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Legal and Ethical issues. Know Your Reporting Responsibilities!. this applies to you!. Special Reporting Requirements (1 of 2). Abuse of children, elderly, and spouse Injury during the commission of a felony Drug-related injury Childbirth. Special Reporting Requirements (2 of 2).

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special reporting requirements 1 of 2
Special Reporting Requirements(1 of 2)
  • Abuse of children, elderly, and spouse
  • Injury during the commission of a felony
  • Drug-related injury
  • Childbirth
special reporting requirements 2 of 2
Special Reporting Requirements(2 of 2)
  • Infectious disease exposure
  • Crime scene
  • Deceased
reporting
Reporting

It is a misdemeanor to fail to report abuse.

  • report suspicion of child abuse, you do not need proof to report an incident.
what when who
What, When & Who

WhatWhen

  • verbal report - immediately
  • written report - within 36 hours

Who

  • law enforcement
  • protective services
elder abuse
Elder Abuse
  • Any person who takes advantage of person, property or emotional state
  • Victims are often hesitant or unable to report
  • Signs of abuse are often overlooked
  • Pt. often has multiple medical conditions and are dependent on others
assessment of elder abuse 1 of 2
Assessment of Elder Abuse (1 of 2)
  • Repeated visits to the emergency room
  • A history of being “accident-prone”
  • Soft-tissue injuries
  • Vague explanation of injuries
  • Psychosomatic complaints
assessment of elder abuse 2 of 2
Assessment of Elder Abuse (2 of 2)
  • Chronic pain
  • Self-destructive behavior
  • Eating and sleeping disorders
  • Depression or a lack of energy
  • Substance and/or sexual abuse
signs of physical abuse
Signs of Physical Abuse
  • may be obvious or subtle.
  • Obvious signs include bruises, bites, and burns.
  • Look for injuries to the ears.
  • Consider injuries to the genitals or rectum as evidence of abuse.
advance directives
Advance Directives
  • Specifies medical treatments desired if patient is unable to make decisions
  • Do not resuscitate (DNR) orders
    • Patients have the right to refuse resuscitative efforts.
do not resuscitate
Do Not Resuscitate
  • AKA - DNR or “no code”
  • supportive measures only - No CPR
  • family member can request resuscitation
medical facility vs home or street

Medical facility Vs. Home or Street

There are different requirements

dnr nursing facilities
DNR- Nursing facilities
  • written order in patient's chart
    • no CPR
    • no code
    • DNR

VERBAL ORDER FROM MD NOT VALID unless put in writing

dnr home street
DNR - home/street
  • L.A. County “Prehospital DNR” Form
  • California “Prehospital DNR” Form**
  • MEDIC ALERT TAG bracelet or necklace
  • no other type of DNR may be honored in Los Angeles County
legal issues
Legal issues
  • Authority for patient care - most qualified at rendering emergency care
  • Physicians at the scene must show identification and agree to assume responsibility in order to direct care
consent three types
Consent – three types
  • Expressed consent
  • Implied consent
  • Minors and mentally incompetent adults
    • “In loco parentis”
    • ALOC
legal age of consent
Legal age of consent
  • Minor is under 18 years-old
  • Emancipated minor
  • Female - pregnancy related
adults competence
Adults - Competence
  • Must be competent to refuse treatment or transport
  • hypotensive
  • hypoglycemic
  • under the influence
  • suicidal ideations or actions
adults competence23
Adults - Competence
  • Any EMT-1 or EMT-P can deem a patient incompetent
  • This is NOT a 5150
refusal of treatment
Refusal of Treatment

Against Medical Advice

  • when a patient refuses care or transport
  • do not need if you believe patient is OK without treatment.
valid ama
Valid AMA
  • Patient Alert and Oriented X3
  • Competent
  • EMT-B should obtain a witnessed signature

MUST advise pt :

  • Of need for treatment
  • Of consequences of refusal
  • That they may re-contact 911
5150 72 hour hold
5150 (72 hour hold)

Patients may be placed on a hold if...

  • danger to self
  • danger to others
  • gravely disabled due to mental disorder
5150 72 hour hold27
5150 (72 hour hold)

who may place hold

  • Law Enforcement
  • PET or PMRT member
  • County “designated” doctors
limited legal authority
Limited Legal Authority
  • As an EMT-B, you have limited legal authority to require or force a patient to undergo care.
  • Police may put a patient in protective custody to allow you to provide care.
  • Know your local laws and protocols.
assault and battery
Assault and Battery
  • Know when to force TX
  • Assault
    • Unlawfully placing a person in fear of immediate bodily harm without consent
  • Battery
    • Unlawfully touching a person
duty to act
Duty to Act
  • Individual’s responsibility to provide patient care
  • Begins once an ambulance responds to a call or treatment is initiated
standard of care
Standard of Care
  • The minimum level of care that a person can expect
  • Imposed by local protocol
  • Imposed by the law
  • Professional or institutional standards
negligence
Negligence
  • Failure to apply the standard of care
  • Failure to provide the same care that a person with similar training would provide
  • Act or omission of an act
  • Good Samaritan Act does not apply to on-duty personnel
negligence determination
Negligence Determination
  • Duty
  • Breech of duty
  • Damages
  • Cause
abandonment
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
ethical responsibilities
Ethical Responsibilities
  • Make physical/emotional needs a priority
  • Practice/maintain skills
  • Critically review performances
  • Attend continuing education/refresher programs
  • Be honest in reporting
confidentiality
Confidentiality
  • Information received from or about a patient is considered confidential.
  • Disclosing information without permission is considered a breach of confidentiality.
  • Generally, information can only be disclosed if the patient signs a written release.
records and reports
Records and Reports
  • Complete documentation is a safeguard against legal complications
  • If an action or procedure is not recorded, it was not performed
  • An incomplete or untidy report is evidence of incompetence
standards imposed by states
Standards Imposed by States
  • Medical Practices Act
    • Exempts EMT-Bs from licensure requirements
  • Certification
    • Process of evaluating and recognizing that EMT-B has met certain predetermined standards
regulation updates
Regulation updates
  • EMT-1 or EMT-B designation only
  • Titles that no longer exist
    • EMT-1(AA)
    • EMT-1 (D)
certification application requirements
Certification Application Requirements

Be 18 years old or older.

Have valid Course Completion Certificate.

Apply within 2 years of course completion.

certification requirements
Certification requirements

Submit application and fees.

Pass a written certification examination.

And ..

background check
Background Check

Disqualifying convictions

Violent crimes

Sex related crimes

Drug related crimes (including DUI)

re certification requirements
Re-certification Requirements
  • Every two years
    • Complete refresher course

Or

    • Obtain 24 hours of approved continuing education
  • Submit application and fees
approved continuing education
Approved Continuing Education
  • BLS level
  • many methods to obtain CE
  • MANDATORY CPR & airway management course at least once every 2 years
  • YOU must find a CE Provider
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