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Legal and Ethical issues

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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Legal and Ethical issues

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  1. Legal and Ethical issues

  2. Know Your Reporting Responsibilities! this applies to you!

  3. Special Reporting Requirements(1 of 2) • Abuse of children, elderly, and spouse • Injury during the commission of a felony • Drug-related injury • Childbirth

  4. Special Reporting Requirements(2 of 2) • Infectious disease exposure • Crime scene • Deceased

  5. Reporting It is a misdemeanor to fail to report abuse. • report suspicion of child abuse, you do not need proof to report an incident.

  6. What, When & Who WhatWhen • verbal report - immediately • written report - within 36 hours Who • law enforcement • protective services

  7. 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

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. Do Not Resuscitate • AKA - DNR or “no code” • supportive measures only - No CPR • family member can request resuscitation

  13. Medical facility Vs. Home or Street There are different requirements

  14. DNR- Nursing facilities • written order in patient's chart • no CPR • no code • DNR VERBAL ORDER FROM MD NOT VALID unless put in writing

  15. 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

  16. 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

  17. Consent – three types • Expressed consent • Implied consent • Minors and mentally incompetent adults • “In loco parentis” • ALOC

  18. Legal age of consent • Minor is under 18 years-old • Emancipated minor • Female - pregnancy related

  19. Adults - Competence • Must be competent to refuse treatment or transport • hypotensive • hypoglycemic • under the influence • suicidal ideations or actions

  20. Adults - Competence • Any EMT-1 or EMT-P can deem a patient incompetent • This is NOT a 5150

  21. Refusal of Treatment Against Medical Advice • when a patient refuses care or transport • do not need if you believe patient is OK without treatment.

  22. 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

  23. 5150 (72 hour hold) Patients may be placed on a hold if... • danger to self • danger to others • gravely disabled due to mental disorder

  24. 5150 (72 hour hold) who may place hold • Law Enforcement • PET or PMRT member • County “designated” doctors

  25. 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.

  26. 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

  27. Duty to Act • Individual’s responsibility to provide patient care • Begins once an ambulance responds to a call or treatment is initiated

  28. 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

  29. 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

  30. Negligence Determination • Duty • Breech of duty • Damages • Cause

  31. 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

  32. Ethical Responsibilities • Make physical/emotional needs a priority • Practice/maintain skills • Critically review performances • Attend continuing education/refresher programs • Be honest in reporting

  33. 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.

  34. 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

  35. 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

  36. Regulation updates • EMT-1 or EMT-B designation only • Titles that no longer exist • EMT-1(AA) • EMT-1 (D)

  37. Certification Application Requirements Be 18 years old or older. Have valid Course Completion Certificate. Apply within 2 years of course completion.

  38. Certification requirements Submit application and fees. Pass a written certification examination. And ..

  39. Background Check Disqualifying convictions Violent crimes Sex related crimes Drug related crimes (including DUI)

  40. Re-certification Requirements • Every two years • Complete refresher course Or • Obtain 24 hours of approved continuing education • Submit application and fees

  41. 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

  42. End questions??

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