Legal and Ethical Aspects of Emergency Medical Services

Lesson Goal Outline potential ethical dilemmas & provide simple approach to resolving those dilemmas Identify & define legal implications of working in EMS

Introduction Many laws & ethical principles apply to EMS work http://www.dphhs.mt.gov/ems/ Be aware of how these issues relate to decisions

Scope of Potential Liability Medical errors—8th leading cause of death 50,000-100,000 Americans die each year because of medical errors

Scope of Potential Liability EMTs operate in unique environment Most lawsuits in EMS arise from vehicle accidents Root cause of many lawsuits—EMT’s attitude & behavior

Key Areas of EMS Law Levels of certification Training requirements Scope of practice Standard of care Requirements for certification Complaints against providers Disciplinary actions Legal protection Patients’ rights Emergency vehicle operations Workplace safety

EMT’s Responsibility Appropriate, timely, compassionate care Reporting of crimes Child abuse Elder abuse Ethical dilemmas—common

Duty to Act & Standard of Care Primary ethical responsibility Provide appropriate care On call Good Samaritan Standard of Care Clinical & technical standards trained to perform

Guiding Ethical Principles Patients’ autonomy Patients’ best interests First, do no harm Fairness

Ethical Issues What is a “good quality of life”? Organ donation

Handling Unethical Situations Consider your own beliefs Promote workplace culture of honesty, integrity, & communication

Negligence Ordinary negligence 4 elements Duty to act Breach of duty Causation Harm

Negligence Immunity defense Gross negligence Good Samaritan laws Always act in good faith

Negligence Personal risk management Be well educated Be well rested Know & follow protocols Maintain skills & knowledge

Attitudes & Communication Create a positive impression Well rested & alert Professional appearance Confidence Empathy Communication skills

Attitudes & Communication Get on patient’s level Introduce yourself Explain what you are doing Reassure patient Do not make false promises Provide basic comfort Communicate with family

Attitudes & Communication Smile Use comforting tone Avoid extraneous chatter Be efficient Say goodbye at end of call

ABANDONMENT Terminating care without legal excuse. Turning pt. over to lesser qualified personnel

Consent Must be obtained Implied Expressed/actual Limited to TRUE EMERGENCY situations Unconscious Delusional Unresponsive Physically unable to express consent Minors Expressed/actual -Consent must be “informed” permission for care of her/himself

Refusal Competency—legal status Decision-making capacity—clinical determination

Refusal Ethics Patient must be informed of meaning & consequences of refusal The time informed refusal takes is worthwhile

Refusal Make sure patient understands Treatment Risks Alternatives Consequences of not being treated

Refusal Considerations Make sure patient understands Make reasonable attempts to persuade patient Make sure decision is not coerced Document discussion Know who can refuse on patient’s behalf Err on side of treatment

Refusal Legally Patients’ rights to self-determination Assessing decision-making capacity Patients can refuse some or all interventions

Refusal A3E3P3 Guidelines 3 As Assess Advise Avoid

Refusal A3E3P3 Guidelines 3 Es Ensure Explain Exploit (uncertainty)

Refusal A3E3P3 Guidelines 3 Ps Persist Protocols Protect Refusal signed Documentation

“Law enforcement on scene on our arrival. Pt “Law enforcement on scene on our arrival. Pt. had been unresponsive prior to EMS arrival per Sgt. Ulrickson. On EMS arrival Pt. was awake, agitated and refused assessment, treatment or transport. No injuries noted on visual assessment. Pt. denied injury. Stated he laid down on sidewalk to ‘take a power nap’. Pt. able to move all extremities equally—insisted on standing up. Gait unsteady. Alert to time, place, date. Refusal signed. Pt. advised he could call EMS or seek further medical assistance at any time. Pt. escorted home by friends.”

Living Wills & Advance Directives Durable power of attorney DNR orders

Advance Directives in Montana EMS Comfort One POLST

Scope of Practice Issues Definition: procedures, actions, and processes that are permitted for the licensed individual—limited to that which the law allows for education, experience, and competency. EMS providers must always act within their scopes of practice

Documentation The patient care report (PCR) Has many purposes Is a reflection on YOU Includes written and verbal

Patients’ Rights Confidentiality & privacy are both legal and ethical issues

Patients’ Rights HIPAA Policies for release of PCRs Superprotection

Patients’ Rights Restraints—When and How When patient is physical threat to himself or others. Contact medical control, if possible. Restrain as little as possible. Involve Law Enforcement, if necessary. Circa 1752

Incident Reports Unusual occurrences Prevent recurrences Individuals System

Future of EMS Law Anticipate regulations as profession matures http://www.dphhs.mt.gov/ems/ Reduce potential for litigation Professional approach Reduce errors Maintain training Team work

Summary EMTs act within an ethical & legal context Common issues Certification/licensure Scope of practice Consent & refusal Negligence Resuscitation decisions

Summary Lawsuits Vehicle collisions Breech of confidentiality EMTs’ behavior & attitudes Personal responsibility & risk reduction

QUESTIONS??