and there's a threat to life or limb.

- Also called the emergency doctrine.

- Common with: diabetic emergencies, overdoses, syncope, seizures.

- If a patient regains consciousness and appears capable of informed decisions, implied consent no longer applies.

- Law allows spouse/close relative/next of kin to consent for an injured person unable to do so — but never delay treatment for imminently life-threatening injuries while seeking this.

• Involuntary Consent

- For patients who are mentally ill, developmentally delayed, or in a behavioral/psychological crisis.

- A mentally incompetent adult cannot give informed consent — legally similar to minors.

- Consent should come from a legal guardian/conservator.

- Many states have protective custody statutes allowing law enforcement to take such a person to a facility.

- Law enforcement/prison officials may consent for an incarcerated/arrested individual — but a conscious, capable prisoner does not surrender the right to make medical decisions and may refuse care.

• Minors and Consent

- Parents or legal guardians must give consent for treatment/transport when available.

- If a parent cannot be reached, health care providers may give emergency care to a child (implied consent applies).

- Some states allow minors to consent depending on age/maturity.

- Emancipated minors: legally treated as adults despite being under 18, e.g., if married, in armed services, are parents, or living independently and not relying on parents for support. A court may also declare emancipation.

- In loco parentis: teachers/school officials may give consent for a minor at school/camp "in the position of a parent" if parent/guardian unavailable.

- Never withhold life-saving care for a minor just because consent isn't immediately available.

- Reach parent/guardian ASAP — some interventions at the hospital could be delayed pending consent, but life-saving care is never delayed.

# 2. FORCIBLE RESTRAINT

- Sometimes necessary for a combative patient who poses a significant physical risk to self, rescuers, or others.

- May result from psychiatric/behavioral conditions, drug effects, or medical conditions (head injury, hypoxia).

- Consult medical control for authorization, or contact law enforcement (in some states, only police officers may forcibly restrain).

- Restraint without legal authority = civil/criminal liability risk.

- If a patient is combative and dangerous, it's often best to wait for law enforcement before treating.

- Once restraints applied, do NOT remove en route unless they pose a risk — even if the patient promises to behave.

- Must protect the airway and monitor respiratory/circulatory status while restrained (avoid asphyxia/aspiration).

- Consider ALS backup for chemical (pharmacologic) restraint — may be safer than physical restraint.

# 3. THE RIGHT TO REFUSE TREATMENT

- Conscious, alert adults with decision-making capacity can refuse treatment/transport at any time — supported by autonomy, even if it may result in death.

- You must assess decision-making capacity: ask/repeat questions, observe behavior.

- Confused/delusional patients cannot be assumed to be making an informed refusal.

- Patients who attempted suicide or expressed suicidal intent should NOT be regarded as having normal mental capacity.

- A single assessment finding usually isn't enough — look at the constellation of findings.

- When in doubt, providing treatment is a more defensible position than failing to treat.

- Contact medical direction when unsure. Don't endanger yourself; use law enforcement assistance if needed.

• Before leaving a refusal scene:

- Encourage patients to accept treatment up to 3 times if the situation allows.

- Remind them to call 911 if they change their mind or condition worsens.

- Advise contacting a personal physician ASAP.

- Have the patient sign a refusal of treatment form.

- Document thoroughly: assessment findings, all consent efforts, possible consequences of refusal.

- Have the signature witnessed (family member or police officer) to protect against negligence/abandonment claims.

- A signed refusal form does NOT guarantee protection from legal action, but it helps.

- Notify medical control per local protocol.

• Parent refusing care for a child: consider emotional effect on parent's judgment; usually resolve with patience/persuasion; may need supervisor, ALS, medical control, or law enforcement help.

---

# 4. CONFIDENTIALITY & HIPAA

• Confidentiality

- Communication between you and a patient is confidential — cannot be disclosed without patient permission or a court order.

- Confidential info includes: patient history, assessment findings, treatment provided.

- Unauthorized disclosure = liability for breach of confidentiality.

- Records may be released with a legal subpoena or patient's written release.

- Sharing with third-party billing personnel is not a breach of confidentiality.

• HIPAA (Health Insurance Portability and Accountability Act of 1996)

- The section most relevant to EMS = patient privacy.

- Protected Health Information (PHI) = all patient info obtained during treatment, including anything that could identify the patient (not just medical info).

- Safeguards: prohibit sharing passwords/login credentials, proper document disposal, never leave devices/reports with PHI unattended.

- Only access PHI of patients you didn't personally treat if there's a legitimate business reason.

- Celebrity records, your own records, family members' records — never viewed without proper authorization from a privacy/security officer.

- PHI may be legally used for: quality improvement/training (identifiers removed first), legally mandated reporting (child abuse, subpoena).

- Only the minimum necessary information should be released (except for treatment purposes).

- Failure to follow HIPAA = civil and/or criminal action against your agency and you personally.

- Each EMS system must have a policy/procedure manual and a privacy officer.

- Never share PHI casually — even "private" conversations at the station or on social media are HIPAA/ethical violations.

- Digital images/photos/recordings from a call = PHI and confidential. Never use a personal device to capture call info. Never post PHI on social media.

- The general public can legally record/photograph patients in public view — EMTs and law enforcement generally cannot stop them or confiscate devices, but a polite request to respect privacy is often effective.

• Social Media

- Sharing personal opinions on work/non-work topics is complex; appropriateness depends on content and context.

- If using agency-supplied equipment or acting in the course of duty, the **agency likely owns the images/info.

• Guidelines:

- Avoid logos, uniforms, vehicles, agency markings when off duty unless you're an official spokesperson.

- Conduct yourself online with the same professionalism as on duty.

- Respect patients, families, bystanders, colleagues, and your organization.

- Free speech doesn't mean no repercussions.

---

# 5. ADVANCE DIRECTIVES & END-OF-LIFE ISSUES

### Advance Directives

- **Competent** = able to make rational decisions about one's own well-being.

- **Advance directive** = written document specifying medical treatment for a competent patient should they become unable to decide later. Also called a **living will** or **health care directive**.

- Most common use: patient becomes comatose.

- Not all advance directives withhold care — may include nutrition/pain medication.

### DNR (Do Not Resuscitate) Orders

- Gives permission to **not attempt resuscitation**.

- Also known as "do not attempt resuscitation" order.

- Laws differ by state — know your state's requirements.

