2. 2 Chapter 3 Medical, Legal, and Ethical Issues

3. 3 Objectives (1 of 4) 1.1.5 Describe the differences between ethical behavior and legal requirements. 1.1.6 State specific activities that are most appropriate to ethical behavior. 1.1.7 Identify whether a particular activity is unethical and/or illegal, given certain patient care situations. 1.1.8 Identify whether a particular activity is ethical or unethical given certain patient care situations.

4. 4 Objectives (2 of 4) 1.2.22 Describe the ability of physician run critique based on documentation. 1.3.1 Discuss the significance and scope of the following in relationship to EMT practice: State Medical Practice Act, Good Samaritan Act/Civil Immunity, state EMS statutes, state motor vehicle codes, and state and local guidelines for "Do Not Resuscitate."

5. 5 Objectives (3 of 4) 1.3.2 Define the following: negligence, medical liability, tort, duty to act, battery, slander, informed consent, expressed consent, implied consent, abandonment, libel, assault, and false imprisonment. 1.3.3 Describe the significance of accurate documentation and record keeping in substantiating incident. 1.3.4 Identify those situations that require the EMT-I to report those incidents to appropriate authorities.

6. 6 Objectives (4 of 4) 1.3.5 Describe the four elements to prove medical liability. 1.3.6 Describe the significance of obtaining expressed consent. 1.3.7 Describe the extent to which force and restraint may be used to protect the EMT, the patient, and the third party.

7. 7 Medical, Legal, and Ethical Issues Scope of practice –Defined by state law –Outlines care you can provide –Further defined in protocols and standing orders –Authorized through online and off-line medical direction

8. 8 Standards of Care (1 of 2) Standard imposed by local custom –Often based on locally accepted protocols Standard imposed by the law –May be imposed by statutes, ordinances, administrative guidelines, or case law

9. 9 Standards of Care (2 of 2) Professional or institutional standards –Recommendations published by organizations and societies –Specific rules and procedures of your service or organization

10. 10 Standards Imposed by States –Medical Practices Act Exempts EMT-Is from licensure requirements –Certification and licensure Process of evaluating and recognizing that EMT-Is have met certain predetermined standards –State EMS legislation Regulations regarding medical control, protocols, and communication

11. 11 Laws Legislative, administrative, and common –Enacted at the federal, state, and local levels by legislative branches of government Criminal law –Federal, state, or local government prosecutes individuals on behalf of society Civil (tort) law –Deals with private complaints brought by a plaintiff against a defendant for illegal act/wrongdoing

12. 12 Duty to Act Individual’s responsibility to provide patient care. Responsibility to provide care comes from either statute or function. Legal duty to act begins once an ambulance responds to a call or treatment is initiated.

13. 13 Negligence The failure to provide the same care that a person with similar training would provide. Negligence is determined by the following factors: –Duty to act –Breach of duty –Damages –Proximate cause

14. 14 Abandonment Termination of care without patient’s consent. Termination of care without provisions for continued care. Care cannot stop unless someone of equal or higher training takes over.

15. 15 Consent Expressed consent Implied consent Minors and consent Mentally incompetent adults Forcible restraint

16. 16 Assault and Battery Assault –Unlawfully placing a person in fear of immediate bodily harm without consent Battery –Unlawfully touching a person

17. 17 The Right to Refuse Treatment Mentally competent adults have the right to refuse care. Patients must be informed of risks, benefits, treatments, and alternatives. The patient must be fully alert and oriented to refuse. EMT-I should obtain a signature and have a witness present, if possible.

18. 18 Good Samaritan Laws and Immunity Good Samaritan –Based on the principle that you should not be liable when assisting another in good faith Immunity –Usually reserved for governments

19. 19 Advance Directives Written documents that specify medical treatment for a competent patient, should he or she become unable to make decisions. DNR orders must meet the following general requirements: –Clearly state the patient’s medical problem(s) –Be signed by the patient or legal guardian –Be signed by one or more physicians –Be dated in the preceding 12 months

20. 20 Ethical Responsibilities Make the physical/emotional needs of the patient a priority. Practice/maintain skills to the point of mastery. Critically review performances. Attend continuing education/refresher programs. Be honest in reporting.

21. 21 Confidentiality Information received from or about a patient is considered confidential. Disclosing information without permission is considered a breach of confidentiality. Generally, information can be disclosed only if the patient signs a written release. Terms: Libel, slander, invasion of privacy, and defamation

22. 22 HIPAA Acronym for the Health Insurance Portability and Accountability Act of 1996. The section that most affects EMS relates to patient privacy. It provides guidance on what types of information is protected, the responsibility of health care providers regarding that protection, and penalties for breaching that protection. Dramatically limits the ability to obtain follow-up information.

23. 23 Records and Reports Complete documentation is a safeguard against legal complications. If an action or procedure is not recorded, courts assume it was not performed. An incomplete or untidy report is considered evidence of incomplete or inexpert care.

24. 24 Special Reporting Requirements Abuse of children, elderly people, and others Injury during the commission of a felony Drug-related injuries Childbirth Suicides Animal bites Certain communicable diseases Assault and rape

25. 25 Scene of a Crime If an emergency scene is also a crime scene, you must notify law enforcement immediately. Do not disturb the scene.

26. 26 The Deceased In most states EMT-Is cannot pronounce a patient dead. Obvious death includes: –Rigor mortis –Mortal injury –Dependent lividity –Decomposition

27. 27 Special Situations Organ donors Medical identification insignia