Silver Cross EMS System November 2015 EMD CE

 Laws differ from one state to another, so EMDs should learn the specific laws that apply in their state or jurisdiction. As an EMD you are responsible to follow state, dispatch center and local EMS system protocols.  Do not lose sight of these concepts: ◦ Above all else, do no harm. ◦ Provide all your care in good faith. ◦ Provide proper consistent care, be compassionate, and maintain your composure.

 Your best protection from liability is to perform a thorough initial caller survey, provide appropriate medical care based on the current EMDPRS, and maintain accurate and complete records.

 Promptly respond to the needs of every caller.  Dispatch appropriate units to the correct address.  Maintain your skills and medical knowledge.  Participate in continuing education.  Critically review your performance, and constantly seek improvement.  Report honestly.

 Something that one is obligated to do. Holds you ultimately responsible for your actions. You and your agency can be held liable for damages that may occur as a result of your actions, practices or conduct.

 Failure to Dispatch  Delay in Dispatch  Failure to Properly Prioritize Calls  Failure to Send Units to the Correct Address  Sending the Wrong Unit to Call

 Constitutional ◦ Based on the U.S. Constitution  Common ◦ Derived from society’s acceptance of customs and norms  Legislative ◦ Created by lawmaking bodies such as Congress and state assemblies  Administrative ◦ Enacted by governmental agencies at either federal or state levels

 Criminal ◦ Division of the legal system that deals with wrongs committed against society or its members  Civil ◦ Division of the legal system that deals with non- criminal issues and conflicts between two or more parties  Tort ◦ A civil wrong committed by one individual against another

 Incident  Investigation  Filing of complaint  Answering complaint  Discovery  Trial  Decision  Appeal  Settlement

 Scope of care is defined by: ◦ The US Department of Transportation, Emergency Medical Dispatcher National Standards ◦ Medical protocols or standing orders, EMDPRS What you are allowed to do, based on your training and protocols.

 The standard of care is the manner in which you must act or behave.  You must meet two criteria: ◦ You must treat the patient to the best of your ability. ◦ You must provide care that a reasonable, prudent person with similar training would provide under similar circumstances.

 Good Samaritan laws provide protection to persons ◦ Acting in emergencies ◦ Acting in “good faith” to the best of your ability ◦ Acting without regard to financial compensation or reward ◦ Not guilty of gross negligence or malicious misconduct toward victim

 Deviation from accepted standards of care recognized by law for the protection of others against the unreasonable risk of harm  Simple Negligence: conduct that was not purposeful or malicious. An honest mistake.  Gross Negligence: Action that was undertaken with malicious intent. Didn’t follow policy.

 Duty to act  Breach of duty  Actual damages  Proximate cause

 A formal contractual or informal legal obligation to provide care Breach of Duty An action or inaction that violates the standard of care expected from an EMD

 Malfeasance ◦ Performance of a wrongful or unlawful act  Misfeasance ◦ Performance of a legal act in a harmful or injurious manner  Nonfeasance ◦ Failure to perform a required act or duty

 Refers to compensable physical, psychological, or financial harm Proximate Cause An action or inaction that immediately caused or worsened the damage

 All EMS providers that function within an EMS System, function under the authority of the EMS Medical Director  EMDPRS are reviewed and approved by the EMS Medical Director

 If medical care is withheld due to any discriminatory reason, an EMS provider may be sued. ◦ Examples:  Race  Creed  Color  Gender  Sexual orientation  National origin  Ability to pay (in some cases)

 Confidentiality ◦ The principle of law that prohibits the release of medical or other personal information about a patient without the patient’s consent ◦ Health Insurance Portability and Accountability Act (HIPAA)

 Established in 1996 ◦ Changed the methods EMS providers use to file for insurance and Medicare payments. ◦ Patients are given the right to inspect and copy their health records.  Privacy protection for EMS patients ◦ All EMS employees must be trained in HIPAA compliance. ◦ EMS providers must develop barriers to unauthorized disclosure of patients’ protected health information. ◦ Disclosures of information—except for treatment, obtaining payment, health care operations, and disclosures mandated or permitted by law—must be preauthorized in writing. ◦ HIPAA requires providers to post notices in prominent places advising patients of their privacy rights. ◦ HIPAA provides both civil and serious criminal penalties for violations of privacy.

 According to Public Safety Communications online, August 26, 2010 edition, HIPAA only applies to “covered agencies”. ◦ General rules of thumb are: 1) nearly all ambulance services and other health-care providers (facilities, physicians, etc.) are covered entities, and 2) most dispatch agencies are not covered entities. Thus, these organizations may freely communicate protected health information, through any means and to any party without violating the privacy regulations. Fortunately, HIPAA permits any disclosures of PHI that are necessary for patient treatment purposes. View full article here:

 Defamation ◦ An intentional false communication that injures another person’s reputation or good name  Libel ◦ The act of injuring a person’s character, name, or reputation by false statements made in writing or through the mass media  With malicious intent or reckless disregard for the falsity of those statements  Slander ◦ The act of injuring a person’s character, name, or reputation by false or malicious statements spoken.  With malicious intent or reckless disregard for the falsity of those statements

 Attempt to develop trust and some rapport with patient.  Regardless of type of problem patient, always document encounter in detail.

 Abandonment occurs when a trained person begins emergency care and then leaves the patient before another trained person takes over. Once you have started treatment, you must continue it until a person who has at least as much training arrives and takes over.

 Assault 720 ILCS 5/12-1: A person commits an assault when, without lawful authority, he engages in conduct which places another in reasonable apprehension of receiving a battery. (Class C Misdemeanor)  Battery 720 ILCS 5/12-3: A person commits battery if he intentionally or knowingly without legal justification and by any means, (1) causes bodily harm to an individual or (2) makes physical contact of an insulting or provoking nature with an individual. (Class A Misdemeanor)

 Reasonable force The minimal amount of force necessary to ensure that an unruly or violent person does not injure themselves or others.  False imprisonment The intentional and unjustifiable detention of a person without his or her consent or other legal authority (IL – Unlawful Restraint – 720 ILCS 5/10-3)

 A document created to ensure that certain treatment choices are honored when a patient is unconscious or otherwise unable to express his or her choice of treatment

Do Not Resuscitate Order (DNR) indicates which, if any, life- sustaining measures should be taken when the patient’s heart and respiratory functions have ceased.

 In Illinois, a photocopy of a DNR is valid as long as it is a full copy.  The DNR must travel with the patient. ◦ The family or nursing home staff must give the DNR or a copy to EMS before transport.  A durable power of attorney for health care ◦ Allows a patient to designate another person to make decisions about medical care

 If there is any indication that a person is alive, you should begin providing care instructions.  You cannot assume a person is dead unless one of these conditions exists: ◦ Decapitation ◦ Rigor mortis (stiffening of muscles) ◦ Tissue decomposition ◦ Dependent lividity (blood pooling)

 If you believe a crime has been committed, involve law enforcement.  Protect victims and callers.  Initiate patient care only when the scene is safe.  Encourage caller to preserve evidence at crime scenes.

 Silver Cross EMSS August 2012 System CME  Will County EMDPRS, April 2012  NHTSA EMD National Standard Curriculum, 1996  AAOS Emergency Medical Responder, 5 th Edition  Public Safety Communications Online, APCO International.org