**To be valid, DNR orders must generally include:**

1. Clear statement of the patient's medical problem(s)

2. Signature of the patient or legal guardian

3. Signature of one or more physicians or other licensed health care providers

4. (In some states) An expiration date — must be dated within the preceding 12 months to be valid

### POLST / MOLST

- **Physician Orders for Life-Sustaining Treatment (POLST)** and **Medical Orders for Life-Sustaining Treatment (MOLST)** — used for patients with terminal illness.

- Describe acceptable interventions as **medical orders**.

- Must be signed by an authorized medical provider (physician, PA, or NP — varies by state).

- Contact medical control if you encounter these.

### Durable Power of Attorney for Health Care / Health Care Proxy

- A person named as a surrogate to make health care decisions if the patient becomes incapacitated.

- Not all powers of attorney authorize medical decision-making — read carefully.

- Only authorized to make decisions when the patient is **no longer capable** of doing so themselves; a competent patient never loses the right to make their own decisions.

- Contact online medical control for help interpreting a power of attorney; **do not delay emergency care** while doing so.

### General DNR/Advance Directive Guidelines

1. Patients have the right to refuse treatment, including resuscitation, if able to communicate wishes.

2. A **written order from a physician** is required for DNR orders to be valid in a health care facility.

3. Periodically review state/local protocols and legislation.

4. **When in doubt or orders are not present, you have an obligation to resuscitate.**

- **DNR does NOT mean "do not treat."** Still obligated to provide supportive measures (oxygen, pain relief, comfort) unless in cardiac arrest.

- Never become annoyed with family members about "why did they call 911."

---

## 6. DEATH, DYING & RELATED ISSUES

### Physical Signs of Death

- Determining **cause** of death = medical responsibility of a physician.

- Death often defined as absence of circulatory and respiratory function; many states also have **brain death** provisions (irreversible cessation of all brain/brainstem function).

- **General rule**: If the body is intact and there are no definitive signs of death, initiate emergency medical care.

### Hypothermia Special Note

- General cooling of the body; internal temp abnormally low.

- People have survived hypothermia at temps as low as 64°F (18°C).

- **A hypothermic patient should not be considered dead until "warm and dead."**

- When unsure, start CPR immediately and contact medical control.

- Hypothermia doesn't only occur outdoors (e.g., elderly person in an unheated home).

### Presumptive Signs of Death (Table 3-1)

- Unresponsiveness to painful stimuli

- Lack of a carotid pulse or heartbeat

- Absence of chest rise and fall

- No deep tendon or corneal reflexes

- Absence of pupillary reactivity

- No systolic blood pressure

- Profound cyanosis

- Lowered or decreased body temperature

### Definitive (Conclusive) Signs of Death

- Obvious mortal damage (e.g., decapitation)

- **Dependent lividity**: blood settling to the lowest point of the body, causing skin discoloration

- **Rigor mortis**: stiffening of body muscles from chemical changes in muscle tissue; starts in face/jaw, extends downward; onset affected by rate of heat loss; occurs **2–12 hours** after death

- **Algor mortis**: cooling of the body until it matches ambient temperature

- **Putrefaction**: decomposition of body tissues; occurs **40–96 hours** after death (temperature-dependent)

### Medical Examiner (Coroner) Cases

- Notify medical examiner when trauma is a factor or death involves suspected criminal/unusual circumstances (e.g., hanging, poisoning).

- When ME/coroner assumes responsibility, that supersedes all others at the scene, **including family**.

**Examples of ME cases:**

- Dead on arrival (DOA)/dead on scene (DOS)

- Death without previous medical care, or physician unable to state cause of death

- Suicide

- Violent death

- Poisoning, known or suspected

- Death from unintentional injuries

- Suspicion of criminal act

- Infant and child deaths

- Limit disturbance of a death scene. If care was initiated, keep thorough notes.

- No urgent reason to move the body — cover it and prevent disturbance. Local protocol determines ultimate action.

### Organ Donors

- Consent to organ donation is voluntary/knowing — evidenced by a donor card or driver's license.

- Certain centers can procure organs (e.g., kidneys, liver) from patients not successfully resuscitated, typically after in-hospital cardiac arrest or specific out-of-hospital situations near specialized centers.

- **Treat a potential organ donor the same as any other patient needing treatment.**

- Donated organs (kidney, heart, liver) need oxygen at all times — give oxygen to a potential donor or the organs will be damaged.

- Your priority is always to save the patient's life first.

### Medical Identification Insignia

- Patients may carry bracelets, necklaces, key chains, or cards with medical history info (DNR orders, medications, allergies, diabetes, epilepsy, etc.).

- Some bracelets contain a USB flash drive with info (drug interactions, allergies, emergency contacts), often stored as a readable PDF.

---

## 7. SCOPE OF PRACTICE & STANDARDS OF CARE

### Scope of Practice

- Most commonly defined by **state law** — outlines the care you are legally able to provide.

- Medical director further defines it via **protocols and standing orders**.

- Gives legal authorization for patient care via **online** (telephone/radio) or **offline** (standing orders/protocols) medical direction.

- Practicing outside your scope of practice = negligence, or in some states, a **criminal offense**.

- **Scope of practice ≠ standard of care** — don't confuse the two.

### Standards of Care

- **Standard of care** = the manner in which you must act or behave as an EMT.

- Established many ways: local customs, statutes, ordinances, protocols, medical literature, textbooks, administrative regulations, case law, professional/institutional standards.

**Standards Imposed by Local Custom:**

- How a reasonably prudent person with similar training/experience/equipment would act in a similar place.

- EMT conduct judged against comparable ambulance services in the same geographic area.

- EMTs are NOT held to the same standard as physicians or more highly trained professionals.

- Conduct must be judged considering: scene safety, general confusion at the scene, needs of other patients, type of equipment available.

- An **emergency** = a serious situation (injury/illness that arises suddenly, threatens life/welfare, requires immediate intervention).

- Prevailing local customs affect: hospital destination selection, when helicopters are used, spinal motion restriction protocols.

**Standards Imposed by Law:**

- Statutes, ordinances, administrative regulation, or case law.

- Violating one of these standards = **presumptive negligence**.

- Must be familiar with your state's legal standards; treatment protocols published by state agencies.

**Professional or Institutional Standards:**

- **Professional standards** = recommendations from organizations/societies in EMS (e.g., ILCOR + AHA update CPR/BLS standards regularly).

