2. Legal and Ethical Aspects of Emergency Medical Services

3. Lesson Goal
Outline potential ethical dilemmas & provide simple approach to resolving those dilemmas
Identify & define legal implications of working in EMS

4. Introduction Many laws & ethical principles apply to EMS work
Be aware of how these issues relate to decisions

5. Scope of Potential Liability
Medical errors—8th leading cause of death
50, ,000 Americans die each year because of medical errors

6. Scope of Potential Liability
EMTs operate in unique environment
Most lawsuits in EMS arise from vehicle accidents
Root cause of many lawsuits—EMT’s attitude & behavior

7. Key Areas of EMS Law Levels of certification Training requirements
Scope of practice
Standard of care
Requirements for certification
Complaints against providers
Disciplinary actions
Legal protection
Patients’ rights
Emergency vehicle operations
Workplace safety

8. EMT’s Responsibility Appropriate, timely, compassionate care
Reporting of crimes
Child abuse
Elder abuse
Ethical dilemmas—common

9. Duty to Act & Standard of Care
Primary ethical responsibility
Provide appropriate care
On call
Good Samaritan
Standard of Care
Clinical & technical standards trained to perform

10. Guiding Ethical Principles
Patients’ autonomy
Patients’ best interests
First, do no harm
Fairness

11. Ethical Issues
What is a “good quality of life”?
Organ donation

12. Handling Unethical Situations
Consider your own beliefs
Promote workplace culture of honesty, integrity, & communication

13. Negligence Ordinary negligence 4 elements Duty to act Breach of duty
Causation
Harm

14. Negligence Immunity defense Gross negligence Good Samaritan laws
Always act in good faith

15. Negligence Personal risk management Be well educated Be well rested
Know & follow protocols
Maintain skills & knowledge

16. Attitudes & Communication
Create a positive impression
Well rested & alert
Professional appearance
Confidence
Empathy
Communication skills

17. Attitudes & Communication
Get on patient’s level
Introduce yourself
Explain what you are doing
Reassure patient
Do not make false promises
Provide basic comfort
Communicate with family

18. Attitudes & Communication
Smile
Use comforting tone
Avoid extraneous chatter
Be efficient
Say goodbye at end of call

19. ABANDONMENT Terminating care without legal excuse.
Turning pt. over to lesser qualified personnel

20. Consent Must be obtained Implied Expressed/actual
Limited to TRUE EMERGENCY situations
Unconscious
Delusional
Unresponsive
Physically unable to express consent
Minors
Expressed/actual
-Consent must be “informed”
permission for care of her/himself

21. Refusal Competency—legal status
Decision-making capacity—clinical determination

22. Refusal
Ethics
Patient must be informed of meaning & consequences of refusal
The time informed refusal takes is worthwhile

23. Refusal Make sure patient understands Treatment Risks Alternatives
Consequences of not being treated

24. Refusal Considerations Make sure patient understands
Make reasonable attempts to persuade patient
Make sure decision is not coerced
Document discussion
Know who can refuse on patient’s behalf
Err on side of treatment

25. Refusal Legally Patients’ rights to self-determination
Assessing decision-making capacity
Patients can refuse some or all interventions

26. Refusal
A3E3P3 Guidelines
3 As
Assess
Advise
Avoid

27. Refusal
A3E3P3 Guidelines
3 Es
Ensure
Explain
Exploit (uncertainty)

28. Refusal A3E3P3 Guidelines 3 Ps Persist Protocols Protect
Refusal signed
Documentation

29. “Law enforcement on scene on our arrival. Pt
“Law enforcement on scene on our arrival. Pt. had been unresponsive prior to EMS arrival per Sgt. Ulrickson. On EMS arrival Pt. was awake, agitated and refused assessment, treatment or transport. No injuries noted on visual assessment. Pt. denied injury. Stated he laid down on sidewalk to ‘take a power nap’. Pt. able to move all extremities equally—insisted on standing up. Gait unsteady. Alert to time, place, date. Refusal signed. Pt. advised he could call EMS or seek further medical assistance at any time. Pt. escorted home by friends.”

30. Living Wills & Advance Directives
Durable power of attorney
DNR orders

31. Advance Directives in Montana EMS
Comfort One
POLST

32. Scope of Practice Issues
Definition: procedures, actions, and processes that are permitted for the licensed individual—limited to that which the law allows for education, experience, and competency.
EMS providers must always act within their scopes of practice

33. Documentation The patient care report (PCR) Has many purposes
Is a reflection on YOU
Includes written and verbal

34. Patients’ Rights
Confidentiality & privacy are both legal and ethical issues

35. Patients’ Rights
HIPAA
Policies for release of PCRs
Superprotection

36. Patients’ Rights Restraints—When and How
When patient is physical threat to himself or others.
Contact medical control, if possible.
Restrain as little as possible.
Involve Law Enforcement, if necessary.
Circa 1752

37. Incident Reports Unusual occurrences Prevent recurrences Individuals
System

38. Future of EMS Law Anticipate regulations as profession matures
Reduce potential for litigation
Professional approach
Reduce errors
Maintain training
Team work

39. Summary EMTs act within an ethical & legal context Common issues
Certification/licensure
Scope of practice
Consent & refusal
Negligence
Resuscitation decisions

40. Summary Lawsuits Vehicle collisions Breech of confidentiality
EMTs’ behavior & attitudes
Personal responsibility & risk reduction

41. QUESTIONS??