Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 6 Medical/Legal Aspects of Advanced Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Legal Duties and Ethical Responsibilities The Legal System Laws Affecting EMS and the Paramedic Legal Accountability of the Paramedic Paramedic-Patient Relationships Resuscitation Issues Crime and Accident Scenes Documentation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction As a paramedic, you must be prepared to make the best medical decisions and the most appropriate legal decisions. The practice of law involves some art, some science, and is always heavily dependent on the unique facts present in each situation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Duties and Ethical Responsibilities

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Duties and Ethical Responsibilities As a paramedic, you have specific legal duties to your patient, crew, medical director, and the public. Failure to do so may result in civil or criminal liability (legal responsibility). © Glen E. Ellman

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Duties and Ethical Responsibilities Ethics are principles that identify desirable conduct by members of a particular group. Your responsibilities include: –Promptly respond to the needs of every patient –Treat all patients and their families with respect –Maintain your skills and medical knowledge –Participate in continuing education

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Duties and Ethical Responsibilities Ethical Responsibilities (cont.) –Critically review your performance, and constantly seek improvement –Report honestly and with respect for patient confidentiality –Work cooperatively and with respect for other emergency professionals Moral Issues are related to individual perceptions of right and wrong.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Legal System

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Legal System Sources of Law –Constitutional Law Based on the Constitution People against governmental abuse –Common Law “Case law” or “judge-made law” Precedents set by the courts should be followed by other courts.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ The Legal System Sources of Law (cont.) –Legislative or Statutory Created by law-making or legislative bodies Takes precedence over common-law decisions –Administrative Enacted by an administrative or governmental agency at either the federal or state level

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Categories of Law Two General Categories of Law –Criminal Division of the legal system that deals with wrongs committed against society or its members –Civil Deals with non-criminal issues, such as personal injury, contract disputes, and matrimonial issues Tort Law is a branch of civil law

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Components of a Civil Lawsuit Incident Investigation Filing of complaint Answering complaint Discovery Trial Decision Appeal Settlement

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Laws Affecting EMS and the Paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Laws Affecting EMS and the Paramedic Scope of Practice Licensure and Certification Motor Vehicle Laws Mandatory Reporting Requirements Legal Protection for the Paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scope of Practice Range of duties and skills paramedics are allowed and expected to perform Most states have a “medical practice act” that governs the practice of medicine and all health care professionals –Describes how a physician may delegate authority

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Scope of Practice Paramedics should follow orders given by on-line and off-line medical direction Physician issues –Incorrect or harmful order –Intervener physician

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Licensure and Certification Certification –The recognition granted to an individual who has met predetermined qualifications to participate in a certain activity Licensure –A process used to regulate occupations generally granted by a governmental body to engage in a profession or occupation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Motor Vehicle Laws Vary from state to state Govern operation of emergency vehicles and the equipment they carry You must be familiar with state and local laws related to EMS vehicle operation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Mandatory Reporting Requirements Spouse abuse Child abuse and neglect Elder abuse Sexual assault Gunshot and stab wounds Animal bites Communicable diseases

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Protection for the Paramedic Immunity –Exemption from liability granted to governmental agencies Good Samaritan laws –Provide immunity to certain people who assist at the scene of a medical emergency Ryan White CARE Act –Requires notification and assistance to paramedics who have been exposed to certain diseases Local laws and regulations

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Accountability of the Paramedic

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Accountability of the Paramedic Paramedics are required to provide a level of care to patients that is consistent with their education and training. Care must be equal to that of any other competent paramedic with equivalent training. Duties must be performed in a reasonable and prudent manner.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Negligence Deviation from accepted standards of care recognized by law for the protection of others against the unreasonable risk of harm Components of a Negligence Claim –Duty to act –Breach of duty –Actual damages –Proximate cause

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Duty to Act A formal contractual or informal legal obligation to provide care The act of voluntarily assuming care of a patient may imply that there was a duty to act.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Breach of Duty An action or inaction that violates the standard of care expected from a paramedic –Malfeasance Performance of a wrongful or unlawful act by a paramedic –Misfeasance Performance of a legal act in a harmful or injurious manner –Nonfeasance Failure to perform a required act or duty

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Actual Damages Refers to compensable physical, psychological, or financial harm The plaintiff may also seek punitive (punishing) damages

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Proximate Cause An action or inaction that immediately caused or worsened the damage The plaintiff needs to prove that the damage to the patient was reasonably foreseeable by the paramedic.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Defenses to Negligence Charges Good Samaritan Laws Governmental Immunity Statute of Limitations Contributory or Comparative Negligence

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Liability Concerns Medical Direction Borrowed Servant Doctrine Civil Rights Off-Duty Paramedics

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Medical Direction The physician may be sued if a paramedic makes a mistake in the field causing harm to the patient –The on-line physician may be liable Physicians may be liable to the patient for the negligent supervision of the paramedic.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Borrowed Servant Doctrine The paramedic may supervise an EMT-I or EMT-B or others. It is your responsibility to make sure they perform their duties in a professional and medically appropriate manner. This doctrine includes students under your direction.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Civil Rights If medical care is withheld due to any discriminatory reason, a paramedic may be sued. Reasons include race, creed, color, gender, national origin, or ability to pay. All patients should be provided with appropriate care regardless of their status, condition, or disease.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Off-Duty Paramedics Generally, Good Samaritan laws protect medical personnel who respond off-duty. Performing advanced procedures that require delegation from a physician may constitute practicing medicine without a license.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic-Patient Relationships

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic-Patient Relationships Confidentiality Consent Refusal of Service Problem Patients

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Confidentiality The principle of law that prohibits the release of medical or other personal information about a patient without the patient’s consent –There are specific reasons for releasing information –The law provides penalties for the breach of confidentiality