- **Institutional standards** = specific rules/procedures of your EMS system/agency/organization.

- Standards you help formulate should be reasonable and not impose undue burden.

- **Ordinary care** = the minimum standard expected of any EMT.

**Standards Imposed by Textbooks:**

- Attorneys often ask if an EMT recognizes textbooks as authoritative.

- Most EMS textbooks follow NHTSA standards — contribute to, but don't completely define, standard of care.

- **Local protocols/state standards override textbook material when they conflict.**

### Certification and Licensure

- Some states provide certification/licensure/credentialing.

- Once certified, obligated to conform to nationally recognized standards, provided by registry groups.

- Must keep certification/licensure current and skills up to date.

### Duty to Act

- **Duty to act** = an individual's responsibility to provide patient care; comes from statute or function.

- A **bystander** is under NO obligation to help a stranger — no duty to act.

- EMT duty to act arises when:

- You are charged with emergency medical response

- Your service/department's policy requires you to assist in any emergency

- Once your ambulance responds/treatment begins, you have a legal duty to act.

- If off duty and happen upon a motor vehicle crash, in most cases you are **not** legally obligated to stop and assist. Know your state/service laws — there may be exceptions.

- If you **choose to intervene while off duty**, you must continue competent care until an equal or higher medical authority assumes care.

---

## 8. NEGLIGENCE, ABANDONMENT & RELATED TORTS

### Negligence

- **Negligence** = failure to provide the same care that a person with similar training would provide in the same/similar situation; deviation from accepted standard of care that may cause further injury.

**Four Factors Required (ALL must be present for liability):**

1. **Duty** — EMT has an obligation to provide care consistent with the standard of care established by training/local protocols.

2. **Breach of duty** — EMT does not act within an expected/reasonable standard of care.

3. **Damages** — patient physically or psychologically harmed in a noticeable way.

4. **Causation** — reasonable cause-and-effect relationship between breach and damages (aka **proximate causation**). Example: dropping a patient during lifting, causing a leg fracture.

### Res Ipsa Loquitur

- ("The thing speaks for itself") — an EMT can be held liable even if the plaintiff can't clearly show how an injury occurred, IF it can be shown that:

- An injury occurred

- The cause of the injury was in the control of the EMT

- Such injuries generally don't occur unless there's negligence

- Example: unconscious diabetic patient dropped from a stretcher and sustains a facial laceration — patient may prevail by showing he was under your care, suffered an injury, and it wouldn't have happened without negligence.

### Negligence Per Se

- May be used when conduct is alleged to have occurred in **clear violation of a statute**.

- Example: performing an ALS skill (e.g., IV cardiac medication) outside your scope, resulting in injury — plaintiff need not prove the circumstances were inappropriate, only that you exceeded your scope.

### Torts

- **Torts** = general category for all forms of negligence; simply defined as **civil wrongs**.

- Not within the jurisdiction of US criminal courts.

- Examples: defamation of character, invasion of privacy.

### Abandonment

- **Abandonment** = unilateral termination of care by the EMT without the patient's consent AND without making provisions for continuing care by an equally/more competent medical professional.

- Once care is started, you've assumed a duty that must not stop until an equally competent provider takes over.

- Can also occur at the **ED** if you fail to give appropriate hospital personnel a report of assessment findings, care provided, and changes in patient status — this failure could lead to a claim for abandonment.

- Example: turning over care of injured patients to an untrained passerby to respond to another call = potential abandonment.

### Assault, Battery, and Kidnapping

- **Assault** = unlawfully placing a person in fear of immediate bodily harm (e.g., threatening to restrain a patient who doesn't want to be transported).

- **Battery** = unlawfully touching a person; includes providing emergency care **without consent**.

- Can be civil or criminal. Civil lawsuits for battery are common in health care; criminal charges are rare (intent to cause harm is rarely present with EMS providers).

- **Kidnapping** = seizing, confining, abducting, or carrying away a person by force. In theory this could include transporting a patient against his/her will, but criminal kidnapping charges against EMS are rare.

- **False imprisonment** = unauthorized confinement of a person that lasts for an appreciable period of time. Example: patient rescinds consent during transport, demands to be let out — if you refuse, you may be accused of false imprisonment. This is far more likely than criminal charges since EMTs are almost always acting in good faith.

- Battery could be considered if you apply a splint or use an EpiPen without consent. A patient might sue for assault, battery, false imprisonment, or all three (criminal charges possible but far less likely).

- **To protect yourself**: obtain expressed consent, or make sure the situation allows for implied consent. Consult your medical director or service attorney if unsure.

### Defamation

- **Defamation** = communication of false information that damages a person's reputation.

- **Libel** = defamation in writing.

- **Slander** = defamation that is spoken.

- Could arise from a false statement in a run report, inappropriate social media comments, or sharing "war stories" with friends/relatives/neighbors.

- To avoid liability: only communicate patient info to authorized people; ensure run reports are accurate/relevant; never comment on patient info irrelevant to your assessment/treatment; never post about a patient on social media.

### Good Samaritan Laws and Immunity

- All states have adopted **Good Samaritan laws** — based on common law: if you reasonably help another person, you shouldn't be liable for errors/omissions made in good-faith emergency care.

- **Apply to Good Samaritans, off duty** — NOT intended for people at work being compensated, and don't necessarily fully protect you from a lawsuit.

- Vary significantly state to state:

- Some provide immunity from lawsuit entirely

- Others provide only an **affirmative defense** if sued

- Most do NOT prohibit the filing of a lawsuit

- Do NOT pertain to acts considered **wanton, gross, or willful negligence**

**Conditions generally required to be protected by Good Samaritan law:**

1. Acted in good faith in rendering care

2. Rendered care without expectation of compensation

3. Acted within the scope of your training

4. Did not act in a grossly negligent manner

- **Gross negligence** = conduct that constitutes a willful or reckless disregard for a duty or standard of care.

- Separate immunity laws grant immunity to **official EMS providers** (EMTs) in some circumstances — vary state to state, don't apply if injury caused by gross negligence/willful misconduct.

- Immunity statutes usually apply to EMS systems that are governmental agencies — known as **sovereign immunity**; usually provides limitations on liability, but immunity is **not complete**.

- Many states grant partial immunity to EMTs, physicians, and nurses who give emergency instructions via radio/other communication.

