Medical, Legal and Ethical Issues

Medical Responsibilities

Scope of Practice The range of duties and skills that emergency medical technicians are allowed and expected to perform.

Scope of Practice  Defined by state law  Outlines care you can provide  Further defined in protocols and standing orders  Authorized through online and off- line medical direction

Standard of Care The degree of skill and judgment expected of an individual when caring for a patient and is defined by training, protocols, and the expected actions of the care providers with similar training and experience, working under similar conditions

Standard of Care  Standard imposed by local custom  Often based on locally accepted protocols  Standard imposed by the law  May be imposed by statutes, ordinances, administrative guidelines, or case law

Standard of Care  Professional or institutional standards  Recommendations published by organizations and societies  Specific rules and procedures of your service or organization

WA State Standards  Authorized care under RCW  Medical Practices Act  Exempts EMT-Bs from licensure requirements  Certification  Process of evaluating and recognizing that EMT-B has met certain predetermined standards

Legal Issues and Liability

Legal Protection  EMS Immunity Act  Governmental (Sovereign) Immunity  “Good Samaritan” Laws  Do not prevent lawsuits  Offer a defense for those who act in “Good Faith” and meet the Standard of Care”  Do not protect against Gross Negligence

Negligence Failure to provide the same care that a person with similar training would provide Failure to provide the same care that a person with similar training would provide

Negligence  Duty  Responsibility to act reasonably based on standard of care  Breech of duty  Failure to act within the expected and reasonable standard of care  Damages  Physical or mental harm created in a noticeable way  Cause  Existence of reasonable cause and effect

Duty to Act  Individual’s responsibility to provide patient care.  Responsibility to provide care comes from either statute or function.  Legal duty to act begins once an ambulance responds to a call or treatment is initiated.

Confidentiality  Information received from or about a patient is considered confidential.  Disclosing information without permission is considered a breach of confidentiality.  Generally, information can only be disclosed if the patient signs a written release.

HIPAA  Health Insurance Portability and Accountability Act of 1996  Amends IRC of 1986 to improve portability and continuity of health insurance coverage in group and individual markets  Federal law mandates privacy and confidentiality in all issues regarding patient care

Adult Consent  Adult - Any person over 18 years of age who is not under a court-ordered disability  Actual Consent (Informed, Expressed)  Implied Consent  Pt. is unconscious or unable to communicate and is suffering from what appears to be a life-threatening injury or illness

Adult Consent  Involuntary Consent  An adult may be treated against his will only if:  Treatment is ordered by a magistrate  Treatment is ordered by a peace officer or corrections officer who has the patient under arrest or in custody  Consent of the Mentally Ill

Adult Consent  Right of Refusal of Treatment/Transport  Mentally competent adults have the right to refuse care  The person must be informed of risks, benefits, treatments, & alternatives  Remember to document and obtain signatures of patient & witness

Minor Consent  Minor - any person under 18 years of age who has never been married and who has not had his/her minority status changed by the court  Actual Consent (Informed, Expressed)  Parents  Guardian  Others Closely Related of Majority Age

Minor Consent  Emancipated Minors  Under 18, married, pregnant, a parent, member of the armed forces, financially independent and living away form home  Implied Consent  Life or Limb Threatening  No Parental Refusal

Minor Consent  Right of Refusal of Treatment/Transport  Mentally competent adults (Parent/Guardian) have the right to refuse care for their children  The person (Parent/Guardian) must be informed of risks, benefits, treatments, & alternatives  Remember to document and obtain signatures of Parent/Guardian & witness

Refusal of Treatment  Mentally competent adults have the right to refuse care.  Patients must be informed of risks, benefits, treatments, and alternatives.  EMT-B should obtain a signature and have a witness present, if possible.

Abandonment  Termination of care without patient’s consent  Termination of care without provisions for continued care  Care cannot stop unless someone of equal or higher training takes over

Assault & Battery  Assault  Unlawfully placing a person in fear of immediate bodily harm without consent  Battery  Unlawfully toughing a person

Libel and Slander  Libel  The act of injuring a person’s character, name, or reputation by false or malicious written statements  Slander  The act of injuring a person’s character, name, or reputation by false or malicious spoken statements

Advance Directives  Specifies medical treatments desired if patient is unable to make decisions  Do not resuscitate (DNR) orders  Patients have the right to refuse resuscitative efforts.  Require a written order from one or more physicians  When in doubt, begin resuscitation.

Advance Directives  POLST Orders  WA State DNR Form  Living Wills or Advance Directives  Must be Presented upon Patient Contact  Specifics of care?  Determine validity  May not be witnessed by anyone who would benefit from the death of the patient

Special Situations  Organ donors  Medical identification insignia

EMT Ethics

Ethical Responsibilities  Make the physical/emotional needs of the patient a priority.  Practice/maintain skills to the point of mastery.  Critically review performances.  Attend continuing education/refresher programs.  Be honest in reporting.