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Confidentiality Health Insurance Portability and Accountability Act (HIPAA) –Added important new layers of privacy protection for EMS patients –Requires training for EMS personnel –Providers must develop administrative, electronic, and physical barriers to unauthorized disclosure.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Confidentiality Defamation –An intentional false communication that injures another person’s reputation or good name Libel involves written communication Slander involves spoken statements Invasion of Privacy –Release of confidential information, without legal justification, regarding a patient’s private life

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Consent The granting of permission to treat a patient Patient must be competent to give or withhold consent –A competent adult is one who is lucid and able to make an informed decision about medical care.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Informed Consent Consent based on full disclosure of the nature, risks, and benefits of a procedure –Nature of the illness or injury –Nature of the recommended treatments –Risks, dangers, and benefits of those treatments –Alternative treatment possibilities –Dangers of refusing treatment and/or transport

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Expressed Consent Verbal, nonverbal, or written communication by a patient who wishes to receive treatment The act of calling for EMS is generally considered an expression of the desire to receive treatment.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Implied Consent Consent for treatment that is presumed for a patient who is mentally, physically, or emotionally unable to give consent It is assumed that a patient would want life- saving treatment if able to give consent. Also called emergency doctrine

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Involuntary Consent Consent for treatment granted by a court order Used for patients who must be held for mental-health evaluation or as directed by law enforcement personnel who have the patient under arrest –A competent adult in police custody does not necessarily lose the right to make medical decisions for himself.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Special Consent Situations Minors –Usually a person under 18 years of age –Consent must be obtained from a parent or legal guardian –Emancipated minors Mentally incompetent adult –Consent must be obtained from the legal guardian

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Withdrawal of Consent A patient may withdraw consent for treatment at any time. Document the reason for refusal and your attempts to convince the patient to change his/her mind.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Refusal of Service Not every EMS run results in the transportation of the patient to the hospital. Emergency care must always be offered to the patient, no matter how minor the injury or illness.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Refusal of Service The refusal of care must be informed. Contact medical control if necessary. Document well.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Problem Patients Many patients can present you with a medical–legal dilemma. –Intoxication, drug abuse, violent, or children Every effort should be made to encourage the patient to accept care. Involve law enforcement. Document well.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Complications Related to Consent Abandonment –The termination of the paramedic-patient relationship without assurance that an equal or greater level of care will continue –Abandonment can occur at any point during patient contact. Leaving a patient unattended, even for a short time

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Complications Related to Consent Assault –Act of unlawfully placing a person in apprehension of immediate bodily harm without his or her consent Battery –The unlawful touching of another person without his or her consent

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Legal Complications Related to Consent False imprisonment –The intentional and unjustifiable detention of a person without his or her consent or other legal authority –This is a particular problem with psychiatric patients Guidelines –Determine whether medical treatment is immediately necessary –Does the patient pose a threat to himself or to the public

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Reasonable Force The minimal amount of force necessary to ensure that an unruly or violent person does not cause injury to himself, herself, or others Involve law enforcement if possible Restraints must conform to your local protocols

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Patient Transportation Maintain the same level of care as was initiated at the scene Know the closest, most appropriate facility Respect the patient’s choice of facility without putting patient care in jeopardy

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Resuscitation Issues

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Resuscitation Issues You are generally under obligation to begin resuscitative efforts when summoned to the scene of a patient who is unresponsive, pulseless, and apneic. There are times, however, when the paramedic will withhold resuscitation.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Withholding Resuscitation Valid DNR order Obvious signs of death Tissue decomposition or lividity Patients in an extremely hazardous atmosphere Protocols should address specific actions for situations involving death.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Advance Directives Patient Self-Determination Act of 1990 –Requires patients and families to be informed regarding severity of illness/injury An advance directive is a document created to ensure that certain treatment choices are honored –Living wills, durable powers of attorney for health care, Do Not Resuscitate orders, and organ donor cards

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Living Will Legal document that allows a person to specify the kinds of medical treatment he wishes to receive

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Do Not Resuscitate (DNR) Usually signed by the patient and his physician Establish which, if any, life-sustaining measures should be taken when the patient’s heart and respiratory functions have ceased.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Do Not Resuscitate (DNR) DNR orders pose a particular problem in the field Valid DNR orders should be honored as your protocols allow “Slow code” or “chemical code only” are not acceptable

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Potential Organ Donation EMS is a vital link to potential organ donation Protocols should specifically address organ viability after a patient’s death.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Death in the Field A death in the field must be appropriately dealt with and thoroughly documented. Consult on-line medical direction if necessary. Paramedics should carefully follow state and local protocols.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Crime and Accident Scenes

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Crime and Accident Scenes If you believe a crime has been committed, involve law enforcement. Protect yourself and other EMS personnel. Initiate patient care only when the scene is safe.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Crime and Accident Scenes Preserve the scene as much as possible: –Observe and document anything moved. –Leave gunshot or stabbing holes intact if possible. –If something must be moved, notify investigating officers and document your actions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Duty to Report Paramedics have an ethical duty to protect those at risk. –Abuse of the elderly, children, and the invalid You should report your concerns to the proper authority in an objective and timely manner. –Do not confront suspected abusers.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Documentation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Documentation A complete, well- written patient care report is your best protection in a malpractice action. The medical record should never be altered. © Jeff Forster

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Documentation Guidelines to Documentation –Complete promptly after patient contact –Be thorough –Be objective –Be accurate –Maintain patient confidentiality –Never alter a patient care record

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Legal Duties and Ethical Responsibilities The Legal System Laws Affecting EMS and the Paramedic Legal Accountability of the Paramedic Paramedic-Patient Relationships Resuscitation Issues Crime and Accident Scenes Documentation