Chapter 3 Legal Responsibilities of the EMT

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Knowledge of Standard of Care  Legal Duty to Act  Respect for Patients’ Rights  Obtaining Patient Consent  Documentation

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Overview  Initiating Resuscitation  Collaborating with Law Enforcement  Reporting Abuse  Common Allegations against EMTs  Protection against Lawsuits

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Knowledge of Standard of Care  The law requires that an EMT act within the guidelines that are recognized as appropriate for others within the same level of training

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 5 Legal Duty to Act  An EMT is under contractual obligation to respond to calls

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Respect for Patients’ Rights  Right to confidentiality –As in any medical field we are bound to confidentiality no matter what the case is; this is a trust between caregiver and patient in all aspects of medicine

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Respect for Patients’ Rights  Health Insurance Portability and Accountability Act (HIPAA)  Sought to allow portability and continuity  Standardization of administrative and financial data exchange  The protection of privacy, confidentiality, and security of health care information

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Respect for Patients’ Rights  Right to refuse care –To refuse care, the patient must be of sound mind –The patient must be an adult. –Base station contact must be made –There must be complete documentation –State and county protocols should be followed

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Respect for Patients’ Rights  Against medical advice –Base station contact is mandatory –The patient should be told the risks of not being transported and the benefits –A form should be filled out and signed by the patient and a witness

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Respect for Patients’ Rights  Do not resuscitate orders –An order written by a physician, after consultation with the patient or family (if the patient is unable to discuss treatment options) –Check your local protocols for specific documentation rules

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Stop and Review  State the legal obligations of the EMT.  What does duty to act mean?  Explain the importance of the patient’s right to confidentiality.

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Obtaining Patient Consent  Expressed or informed consent –A patient verbally agrees to treatment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Obtaining Patient Consent  Expressed or informed consent –A patient verbally agrees to treatment  Implied consent –The condition where an otherwise competent person would want to be treated  Children and consent –Children cannot give consent for themselves –Attempt contact with a parent or guardian –Use implied consent to treat the patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Obtaining Patient Consent  Children and consent –Children cannot give consent for themselves –Attempt contact with a parent or guardian –Use implied consent to treat the patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Obtaining Patient Consent  Prisoners and consent –Emergency doctrine: a legal principle that allows for emergency treatment of prisoners –Law enforcement will likely ride with you

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 Obtaining Patient Consent  Mentally disturbed patients –These patients can be treated under implied consent –May have to have law enforcement there to aid in an involuntary commitment –A mental health professional can also do an involuntary commitment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Stop and Review  Can an adolescent consent to care? Are there exceptions?  Who can consent for an adolescent? What if they are unavailable?  What is the difference about consent in the “Consent” case study?  Can an adolescent legally refuse care? Are there exceptions?  What duties does the EMT have for the teenager in the “Consent” case study?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Documentation  Be complete with documentation –Be sure you state why you use implied consent –If law enforcement or mental heath is involved, document the official’s name

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Initiating Resuscitation  Generally, resuscitation should be done unless: –The patient has a DNR –There are obvious signs of death: decapitation, lividity, rigor mortis, decomposition When in doubt resuscitate!

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Collaborating with Law Enforcement  Some emergency responses are also crime scenes  It is important to know how to respond in these situations and to preserve evidence to the best of one’s ability

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Collaborating with Law Enforcement  Motor vehicle collisions –You may be called to testify about scenes involving drunk drivers; these are crime scenes –Carefully document all of your findings with the scene and the patient

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Collaborating with Law Enforcement  Threat of violence on scene –Your safety is first! –Stage away until you know it is safe –If you are on a scene that becomes unsafe for you, leave immediately--without the patient if necessary –Be aware of weapons or objects that may be used as weapons

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Collaborating with Law Enforcement  Physical restraint of combative patients –Restraints may be used if the patient is a threat to himself or others –Refer to local laws –Always restrain face up –Calling law enforcement is advised

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Reporting Abuse  Child abuse –Any act of physical, sexual, or psychological maltreatment  Domestic violence –Acts of violence against a spouse, partner, or family member  Elder abuse –An act of violence toward or neglect of an elderly person

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Stop and Review  What is the legal importance of documentation?  Under what circumstances can resuscitation be withheld?  How does EMS collaborate with law enforcement?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Common Allegations against EMTs  In a 1999 study published in the Journal of Emergency Medicine –72% of lawsuits were the result of motor vehicle accidents involving an emergency vehicle –35% of lawsuits were related to medical negligence

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Common Allegations against EMTs  Ambulance collisions and liability –When driving an emergency vehicle, the EMT has a responsibility to the crew, patients, other motorists, and pedestrians to operate in a safe manner –You can be held responsible for collisions in many cases –Emergency vehicle accident prevention classes are available nationwide

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Common Allegations against EMTs  Negligence –Duty to act –Breach of duty –Causation of injury –Damages occurred

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Common Allegations against EMTs  Patient abandonment –Begin care and leave the patient –You must turn the patient over to someone of equal or higher care

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Common Allegations against EMTs  Breach of confidentiality –The EMT holds privileged information and is expected to keep it in the strictest of confidence

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Common Allegations against EMTs  Assault –A patient is afraid that he or she may be touched without consent  Battery –The actual act of being touched without consent  Good Samaritan Act –The legislation to protect you in your off duty time if you render care within your scope of practice; this is also known as immunity statutes

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Protection against Lawsuits  Good Samaritan Act –The legislation to protect you in your off duty time if you render care within your scope of practice; this is also known as immunity statutes

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Protection against Lawsuits  Best practices –The best strategy to avoid litigation is to use common sense in everyday practice

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Stop and Review  What is necessary to prove a case of negligence?  What should be included in documentation to avoid a lawsuit claiming negligence?  What laws help protect the EMT against litigation?