1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Introduction to Emergency Medical Care 1

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Scope of Practice

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Scope of Practice Regulations and ethical considerations that define extent or limits of job duties May include skills and procedures Determined by national, state, local laws, statutes, and protocols

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Standard of Care Care expected from EMT with similar training for patient in a similar situation Meeting standard of care reduces risk of legal action Scope of practice: what you can do Standard of care: how you should do it

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Ethics Morals or standards governing actions Not always required by law “Golden Rule” standard Very important in EMS Good ethical behavior—what you do when no one is looking

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Legal Issues in Health Care Video Click on the screenshot to view a video on the topic of legal issues in health care. Back to Directory

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient Consent and Refusal

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient Consent Permission from patient to assess, treat, and transport Expressed consent –Must be informed Implied consent –Assumed consent –Follow local laws and protocols

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Consent for Children Minors not permitted to provide consent for treatment Obtain from parent or legal guardian Possible exceptions (check local law) –In loco parentis –Emancipated minors –Life-threatening illness or injury –Minors who have children –Minors serving in armed forces

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Consent for Mentally Incompetent Adults Adult patients incapable of informed decisions about care State and local laws and protocols permit transport of such patients under implied consent

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Involuntary Transportation Patient considered threat to self or others Court order Usually requires decision by mental health professional or police officer If patient restrained, must not risk legal liability

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Refusal of Care Patient may refuse care or transport –Legally able to consent –Mentally competent and oriented –Fully informed of risks –Sign release form Despite all precautions, EMT may still be held liable

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson If in Doubt About Refusal Discuss decision with patient Ensure patient understands risks Consult medical direction Ask to contact family member Contact law enforcement Listen to patient to determine why refusing care

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It What are the risks of beginning treatment and/or transport without getting consent from the patient? What if the patient refuses to sign the refusal of care form?

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Things to Consider During Refusal Have witnesses to refusal Inform patient that if changes mind, can call back If possible have friend or relative remain with patient Document, document, document

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Advance Directives Legal document expressing patient’s wishes if patient unable to speak for self Do not resuscitate order (DNR) Living will Health care proxy Does not prevent EMT from providing comfort measures

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Physical Signs of Death (1 of 4) A physician determines cause of death. Presumptive signs of death: –Unresponsiveness to painful stimuli –Lack of a carotid pulse or heartbeat –Absence of breath sounds –No deep tendon or corneal reflexes

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Physical Signs of Death (3 of 4) Definitive signs of death: –A body in parts (decapitation) –Dependent lividity (blood settling)

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Physical Signs of Death (2 of 4) Presumptive signs of death (cont’d): –Absence of eye movement –No systolic blood pressure –Profound cyanosis –Lowered or decreased body temperature

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Physical Signs of Death (4 of 4) Definitive signs of death (cont’d): –Rigor mortis (stiffening) –Putrefaction (decomposition)

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Examiner Cases (1 of 2) Involvement depends on nature/scene of death. Examiner notified in cases of: –Dead on arrival (DOA)/dead on scene (DOS) –Death without previous medical care –Suicide –Violent death

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Examiner Cases (2 of 2) Examiner notified in cases of (cont’d): –Poisoning, known or suspected –Death from accidents –Suspicion of a criminal act Source: © Corbis

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Assault and Battery, and Kidnapping (1 of 2) Assault: Unlawfully placing person in fear of immediate bodily harm –Example: restraint Battery: Unlawfully touching a person –Example: providing care without consent

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Assault and Battery, and Kidnapping (2 of 2) Kidnapping: Seizing, confining, abducting, or carrying away by force –Example: transport against will –A false imprisonment charge is more likely (defined as unauthorized confinement of a person).

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Defamation (1 of 2) Communication of false information that damages reputation of a person –Libel if written –Slander if spoken

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Defamation (2 of 2) Defamation could happen with: –False statement on a run report –Inappropriate comments made during conversation Run report should be accurate, relevant, and factual.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Other Legal Issues

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Duty to Act Obligation to provide care While on duty, EMT obligated to provide care if no threat to safety Duty to act not always clear –Off duty –On duty, out of jurisdiction Follow local laws and protocols Follow own conscience

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Negligence Something was not done, or was done incorrectly Must prove: –EMT had duty to act –Breach of duty—EMT failed to provide standard of care expected or failed to act –Proximate causation—patient suffered harm because of EMT action or inaction continued

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Negligence Negligent EMT may be required to pay damages Res ipsa loquitur (the thing speaks for itself): legal concept important in negligence cases

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Abandonment Once care initiated, may not be discontinued until transferred to medical personnel of equal or greater training Failure to do so may constitute abandonment

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Good Samaritan Laws Grant immunity from liability if person acts in good faith within level of training Rarely applies to on-duty personnel May not cover EMTs in some situations Does not protect persons from gross negligence or violations of law

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It You arrive on the scene of a patient in cardiac arrest. The family says she has a DNR, but don’t know where it is. How should you handle this? You are off duty and arrive on the scene of a vehicle crash. Police and EMS have not yet arrived. Are you legally obligated to stop and render aid?

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Confidentiality Information on patient’s history, condition, treatment considered confidential Can be shared with other health care personnel as part of patient’s continuing care Otherwise must be obtained through subpoena

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medical Identification Devices

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Organ Donor Person with completed legal document allowing donation of organs and tissues in event of death May be identified by family members, donor card, driver’s license Receiving hospital and/or medical direction should be advised per protocol

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Safe Haven Laws Allow person to drop an infant or child at any fire, police, or EMS station States have different guidelines for ages of children included Protect children who may otherwise be abandoned or harmed by parents unwilling or unable to care for them

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Crime Scenes Location where crime was committed or anywhere evidence may be found Once police have made scene safe, EMT’s priority is patient care Know what evidence is Take steps to preserve evidence

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Examples of Evidence Condition of scene Patient Fingerprints and footprints Microscopic evidence

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Evidence Preservation Remember what you touch Minimize impact on scene Work with police If patient transported on your stretcher, stretcher sheet may be valuable source of evidence Document thoroughly

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Mandatory Reporting Guidelines Child, elderly, or domestic abuse Sexual assault Stab/gunshot wounds Animal attacks Check local laws and protocols

42. The EMT in Court (1 of 5) You can end up in court as a: –Witness –Defendant Case can be civil or criminal. Source: © Photodisc

43. The EMT in Court (2 of 5) Whenever called to testify, notify: –Your service director –Legal counsel As witness: –Remain neutral –Review run report before court

44. The EMT in Court (3 of 5) As a defendant, an attorney is required. Defenses may include: –Statute of limitations –Governmental immunity –Contributory negligence

45. The EMT in Court (4 of 5) Discovery allows both sides to obtain more information through: –Interrogatories Written requests or questions –Depositions Oral requests or questions

46. The EMT in Court (5 of 5) Most cases are settled following the discovery phase during the settlement phase. If not settled, the case goes to trial Damages that may be awarded: –Compensatory damages –Punitive damages

47. Records and Reports (1 of 3) Compile record for all incidents involving sick or injured patients Important safeguard against legal complications

48. Records and Reports (2 of 3) Courts consider: –An action not recorded was not performed –Incomplete or untidy reports is evidence of poor emergency medical care