---

## 9. RECORDS, REPORTS & MANDATORY REPORTING

### Records and Reports

- EMS providers are in a position to observe/gather info about diseases, injuries, emergency events — you may be obligated to compile and report this info.

- A complete/accurate record is an important safeguard against legal complications.

- Absence/incomplete records increase the likelihood you'll have to testify on memory alone — inadequate and embarrassing under cross-examination.

**Two general rules:**

- If an action/procedure is **not recorded**, it was **not performed**.

- An **incomplete or untidy report** is evidence of incomplete/inexpert emergency medical care.

- PCRs help evaluate individual/service provider performance (quality assurance), and data extraction is used for prehospital research to improve outcomes.

- **National EMS Information System (NEMSIS)**: collects, stores, and shares standardized EMS data nationwide; can improve speed/accuracy of data collection; could provide early warning of a disease outbreak.

**Street Smarts**: Most lawsuits take years to unfold. If you testify 2–3 years after a routine-seeming call, your documentation (especially the narrative) may be your only memory of the call on the stand.

### Special Mandatory Reporting Requirements

**Abuse of Children, Older People, and Others**

- All states have laws to protect abused children; some also protect older adults and at-risk adults.

- Most states have reporting obligations ranging from physicians to **any person**.

- Must know your state's requirements.

- Statutes frequently grant immunity from libel, slander, or defamation of character to the reporter — even if reports are later shown to be unfounded, **as long as made in good faith**.

- Elder abuse is as prominent in society as other forms — do not forget to report any suspicious signs of it to authorities.

**Injury During the Commission of a Felony**

- Many states require reporting any injury likely to have occurred during a crime (gunshot wounds, knife wounds, poisonings).

- Must be familiar with legal requirements of your state.

**Drug-Related Injuries**

- Some drug-related injuries must be reported.

- The **US Supreme Court has held that drug addiction is an illness, not a crime** (in contrast to drug possession or sale). Therefore, an injury from a drug overdose may not be within the definition of an injury resulting from a crime.

- Some states, by statute, establish confidentiality and excuse certain people from reporting drug cases to a government agency or a minor's parents if withholding is deemed necessary.

**Childbirth**

- Many states require reporting a live birth in any place other than a medical facility.

- Be familiar with your state's requirements.

**Other Reporting Requirements**

- May include: injuries in children under a certain age, suicides, dog bites, certain assaults, domestic violence, rape.

**General notes on mandatory reporting:**

- Consult your medical director or state EMS agency for more info on laws in your area.

- Reporting requirements vary significantly from state to state in methods/procedures.

- Some states require suspected child abuse be reported to law enforcement, others to a different agency, and others to both — often time-sensitive.

- It's important to know your state's requirements — failure to comply can result in disciplinary action, including loss of your privilege to practice as an EMT, and possibly prosecution.

---

## 10. ETHICS AND MORALITY

### Core Definitions

- **Ethics** = the philosophy of right and wrong, of moral principles, and of ideal professional behavior; often referred to as the **study of morality**.

- **Morality** = a code of conduct that can be defined by society, religion, or a person, affecting character, conscience, and the definition of right versus wrong.

- **Bioethics** = an entire field of ethics that has evolved over the past several decades addressing issues that arise in the practice of health care (e.g., termination of life support, rationing of medical resources, physician-assisted suicide). Many such issues have drawn national attention.

- **Applied ethics** = the manner in which principles of ethics are incorporated into professional conduct.

- Ethical issues are present in **nearly every EMS incident**.

- You are expected to conduct yourself consistent with the standards of your profession and keep the **best interests of your patients** at the forefront of your conduct and decision making.

### Ethical Dilemma Examples (know these)

- Your partner arrives at work smelling of alcohol.

- You're called to the scene of a belligerent driver who seriously injured several children after causing a crash while drag racing.

- You're dispatched to a 9-1-1 call for chest pain; your partner recognizes the address and tells you not to use lights/siren because this is a "frequent flyer" who calls constantly for attention.

- You respond to an older woman in cardiac arrest — one relative hands you DNR paperwork and states the patient did not want to be resuscitated, while another relative demands you do everything possible.

- A coworker is unable to attend a training session and asks you to sign him in, saying "You know I would do it for you."

- **How you respond requires you to evaluate and apply your own moral standards as well as those of your profession** — these choices can be difficult, especially where your personal standards of right/wrong don't necessarily agree with the standards of your profession.

### Behavior On and Off the Job

- Your behavior both on and off duty is a reflection of your personal ethical standards.

- News stories depicting EMS personnel engaging in immature or illegal activities lessen public confidence in EMS.

- **Should be strictly forbidden**: illegal drug use/selling drugs, inappropriate use of emergency vehicles, inappropriate visitors entertained at the station, use of alcohol on duty.

- If you care about your patients, coworkers, and the EMS system as a whole, you may not stand by silently and watch other EMS providers engage in misbehavior — **misconduct should be promptly reported to the appropriate chain of command**.

- You are also obligated to **report medical errors** you make or witness to the medical director or another appropriate person **as soon as possible**.

### Making Ethical Decisions in the Field

EMS providers should establish their own ethical standards and monitor the ethical behavior of their members. To decide if you're acting ethically:

- Consider all options available to you and the consequences of each option.

- Have decisions been made in the past regarding a similar situation? Can an existing policy or rule be applied?

- How will the consequences of your decision provide the greatest benefit in view of all the alternatives?

- Involve **online medical control** in your decision making.

**TABLE 3-2: Ethical Decision-Making Checklist** (Yes/No for each):

1. Is the decision in the best interests of the patient?

2. Is the decision based on logic and reason rather than emotion?

3. Does the decision protect the patient's rights?

4. Would you agree to the same decision if you were the patient?

5. Would you make the same decision again in similar circumstances?

6. Can you defend this decision to others?

- There will be circumstances where your own personal sense of morals might lead you to a different result — **in short, your professional ethics trump personal morals while on duty.**

- **One unquestionable responsibility: honest reporting.** Absolute honesty in reporting is essential. You must provide a complete and accurate account of the events and details of all patient care and professional duties.

---

## 11. THE EMT IN COURT

- As an EMT, you may end up in court as a **witness or a defendant** in either a **civil lawsuit** or a **criminal case**.

- Being in court is often stressful.

- **As a witness in a civil case**: you may testify about the condition of the plaintiff when you arrived and about treatment you provided.

