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 Chapter 3 Medical, Legal, and Ethical Issues

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson National EMS Education Standard Competencies (1 of 3) Preparatory Applies fundamental knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical issues to the provision of emergency care.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson National EMS Education Standard Competencies (2 of 3) Medical/Legal and Ethics Consent/refusal of care Confidentiality Advanced directives Tort and criminal actions Evidence preservation Statutory responsibilities

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson National EMS Education Standard Competencies (3 of 3) Medical/Legal and Ethics (cont’d): Mandatory reporting Ethical principles/moral obligations End-of-life issues

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 4.1Define key terms introduced in this chapter. Slides 11–12, 14, 16–22, 24, 26–32, 34–35, 39 11–121416–222426–3234–3539 4.2Describe your scope of practice as an EMT. Slides 11–12 11–12 4.3Differentiate between scope of practice and standard of care. Slide 1212 4.4Given a variety of scenarios, determine which type of patient consent applies. Slides 16–1916–19 continued

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 4.5Given a variety of ethical dilemmas, discuss the issues that must be considered in each situation. Slides 13, 301330 4.6Explain legal and ethical considerations in situations where patients refuse care. Slides 20–2320–23 4.7Discuss the EMT’s obligations with respect to advance directives, including do not resuscitate orders. Slide 2424 continued

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 4.8Given a variety of scenarios, identify circumstances that may allow a claim of negligence to be established. Slides 27–3027–30 4.9Explain the purpose of Good Samaritan laws. Slide 30 30 4.10Identify situations that would constitute a breach of patient confidentiality. Slide 3232 continued

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Objectives continued OBJECTIVES 4.11Identify situations that would constitute libel or slander. Slide 3232 4.12Recognize medical identification devices and organ donor status. Slides 33–3433–34 4.13List items that may be considered evidence at a crime scene. Slide 3939

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 4.14Describe ways in which you can minimize your impact on evidence while meeting your obligations to care for your patient. Slides 36, 383638 4.15Recognize situations that may legally require reporting to authorities. Slide 3939 4.16Given a scenario involving an ethical challenge, decide the most appropriate response for an EMT. Slides 22, 45–462245–46

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson MULTIMEDIA Slide 14Legal Issues in Healthcare VideoSlide 14Legal Issues in Healthcare Video

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The scope of practice of an EMT How a patient may consent to or refuse emergency care The legal concepts of negligence, torts, and abandonment What it means to have a duty to act The responsibilities of an EMT at a crime scene CORE CONCEPTS

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Topics Scope of Practice Patient Consent and Refusal Other Legal Issues

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Introduction (1 of 2) A basic principle of emergency care is to do no further harm. A health care provider usually avoids legal exposure if he or she acts: –In good faith –According to an appropriate standard of care

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Introduction (2 of 2) The EMT is often the first link in the chain of prehospital care. Litigation against EMS will increase due to wider availability and more complex care.

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

17. 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

18. 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

19. 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

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

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

22. 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

23. 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

24. 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

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Expressed Consent Patient acknowledges he or she wants you to provide care or transport. To be valid, patient must provide informed consent. –You have explained treatment, risks, and benefits to patient.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient of legal age and rational Must be informed consent Must be obtained from conscious, competent adults before treatment Consent: Expressed

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Implied Consent (1 of 2) Applies to patients who are –Unconscious –Otherwise incapable of making informed decision Source: © Dan Myers

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Implied Consent (2 of 2) Should never be used unless there is a threat to life or limb. Principle of implied consent is known as the emergency doctrine. Good to get consent from a spouse or relative.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Consent implied for unconscious patient Based on the assumption the patient would consent if conscious Consent: Implied

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Consent required from parent/guardian Consent implied in life-threatening emergency State regulations vary for age and emancipation Consent: Children and Incompetent Adults

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Involuntary Consent Applies to patients who are: –Mentally ill –In behavioral crisis –Developmentally delayed Obtain consent from guardian –Not always possible, so understand local provisions

32. 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

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The Right to Refuse Treatment (1 of 2) Conscious, alert adults with decision- making capacity: –Have the right to refuse treatment –Can withdraw from treatment at any time –Even if the result is death or serious injury Places burden on EMT to clarify need for treatment

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The Right to Refuse Treatment (2 of 2) Before you leave a scene where a patient, parent, or caregiver has refused care: –Encourage them again to allow care. –Ask them to sign a refusal of care form. –Document all refusals. –A witness is valuable in these situations.

35. 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

36. 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

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient Refusal When in doubt, err in favor of providing care!

38. 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?

