1. Chapter 3 Medical, Legal, and Ethical Issues Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

2. CASE STUDY Dispatch

3. EMS Unit 105 Proceed to 733 East Third Street for an elderly male with abdominal pain. Time out 1430

4. Upon Arrival You find an elderly female at the door The house is so cluttered you can barely pass through Male lying on bed moaning; undergarments stained Room is very cold

5. How would you proceed?

6. Back to Topics The Scope of Practice

7. Legal Duties Back to Objectives

8. Scope of practice Standard of care (© Craig Jackson/In the Dark Photography)

9. Legal Duties Duty to Act Back to Objectives

10. Duty to act Duty to patient Duty to self Duty to your partner Duty for your equipment (© Sun Herald/Corbis ) Back to Objectives

11. Legal Duties Good Samaritan Laws Back to Objectives

12. Enacted in 1959 in California For unpaid services Does not prevent you from being sued (© Mark C. Ide)

13. Legal Duties Other Legal Protections Back to Objectives

14. Sovereign immunity Statute of limitations Contributory negligence

15. Legal Duties Medical Direction Back to Objectives

16. Follow standing orders as approved by medical direction Establish communication with medical direction as needed

17. Ethical Responsibilities Back to Objectives

18. Ethics Morals Code of ethics Back to Objectives

19. Back to Topics Issues of Patient Consent and Refusal

20. Types of Consent Back to Objectives

21. Informed consent Expressed consent Implied consent Consent to treat a minor Involuntary consent

22. Advance Directives Back to Objectives

23. Do not resuscitate order (DNR) Living will Durable power of attorney Physician order for life-sustaining treatment (POLST)

24. Know your state’s laws and protocols DNR must be present Make sure it is valid If there are any questions, start resuscitation

25. Refusing Treatment Competency Back to Objectives

26. Patient must be lucid and capable of making an informed decision You must make patient fully aware of the consequences

27. Refusing Treatment Protecting Yourself In Refusal Situations

28. Try again to persuade the patient Make sure the patient is competent Any questions, contact medical direction Encourage the patient to seek help later Document, document, document

29. Back to Topics Other Legal Aspects of Emergency Care

30. Negligence Back to Objectives

31. Criminal Civil Tort Negligence Back to Objectives

32. The EMT had a duty to act The EMT breached that duty to act The patient suffered injury or harm The injuries were the result of the breach of the duty Four Elements to Prove

33. Negligence Duty to Act

34. Obligation to respond to the scene and provide emergency care to patient

35. Negligence Breach of Duty to Act

36. Negligence Simple negligence Gross negligence

37. Negligence Damages

38. Damages refers to injuries that are real, demonstrable, and recognizable by the law. (© David Handschuh)

39. Negligence Proximate Cause

40. Injuries a direct result of EMT negligence

41. Intentional Tort Back to Objectives

42. Action knowingly committed by an individual that is considered to be civilly wrong according to the law

43. Intentional Tort Abandonment

44. Stopping treatment without transferring care to another professional of equal or higher training

45. Intentional Tort Assault and Battery

46. Assault Battery

47. Intentional Tort False Imprisonment or Kidnapping

48. Transporting a competent patient without his consent

49. Intentional Tort Defamation

50. Slander Libel

51. Confidentiality Back to Objectives

52. Know your jurisdiction's laws Release information only in specific cases

53. Health Insurance Portability and Accountability Act (HIPAA)

54. Federal law that protects the privacy of patient health care information

55. COBRA and EMTALA Back to Objectives

56. Consolidated Omnibus Budget Reconciliation Act (COBRA) Emergency Medical Treatment and Active Labor Act (EMTALA)

57. Protecting Yourself in Transport and Transfer Situations Back to Objectives

58. Get a full report about the patient’s condition Ensure you can provide appropriate level of care Obtain signed informed consent form Obtain written certification of transfer from physician Know where you are going; take the quickest possible route (©Maria A.H. Lyle)

59. Special Situations Donors and Organ Harvesting Back to Objectives

60. Identify patient as potential donor Relay information to hospital Provide emergency care

61. Special Situations Medical Identification Insignia

62. Look for tags identifying medical conditions Look on wrist, around neck, or on a card

63. Special Situations Recognizing Death in the Field Back to Objectives

64. No pulse, breathing, or breath sounds Complete unresponsiveness No pupil response Absence of a blood pressure No reflexes Presumptive Signs of Death

65. Obvious Signs Decapitation Rigor mortis Decomposition Dependent lividity

66. Special Situations Crime Scenes Back to Objectives

67. Observe and document the unusual Do not cut through holes from bullet or stab wounds (© Craig Jackson/In the Dark Photography) Scene safety Take one way in and out Touch only what you have to Tell police if you move or touch anything

68. Special Situations Special Reporting Situations Back to Objectives

69. Abuse Crime Drug-related injuries (© Robert A. Felter, M.D.)

70. Follow-Up CASE STUDY

71. Assessment CASE STUDY S: conscious but disoriented; complains of abdominal pain; no signs of acute distress AMPLE: unable to obtain from patient or wife

72. Assessment CASE STUDY Wife appears not to understand situation No change in condition during transport

73. An Ethical Obligation CASE STUDY After transfer to hospital personnel, you contact social services; believe it is elderly neglect Two weeks later you are told patient was diagnosed with a gastric ulcer and organic brain syndrome

74. An Ethical Obligation CASE STUDY Mrs. Schuman, wife, diagnosed with Alzheimer’s disease Both are now residents of extended-care nursing home

75. 34-year-old female patient complaining of abdominal pain Upon arrival, you find the patient lying in bed She is alert and holding her abdomen She states that she is having bad “belly pain” Pain began about an hour ago Critical Thinking Scenario

76. You perform an assessment, place the patient on oxygen, and prepare for transport The patient suddenly states, “I don’t want to go to the hospital” Critical Thinking Scenario

77. 1.How would you initially gain consent from this patient? 2.How would you manage the patient’s refusal to be transported? 3.What legal issues may you face if you continue with treatment and transport? Critical Thinking Questions