- **As a witness in a criminal case**: you may describe a crime scene, injuries found when examining a victim, or testify about admissions/statements made to you by a criminal defendant.

- Whenever subpoenaed to testify, **immediately notify the director of your service and legal counsel**.

- As a witness, remain **neutral** during testimony — you are simply there to provide the facts as observed, not to take sides.

- Many questions will be based on the **documentation you wrote at the time of the incident** — review your run report before your court appearance.

- **As a defendant** (civil or criminal), your involvement is far more significant with far greater personal consequences — you will need an attorney. In a civil lawsuit where you're sued as an employee/volunteer of an EMS system, your service or its insurance company generally provides legal counsel.

### The Civil Lawsuit Process (in order)

1. **Summons and complaint**: A civil lawsuit begins with service of a summons and complaint. The complaint sets forth the details of the plaintiff's case and the theory on which the plaintiff relies to recover a judgment. If served, bring it to your service director immediately — must be responded to within a set period (usually **20–30 days**).

2. **Answer**: The response to the complaint; generally denies the claims and sets forth one or more **defenses** on behalf of you and your service.

- Possible defenses: **statute of limitations**, **immunity**, or **contributory negligence**.

- **Statute of limitations** = the time within which a claim must be initiated (e.g., many states require negligence claims within 3 years of the injury-causing event); varies for children (may extend to a maximum age, e.g., a claim for a 12-year-old's injury might not need to be filed until their 21st birthday in some states).

- **Governmental immunity** = generally applies only to EMS systems operated by municipalities/governmental entities; may mean you cannot be sued at all in some cases, or may limit the amount of a monetary judgment. State laws vary significantly.

- **Contributory negligence** = a defense raised when the defendant believes the plaintiff's own conduct somehow contributed to the injuries/damages sustained (e.g., patient denied an aspirin allergy, you gave aspirin per protocol, patient had a severe reaction, and it's later revealed the patient did have a known allergy and simply forgot/denied it).

3. **Discovery**: The phase where both sides obtain information to have a better understanding of the case and to assist in negotiating a settlement or preparing for trial. Includes:

- **Interrogatories** = written questions each side sends to the other.

- **Depositions** = oral questions asked of parties and witnesses **under oath**.

- Requests for production of documents, and physical examinations.

- Most cases settle after discovery and do not go to trial. If not settled, the case is set for trial (can take **several years** to get to trial).

4. **Trial**: Each side presents evidence, including witness testimony and documents (medical reports, your run report). Witnesses may include experts such as physicians. A judge or jury renders a decision/verdict.

5. **Judgment/Damages**: If judgment is rendered against you/your service, the plaintiff may be awarded:

- **Compensatory damages** = intended to compensate the plaintiff for injuries sustained, including economic damages (medical bills, damage to property, lost earnings) and noneconomic damages (physical/emotional pain and suffering) — intended to restore the plaintiff to the condition they were in prior to the incident.

- **Punitive damages** = NOT commonly awarded in negligence cases; reserved for cases where the defendant acted **intentionally** or with **reckless disregard for the safety of the public**.

- In most cases, if a judgment is rendered against you, your service or its insurance carrier will pay it.

**Street Smarts**: When testifying, be brief. Answer only the specific question asked, based on your review of the patient report or vivid memories. It's perfectly acceptable to say "I don't know" or "I can't recall" if unsure — opinions/elaborations subject you to challenges by attorneys and can make your testimony seem less believable.

### Criminal Charges Against EMTs

- It is possible (though rare) to be arrested and charged with a criminal offense arising out of your employment as an EMS provider.

- Examples EMTs have been charged with: theft of patient property, assault or sexual assault on a patient, operating a vehicle under the influence, manslaughter, various drug-related offenses.

- Any arrest is very serious — conviction could lead to imprisonment, fines, and loss of the ability to practice as an EMT.

- **Any EMT charged with a criminal offense should immediately secure the services of a highly experienced criminal attorney.**

---

## 12. SCENE OF A CRIME & THE DECEASED

### Scene of a Crime

- If there is evidence a crime may have been committed, in most cases **notify the dispatcher immediately** so law enforcement can respond.

- This should NOT stop you from providing life-saving emergency medical care — but your **safety is a priority**; ensure the scene is safe to enter.

- You may have to transport the patient before law enforcement arrives.

- While providing care, be careful **not to disturb the scene** any more than absolutely necessary.

- Make notes/drawings of the position of the patient and the presence/position of any weapon or objects valuable to investigators.

- **Do not cut through holes in clothing** caused by weapons or gunshot wounds.

- Avoid walking through blood; try to avoid leaving footprints in dirt/grass at or near the scene.

- When sexual assault is suspected, try to **persuade the victim not to shower or clean themselves**.

- Confer periodically with local authorities about their wishes regarding your actions at the scene — best if guidelines are established by protocol.

- **State laws vary on whether EMS personnel must report rape/sexual assault** — in some states, the decision to report lies with the patient. However, suspected sexual abuse of children or older adults, and domestic abuse, **must be reported in most states**.

### The Deceased

- In most states, **EMTs do not have the authority to pronounce a patient dead**.

- If there is any chance life exists or the patient can be resuscitated, make every effort to save the patient at the scene and during transport.

- At times, death is obvious. **If a victim is clearly dead and the scene may be where a crime was committed, do not move the body or disturb the scene.**

---

## 13. SAMPLE PATIENT CARE REPORT (PCR) — Worked Example

*(From the textbook's "You Are the Provider" case — useful as a model of what a complete, well-documented PCR/run report looks like.)*

**Nature of Call**: Headache | **Chief Complaint**: Severe headache

**Patient**: 32-year-old male, 91 kg (200 lb); Allergies: none; Medications: Prinivil; PMH: Hypertension

**Vital signs trended over time** (shows the value of serial vitals):

| Time | BP | Pulse | Respirations | SpO₂ |

|---|---|---|---|---|

| 1735 | 200/110 | 110 | 24 | 98% |

| 1741 | 194/108 | 104 | 22 | 99% |

| 1747 | 166/94 | 90 | 18 | 99% |

**Narrative structure** (follow this format — History → Assessment → Treatment → Transport):

- **History**: Onset, associated symptoms, relevant PMH, denial of trauma/LOC.

- **Assessment**: Scene findings, LOC, ABCs, vital signs.

- **Treatment (Rx)**: Consent process (including initial hesitancy and how refusal risks were explained), interventions performed (dimmed lights, position of comfort).