39. 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

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient has the right to refuse resuscitative efforts. Usually requires written physician order Advance Directives: DNR Orders

41. 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

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

43. 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

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Duty to Act Individual’s responsibility to provide patient care Duty to act applies: –Once your ambulance responds to a call –Treatment is begun

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Negligence (1 of 2) Failure to provide same care that person with similar training would provide in same or similar situation.

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Negligence (2 of 2) All four of the following elements must be present for negligence to apply: –Duty –Breach of duty –Damages –Causation

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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)

53. 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)

54. 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

55. 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

56. 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

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Good Samaritan Laws and Immunity (1 of 2) If you reasonably help another person, you will not be held liable for error/omission Good Samaritan actions to be met: –Good faith –Without expectation of compensation –Within scope of training –Did not act in grossly negligent manner

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Good Samaritan Laws and Immunity (2 of 2) Gross negligence is conduct that constitutes willful or reckless disregard. There is another group of laws that grants immunity from liability to official providers. –Laws vary; always consult with the medical director.

59. 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?

60. 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

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Patient history Assessment findings Treatment rendered Written release required to release information Confidential Information

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Confidential Information Exceptions to written release: Subpoena Other health care personnel treating patient Mandatory reporting (rape, abuse) Insurance

63. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Health Insurance Portability and Accountability Act mandates increased privacy of patient-specific medical information and their: Record keeping Storage Access Discussion HIPAA

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

65. 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

66. 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

67. 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

68. 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

69. 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

70. 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

71. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review

72. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review Medical, legal, ethical issues part of every EMS call. Morals are how a person expresses beliefs of right and wrong. Consent may be expressed or implied continued

73. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review If a competent patient refuses care or transport, you should make every effort to persuade him, but you cannot force him to accept care or go to the hospital. Negligence is failing to act properly when you have a duty to act. continued

74. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review Abandonment is leaving a patient after you have initiated care and before you have transferred the patient to a person with equal or higher training.

75. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember EMTs must use good judgment and decision-making skills when dealing with patient consent and refusal. Avoiding negligence implies using good judgment; critical thinking is an essential component for avoiding liability. continued

76. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember EMTs hold responsibility for patients’ protected health information; exercising care when dealing with this information is a legal and ethical obligation.

77. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Questions to Consider Define scope of practice, negligence, duty to act, abandonment, and confidentiality. What steps must you take when a patient refuses care or transportation? What types of evidence may be found at a crime scene? How should you act to preserve evidence?

78. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Critical Thinking You respond to a motor vehicle crash and find a seriously injured patient. He has no pulse and you are about to begin CPR when someone says, “Don’t do that! He’s got cancer and a DNR!” No one has the DNR at the scene. Do you start CPR and transport the patient?

79. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (1 of 8) Consent is generally required from a conscious adult before care can be started. Never withhold lifesaving care unless a valid DNR order is present.

80. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (2 of 8) A parent or legal guardian must give consent for treatment or transport of a minor. Conscious, alert adults have the right to refuse treatment or withdraw from treatment.

81. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (3 of 8) Patient communication is confidential. Advance directives, living wills, or health care directives are often used when a patient becomes comatose. There are both definitive and presumptive signs of death.

82. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (4 of 8) A donor card or driver’s license indicates consent to organ donation. Standard of care is established in many ways. When your ambulance responds to a call or treatment is begun, you have a legal duty to act.

83. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (5 of 8) Negligence is based on duty, breach of duty, damages, and causation. Abandonment is termination of care without the patient’s consent or provisions for transfer of care. Assault is unlawfully placing a person in fear of immediate bodily harm.

84. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (6 of 8) Battery is unlawfully touching a person, which includes providing emergency care without consent. Good Samaritan laws protect persons who stop to render aid.

85. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (7 of 8) Records and reports are important, particularly if a case goes to court. You should know the special reporting requirements for abuse of children, the elderly, and others; injuries related to crimes; drug-related injuries; and childbirth.

86. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Summary (8 of 8) You must meet legal and ethical responsibilities while caring for the patient’s physical and emotional needs. As an EMT, a number of situations might cause you to end up in court.

87. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 1.You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of: A.implied consent. B.informed consent. C.expressed consent. D.emergency consent.

88. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: Expressed consent (also called actual consent) is when the patient authorizes you to provide treatment and transport, either verbally or nonverbally. For example, a patient who holds out his or her arm to allow you take a blood pressure is nonverbally giving you expressed consent.

89. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 1.You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of: A.implied consent. Rationale: Implied consent is limited to life-threatening emergencies and is appropriate when a person is unconscious and/or delusional. B.informed consent. Rationale: Informed consent is when the patient has been told of the specific risks, benefits, and alternative treatments.

90. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 1.You arrive at the scene of an elderly lady complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This is an example of: C.expressed consent. Rationale: Correct answer. It is also known as actual consent. D.emergency consent. Rationale: This does not exist as a form of consent.

91. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 2.Which of the following is an example of abandonment? A.An EMT leaves the scene after a competent adult has refused care. B.An EMT transfers care of a patient to an emergency department nurse. C.An AEMT transfers care of a patient to a Paramedic. D.An EMR is transferred patient care from an AEMT.

92. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: D Rationale: Abandonment occurs when patient care is terminated without the patient’s consent or when care is transferred to a provider of lesser training and level of certification.

93. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 2.Which of the following is an example of abandonment? A.An EMT leaves the scene after a competent adult has refused care. Rationale: Mentally competent adults have the right to refuse treatment or withdraw from treatment at any time. B.An EMT transfers care of a patient to an emergency department nurse. Rationale: An EMT can transfer care to someone of equal or higher medical authority.

94. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 2.Which of the following is an example of abandonment? C.An AEMT transfers care of a patient to a Paramedic. Rationale: An AEMT can transfer care to someone of equal or higher medical authority. D.An EMR is transferred patient care from an AEMT. Rationale: Correct answer

95. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 3.The unauthorized confinement of a person is called: A.assault. B.battery. C.false imprisonment. D.slander.

96. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: False imprisonment is defined as the confinement of a person without legal authority or the person’s consent.

97. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 3.The unauthorized confinement of a person is called: A.assault. Rationale: Assault is unlawfully placing a person in fear of bodily harm. B.battery. Rationale: Battery is touching a person or providing care without consent.

98. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 3.The unauthorized confinement of a person is called: C.false imprisonment. Rationale: Correct answer. D.slander. Rationale: Slander is false and damaging information about a person that is communicated by the spoken word.

99. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 4.Failure of the EMT to provide the same care as another EMT with the same training is called: A.libel B.slander C.negligence D.abandonment

100. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: An EMT could be held liable for negligence if he or she fails to provide the same care as another EMT with the same training would provide in the same situation. For example, if an EMT fails to give oxygen to a patient with shortness of breath (an intervention that is clearly indicated), he or she may be held liable for negligence.

101. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 4.Failure of the EMT to provide the same care as another EMT with the same training is called: A.Libel Rationale: Libel is making a false statement in a written form that injures a good person’s name. B.Slander Rationale: Slander is verbally making a false statement that injures a good person’s name. C.Negligence Rationale: Correct answer D.Abandonment Rationale: Abandonment is the abrupt termination of contact with a patient.

102. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 5.An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the child’s parents. You should: A.continue to treat the child and transport as soon as possible. B.cease all treatment until the child’s parents can be contacted. C.continue with treatment only if authorized by medical control. D.only provide airway management until the parents are contacted.

103. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: A Rationale: The child in this scenario is critically-injured and requires immediate treatment and transport; waiting until his parents are contacted wastes time and increases his chance of a negative outcome. If you are unable to contact a minor’s parents or legal guardian, you should proceed with care based on the law of implied consent.

104. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 5.An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the child’s parents. You should: A.continue to treat the child and transport as soon as possible. Rationale: Correct answer B.cease all treatment until the child’s parents can be contacted. Rationale: If a true emergency exists, then consent is implied.

105. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 5.An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the child’s parents. You should: C.continue with treatment only if authorized by medical control. Rationale: If a true emergency exists, then consent is implied. D.only provide airway management until the parents are contacted. Rationale: If a true emergency exists, then consent is implied.

106. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 6.An advance directive is: A.a set of specific guidelines that clearly defines the different types of consent. B.a formal list that defines by state law whether a patient has decision-making capacity. C.a written document that specifies the care you should provide if the patient is unable to make decisions. D.a verbal order given to you by a dying patient's family regarding whether treatment should be provided.

107. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: An advance directive is a written document signed by the patient and a witness that specifies the medical care that should be provided if the patient loses decision-making capacity (ie, he or she is no longer deemed competent).

108. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 6.An advance directive is: A.a set of specific guidelines that clearly defines the different types of consent. Rationale: An Advance Directive specifies the specific care a patient will receive and does not address any type of consent. B.a formal list that defines by state law whether a patient has decision-making capacity. Rationale: An Advance Directive document has already determined that a patient was competent to make decisions when the document was created and signed.

109. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 6.An advance directive is: C.a written document that specifies the care you should provide if the patient is unable to make decisions. Rationale: Correct answer D.a verbal order given to you by a dying patient's family regarding whether treatment should be provided. Rationale: An Advance Directive is a written order that defines the patient’s medical decisions.

110. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 7.Which of the following patients is competent and can legally refuse EMS care? A.A confused young female who states that she is the president B.A man who is staggering and states that he only drank three beers C.A conscious and alert woman who is in severe pain from a broken leg D.A diabetic patient who has slurred speech and is not aware of the date

111. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: C Rationale: A patient who is of legal age (18 in most states), is conscious, and is alert to person, place, time, and event, likely has decision-making capacity and can legally refuse EMS care. However, patients who are confused, possibly intoxicated, or delusional are not capable of making a rationale decision; therefore, you should provide care based on the law of implied consent.

112. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 7.Which of the following patients is competent and can legally refuse EMS care? A.A confused young female who states that she is the president Rationale: You must assess whether this patient’s mental condition is impaired. B.A man who is staggering and states that he only drank three beers Rationale: You must assess whether this patient’s mental condition is impaired.

113. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 7.Which of the following patients is competent and can legally refuse EMS care? C.A conscious and alert woman who is in severe pain from a broken leg Rationale: Correct answer D.A diabetic patient who has slurred speech and is not aware of the date Rationale: You must assess whether this patient’s mental condition is impaired.

114. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 8.You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of: A.assault. B.battery. C.negligence. D.abandonment.

115. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: A Rationale: Unlawfully placing a person in fear of immediate bodily harm (ie, having him restrained) without his consent constitutes assault. Unlawfully touching a person without his or her consent constitutes battery.

116. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 8.You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of: A.assault. Rationale: Correct answer B.battery. Rationale: Battery is unlawfully touching a person. This includes care without consent.

117. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 8.You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him restrained if he does not give you consent. Your actions in this case are an example of: C.negligence. Rationale: Negligence is failure to provide the same care that a person with similar training would provide. D.abandonment. Rationale: Abandonment is the unilateral termination of care without the patient’s consent.

118. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 9.The EMT has a legal duty to act if he or she is: A.off duty and witnesses a major car accident. B.a volunteer, is on duty, and is dispatched on a call. C.paid for his or her services, but is not on duty. D.out of his or her jurisdiction and sees a man choking.

119. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: B Rationale: The EMT—paid or volunteer— has a legal duty to act if he or she is on duty and is dispatched on a call, regardless of the nature of the call. If the EMT is off duty and/or out of his or her jurisdiction, he or she has a moral obligation to act, but not necessarily a legal one.

120. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 9.The EMT has a legal duty to act if he or she is: A.off duty and witnesses a major car accident. Rationale: This is a moral obligation to act and not a legal one. B.a volunteer, is on duty, and is dispatched on a call. Rationale: Correct answer C.paid for his or her services, but is not on duty. Rationale: Whether paid or volunteer, the EMT must be on duty. D.out of his or her jurisdiction and sees a man choking. Rationale: This is a moral obligation to act, and not a legal one.

121. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review 10.Which of the following statements about records and reports is FALSE? A.Legally, if it wasn't documented, it was not performed B.A complete, accurate report is an important safeguard against legal problems C.An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical care D.Your patient care report does not become a part of the patient’s hospital record because your treatment was provided outside the hospital

122. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review Answer: D Rationale: One of your most important safeguards against legal problems is a complete, accurate report; if it wasn’t documented, it wasn’t done! Furthermore, an incomplete or untidy patient care report (PCR) suggests incomplete or inexpert medical care. The PCR becomes a part of the patient’s hospital medical record; even though your treatment was provided outside the hospital, the PCR ensures continuity of care in the hospital.

123. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (1 of 2) 10.Which of the following statements about records and reports is FALSE? A.Legally, if it wasn't documented, it was not performed Rationale: True. If it was not written, then it was not performed. B.A complete, accurate report is an important safeguard against legal problems Rationale: True. The most important safeguard against legal problems is a complete, accurate report.

124. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Review (2 of 2) 10.Which of the following statements about records and reports is FALSE? C.An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical care Rationale: True. An incomplete or untidy report equals incomplete or inexpert emergency care. D.Your patient care report does not become a part of the patient’s hospital record because your treatment was provided outside the hospital Rationale: Correct answer

125. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Credits Chapter Opener: © Steve Hamblin/Alamy Images Background slide image (ambulance): © Galina Barskaya/ShutterStock, Inc. Background slide images (non- ambulance): © Jones & Bartlett Learning. Courtesy of MIEMSS.

126. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Please visit Resource Central on www.bradybooks.com to view additional resources for this text. www.bradybooks.com