- **Transport**: Interventions en route, reassessment findings/trends, patient disclosures (e.g., cocaine use) documented as relevant medical information, and confirmation that the patient was delivered to the ED with an oral report given to the **charge/receiving nurse**.

- **"End of report"** marker closes out the narrative.

**Key takeaways illustrated by this case:**

- Even when a patient is initially hesitant to consent, if they have decision-making capacity you **cannot legally force treatment or transport** — explain the potential consequences of refusal (e.g., a stroke/bleed) honestly; this is not a scare tactic, it's the patient's right to hear the truth.

- **Patient's drug use (e.g., cocaine) IS pertinent medical information** — include it in your PCR and oral report to the receiving facility because it affects care. However, per the **US Supreme Court**, drug addiction/use is an illness, not a crime — you are **not legally required to report a patient's admitted drug use to law enforcement**. Consult your medical director if in doubt, and know your state's specific reporting requirements.

- When a bystander/clerk asks about a patient's condition, you can **thank them for their help without disclosing confidential patient information** — protect the patient's privacy while still reassuring the public that care is being handled ("We are required to protect the patient's privacy, but I want to reassure you we will take excellent care of the patient").

- Getting the **receiving nurse's signature** on your PCR is important because it: confirms an equal/higher medical authority has accepted care, provides a record of who accepted the patient, and protects you from a later abandonment claim — your documentation should show you met this obligation.

---

## 10. SCENE OF A CRIME & THE DECEASED

### Scene of a Crime

- If there's evidence a crime may have been committed, **notify the dispatcher immediately** so law enforcement can respond.

- This should NOT stop you from providing life-saving care — but your safety is a priority; ensure the scene is safe to enter.

- You may have to transport the patient before law enforcement arrives.

- While providing care, **disturb the scene as little as absolutely necessary**:

- Make notes/drawings of the patient's position and the position/presence of any weapon or other objects that may be valuable to investigators.

- Do NOT cut through holes in clothing caused by weapons or gunshot wounds (if possible).

- Avoid walking through blood; try not to leave footprints in dirt/grass at or near the scene.

- If sexual assault is suspected, try to persuade the victim **not to shower or clean themselves**.

- Confer periodically with local authorities about their wishes for scene actions — best if established by protocol.

- **State laws vary on whether EMS must report rape/sexual assault.** In some states, the decision to report lies with the patient. **Suspected sexual abuse of children or older adults, and domestic abuse, must be reported in most states.**

### The Deceased

- In most states, **EMTs do NOT have the authority to pronounce a patient dead.**

- If there's any chance life exists or the patient can be resuscitated, you must make every effort to save them at the scene and during transport.

- At times death is obvious. If a victim is clearly dead and the scene may be a crime scene, **do not move the body or disturb the scene.**

---

## 11. ETHICAL RESPONSIBILITIES

### Definitions

- **Ethics** = the philosophy of right and wrong, of moral principles, and of ideal professional behavior; often called the study of **morality**.

- **Morality** = a code of conduct defined by society, religion, or a person, affecting character/conscience and the definition of right vs. wrong.

- **Bioethics** = a field of ethics that has evolved over recent decades addressing issues in health care practice (e.g., termination of life support, rationing of medical resources, physician-assisted suicide).

- **Applied ethics** = the manner in which principles of ethics are incorporated into professional conduct.

- You have ethical responsibilities to: **yourself, your patients, your coworkers, and the public.**

- Keep the best interests of your patients at the forefront of your conduct and decision-making.

### Example Ethical Dilemmas (know these)

- Your partner arrives at work smelling of alcohol.

- You're called to a belligerent driver who seriously injured several children while drag racing.

- Dispatched for chest pain; your partner recognizes the address as a "frequent flyer" and tells you not to use lights/siren.

- Responding to a cardiac arrest: one relative hands you DNR paperwork saying the patient didn't want resuscitation; another relative demands you do everything possible.

- A coworker asks you to sign them in for a training session they couldn't attend, saying "I would do it for you."

- Resolving these requires you to evaluate and apply **your own moral standards** as well as those of your profession — these don't always agree.

- **Your behavior on and off the job is a reflection of your personal ethical standards.** News stories depicting EMS personnel engaging in immature/illegal activity lessen public confidence in EMS.

- Illegal drug use/selling drugs, inappropriate use of emergency vehicles, inappropriate visitors at the station, and alcohol use on duty should be **strictly forbidden**.

- You are obligated to **promptly report misconduct** you witness to the appropriate chain of command, and to report medical errors you make or witness to the medical director or another appropriate person **as soon as possible**.

- EMS providers/agencies should establish their own ethical standards and monitor members' ethical behavior.

### Making Ethical Decisions

Steps to consider:

- Consider all options available and the consequences of each option.

- Have decisions been made in the past regarding a similar situation? Can an existing policy/rule be applied?

- How will the consequences of your decision provide the greatest benefit in view of all the alternatives?

- Involve online medical control in your decision-making.

**Table 3-2: Ethical Decision-Making Checklist** (Yes/No for each):

1. Is the decision in the best interests of the patient?

2. Is the decision based on logic and reason rather than emotion?

3. Does the decision protect the patient's rights?

4. Would you agree to the same decision if you were the patient?

5. Would you make the same decision again in similar circumstances?

6. Can you defend this decision to others?

- **Your professional ethics trump your personal morals while on duty** — even in circumstances where your own personal sense of morals might lead you to a different result.

- **One unquestionable responsibility: honest reporting.** Absolute honesty in reporting is essential — provide a complete and accurate account of events and details of all patient care and professional duties.

---

## 12. THE EMT IN COURT

- You may end up in court as: a **witness** or a **defendant**, in either a **civil lawsuit** or a **criminal case**.

- Being in court is often stressful regardless of role.

- **As a witness in a civil case**: you may testify about the patient's condition on arrival and the treatment you provided.

- **As a witness in a criminal case**: you may describe a crime scene, injuries found when examining a crime victim, or testify about admissions/statements made to you by a criminal defendant.

- **If subpoenaed**, immediately notify your service director and legal counsel.

- **As a witness, remain neutral** — you're there to provide the facts as observed, not to take sides.

- Many questions asked will be based on the documentation you wrote at the time of the incident — **review your run report before your court appearance.**

- **As a defendant** (civil or criminal), your involvement is far more significant with greater personal consequences — you will definitely need an attorney.

- Civil lawsuit: if sued in your capacity as an employee/volunteer, your service or its insurance company generally provides legal counsel.

### Civil Lawsuit Process

1. **Summons and complaint**: A civil lawsuit begins with service of a summons and complaint. The complaint sets forth details of the plaintiff's case and the theory for recovering judgment against you/your service.

- If served with a summons, bring it to your service head immediately — the complaint must be **responded to within a set period, usually 20–30 days**.

2. **Answer**: The response to the complaint; generally denies the claims and sets forth one or more **defenses**.

**Possible Defenses:**

- **Statute of limitations** — the time within which a claim must be initiated (e.g., many states require negligence claims within 3 years of the event). A case filed beyond this is barred. The statute is often different for children (may extend to a set age, e.g., 21st birthday).

- **Governmental (sovereign) immunity** — generally applies only to EMS systems operated by municipalities/governmental entities; may mean you can't be sued at all in an emergency situation, or may limit the monetary judgment amount. Varies by state.

- **Contributory negligence** — raised when the defendant believes the plaintiff's own conduct contributed to their injuries/damages (e.g., patient denied an aspirin allergy, you administered aspirin per protocol, patient had an allergic reaction, and it's later found the patient did have a known allergy they forgot about/denied).

3. **Discovery**: The phase where both sides obtain information to better understand the case and assist in negotiating a settlement or preparing for trial.

- **Interrogatories** = written questions each side sends to the other.

- **Depositions** = oral questions asked of parties and witnesses under oath.

- Also includes requests for production of documents and physical examinations.

- Most cases settle and do not go to trial. Cases can take **several years** to reach trial.

4. **Trial**: Each side presents evidence (testimony of witnesses, documents like medical reports and your run report). Witnesses may include experts such as physicians. A judge or jury renders a decision/verdict.

**If judgment is rendered against you, damages may include:**

1. **Compensatory damages** — intended to compensate the plaintiff for injuries sustained, including economic damages (medical bills, damaged property, lost earnings) and noneconomic damages (physical/emotional pain and suffering).

2. **Punitive damages** — NOT commonly awarded in negligence cases; reserved for cases where the defendant acted **intentionally or with reckless disregard for public safety**.

- In most cases, if judgment is rendered against you, your **service or its insurance carrier will pay the judgment.**

### Criminal Charges Against EMTs

- It is possible (though rare) to be arrested/charged with a criminal offense arising from your EMS employment — e.g., theft of patient property, assault or sexual assault on a patient, DUI, manslaughter, drug-related offenses.

- Any arrest is serious — a conviction could mean imprisonment, fines, and loss of your ability to practice as an EMT.

- **Any EMT charged with a criminal offense should immediately secure a highly experienced criminal attorney.**

**Street Smarts**: When testifying, be brief. Answer only the specific question asked based on your review of the patient report or vivid memory of the incident. It's acceptable to say "I don't know" or "I can't recall" if unsure — elaboration/opinions can be challenged by attorneys and make your testimony seem less believable.

---

## 13. SAMPLE PCR (Patient Care Report) — Reference Format

*From the chapter's running case study — useful as a model of how a complete, well-documented PCR should look:*

| Field | Example |

|---|---|

| Date / Incident No. | 4-19-20 / 040109 |

| Nature of Call | Headache |

| Dispatched / En Route / At Scene / Transport / At Hospital / In Service | 1720 / 1721 / 1736 / 1743 / 1748 / 1801 |

| Age / Sex / Weight | 32 / M / 91 kg (200 lb) |

| Allergies / Medications / PMH / Chief Complaint | None / Prinivil / Hypertension / Severe headache |

**Vital signs trend (shows reassessment over time):**

| Time | BP | Pulse | Respirations | SpO2 |

|---|---|---|---|---|

| 1735 | 200/110 | 110 | 24 | 98% |

| 1741 | 194/108 | 104 | 22 | 99% |

| 1747 | 166/94 | 90 | 18 | 99% |

**Narrative structure** (follow this format — Chief Complaint → History → Assessment → Treatment → Transport):

- *Chief Complaint*: Severe headache.

- *History*: Onset, relevant details (e.g., missed antihypertensive medication), pertinent negatives (denies LOC, nausea, other symptoms).

- *Assessment*: LOC, airway, breathing, vitals obtained.

- *Treatment (Rx)*: What was explained/offered, consent obtained, interventions performed (e.g., dimmed lights, position of comfort).

- *Transport*: What was done en route, reassessment findings, and how patient was delivered/handed off (oral report to receiving nurse) — **end with "\*\*End of report\*\*"**.

**Key documentation takeaways illustrated by this example:**

- Document **reassessment vital signs with times** to show trending (e.g., improving BP after treatment).

- Document **patient's own statements** relevant to care (e.g., admission to cocaine use) — this is pertinent medical information that affects care and should be included in your PCR and oral report to the receiving facility, **even though you are not legally required to report drug use itself to law enforcement** (drug addiction/use is treated as an illness, not a crime, per US Supreme Court).

- Always **document "Other"** interventions not covered by checkboxes (e.g., dimmed lights, position of comfort) — comfort measures count as care.

- Get **signature/sign-off from the receiving nurse/facility** acknowledging transfer of care — protects you from abandonment claims, confirms an equal/higher authority accepted the patient, and provides a record in case of later questions.

---

## Quick-Reference Memory Aids

**4 Factors of Negligence**: Duty → Breach → Damages → Causation ("DBDC")

**4 Conditions for Good Samaritan Protection**: Good faith → No compensation expected → Within scope of training → Not grossly negligent

**4 DNR Requirements**: Clear statement of problem → Patient/guardian signature → Physician signature → (sometimes) expiration date within 12 months

**Signs of Death**:

- *Presumptive* = things you might see on a living but critically ill patient too (no pulse, no breathing, fixed pupils, low BP, cyanosis, low body temp)

- *Definitive* = conclusive, unmistakable (decapitation, dependent lividity, rigor mortis, algor mortis, putrefaction)

- Rigor mortis: 2–12 hrs | Putrefaction: 40–96 hrs

**Assault vs. Battery**: Assault = fear of harm (no touching required); Battery = actual unlawful touching (including care without consent)

**Libel vs. Slander**: Libel = written; Slander = spoken

**Consent types**: Expressed (patient says/gestures yes) → Implied (unconscious/emergency doctrine) → Involuntary (mentally incompetent/law enforcement custody)

**Civil lawsuit flow**: Summons/Complaint → Answer (+ Defenses) → Discovery (interrogatories, depositions) → Settlement or Trial → Verdict/Damages

**3 Possible Defenses to a civil suit**: Statute of limitations → Governmental/sovereign immunity → Contributory negligence

**2 Types of Damages**: Compensatory (economic + noneconomic, common) vs. Punitive (rare — intentional/reckless conduct only)

**Ethics vs. Morality vs. Law**: Morality = your personal code; Ethics = the philosophy/study of right & wrong professionally; Law = what's legally enforceable. Professional ethics > personal morals while on duty.

---

## Full Vital Vocabulary (Chapter 3 Glossary)

- **Abandonment**: Unilateral termination of care by the EMT without the patient's consent and without making provisions for transferring care to another medical professional with the skills/training necessary to meet the patient's needs.

- **Advance directive**: Written documentation specifying medical treatment for a competent patient should the patient become unable to make decisions; also called a living will or health care directive.

- **Algor mortis**: Cooling of the body after death until it matches the ambient temperature.

- **Applied ethics**: The manner in which principles of ethics are incorporated into professional conduct.

- **Assault**: Unlawfully placing a patient in fear of immediate bodily harm.

- **Battery**: Unlawfully touching a patient or providing emergency care without consent.

- **Bioethics**: The study of ethics related to issues that arise in health care.

- **Breach of confidentiality**: Disclosure of information without proper authorization.

- **Compensatory damages**: Damages awarded in a civil lawsuit intended to restore the plaintiff to the same condition they were in prior to the incident.

- **Competent**: Able to make rational decisions about personal well-being.

- **Consent**: Permission to render care.

- **Contributory negligence**: A legal defense raised when the defendant thinks the plaintiff's own conduct contributed to their injuries/damages.

- **Decision-making capacity**: Ability to understand and process information and make a choice regarding appropriate medical care.

- **Defamation**: Communication of false information about a person that is damaging to that person's reputation/standing in the community.

- **Dependent lividity**: Blood settling to the lowest point of the body, causing discoloration of the skin; a definitive sign of death.

- **Depositions**: Oral questions asked of parties and witnesses under oath.

- **Discovery**: The phase of a civil lawsuit where the plaintiff and defense obtain information from each other to better understand the case and assist in negotiating settlement/preparing for trial.

- **Do not resuscitate (DNR) order**: Written documentation by a physician giving permission to medical personnel not to attempt resuscitation in the event of cardiac arrest.

- **Durable power of attorney for health care**: A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on their behalf if they lose decision-making capacity.

- **Duty to act**: A medicolegal term relating to certain personnel who, by statute or function, have a responsibility to provide care.

- **Emancipated minor**: A person under the legal age in a given state but, due to other circumstances, legally considered an adult.

- **Emergency**: A serious situation, such as injury or illness, that threatens the life or welfare of a person or group and requires immediate intervention.

- **Emergency doctrine**: The principle of law that permits a health care provider to treat a patient in an emergency when the patient is incapable of granting consent due to an altered level of consciousness, disability, drug/alcohol effects, or the patient's age.

- **Emergency medical care**: Immediate care or treatment.

- **Ethics**: The philosophy of right and wrong, of moral duties, and of ideal professional behavior.

- **Expressed consent**: A type of consent where a patient gives verbal or nonverbal authorization for care/transport.

- **False imprisonment**: The confinement of a person without legal authority or the person's consent.

- **Forcible restraint**: The act of physically preventing an individual from initiating any physical action.

- **Good Samaritan laws**: Statutory provisions enacted by many states to protect citizens from liability for errors/omissions in giving good-faith emergency care, unless there is wanton, gross, or willful negligence.

- **Governmental immunity**: Legal doctrine that can protect an EMS provider from being sued, or may limit the amount of monetary judgment recoverable; generally applies only to EMS systems operated by municipal or other governmental entities.

- **Gross negligence**: Conduct that constitutes a willful or reckless disregard for a duty or standard of care.

- **Health care directive**: A written document specifying medical treatment for a competent patient should they become unable to make decisions; also known as an advance directive or living will.

- **Health care proxy**: A type of advance directive executed by a competent adult appointing another individual to make medical treatment decisions on their behalf if they lose decision-making capacity; also known as a durable power of attorney for health care.

- **Implied consent**: A type of consent where a patient unable to give consent is given treatment under the legal assumption they would want treatment.

- **Informed consent**: Permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained.

- **In loco parentis**: The legal responsibility of a person or organization to take on some of the functions/responsibilities of a parent.

- **Interrogatories**: Written questions that the defense and plaintiff send to one another.

- **Kidnapping**: The seizing, confining, abducting, or carrying away of a person by force, including transporting a competent adult for medical treatment without consent.

- **Libel**: False and damaging information about a person communicated in writing.

- **Medicolegal**: A term relating to medical jurisprudence (law) or forensic medicine.

- **Morality**: A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

- **Negligence**: Failure to provide the same care that a person with similar training would provide.

- **Negligence per se**: A theory used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute.

- **Patient autonomy**: The right of a patient to make informed choices regarding their own health care.

- **Protected health information (PHI)**: Any information about health status, provision of health care, or payment for health care that can be linked to an individual — interpreted broadly, includes any part of a patient's medical record or payment history.

- **Proximate causation**: When a person who has a duty abuses it and causes harm to another individual, and the EMT, agency, and/or medical director may be sued for negligence.

- **Punitive damages**: Damages sometimes awarded in a civil lawsuit when the defendant's conduct was intentional or constituted a reckless disregard for public safety.

- **Putrefaction**: Decomposition of body tissues; a definitive sign of death.

- **Res ipsa loquitur**: When the EMT or an EMS system is held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred.

- **Rigor mortis**: Stiffening of the body muscles; a definitive sign of death.

- **Scope of practice**: Most commonly defined by state law; outlines the care that the EMT is legally able to provide for the patient.

- **Slander**: False and damaging information about a person communicated by spoken word.

- **Standard of care**: Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so patients are not exposed to unreasonable risk or harm.

- **Statute of limitations**: The time within which a case/claim must be commenced.

- **Torts**: Wrongful acts that give rise to a civil lawsuit; civil wrongs, not within the jurisdiction of US criminal courts.