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Chapter 3. Medical, Legal, and Ethical Issues. Topics. 3. Legal responsibilities Issues of patient consent and refusal Other legal aspects of emergency care Special situations. Legal Responsibilities. 3. Scope of practice Defines actions and/or care that are legally allowed

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chapter 3

Chapter 3

Medical, Legal, and Ethical Issues

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide2

Topics

3

  • Legal responsibilities
  • Issues of patient consent and refusal
  • Other legal aspects of emergency care
  • Special situations

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide3

Legal Responsibilities

3

  • Scope of practice
    • Defines actions and/or care that are legally allowed
    • National EMS scope of practice

http://www.jems.com/data/pdf/SOPFinal4.0.pdf

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide4

Legal Responsibilities

3

  • Standard of care
    • Right assessment and care
    • Properly performed assessment and care
    • Sources influencing standard of care vary

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide5

Legal Responsibilities

3

  • Duty to act
    • Refers to your legal obligation to provide care to a patient
      • Implied
      • Formal
    • Legal duty may not exist in certain situations

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide6

Legal Responsibilities

3

  • Good samaritan laws
    • Protection from liability
    • Performed in good faith
    • Willful or wanton harm
  • Sovereign immunity

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide7

Legal Responsibilities

3

  • Medical direction
    • Your ability to function is contingent on medical direction
    • Use approved standing orders
    • Consult with medical direction when necessary

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide8

Ethical Responsibilities

3

  • Ethical responsibilities
    • Describe rules of ideal conduct for the EMT
    • Keep the patient as your priority
    • Remain professional and efficient in your skills

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide9

Issues of Patient Consent and Refusal

3

  • Treating a patient can only occur after you gain permission
  • If the EMT-B does not follow this criteria, he may be found liable for negligence

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide10

Issues of Patient Consent and Refusal

3

  • Types of consent
    • Informed
    • Expressed
    • Implied
    • Children and mentally incompetent adults

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide11

Advanced Directives

3

  • Do Not Resuscitate (DNR) orders
    • DNAR
  • Living will
  • Health care proxy

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

refusals
Refusals

3

Do Not

Resuscitate

form

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide13

Refusals

3

  • Refusals
    • The patient may refuse care
    • The patient may withdraw from care
    • The patient must be informed of the risks

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide14

Issues of Patient Consent and Refusal

3

Common style of refusal form

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide15

Other Legal Aspects ofEmergency Care

3

  • Negligence
    • Act of deviating from an accepted standard

of care

      • Simple
      • Gross

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide16

Other Legal Aspects ofEmergency Care

3

  • Four elements to show negligence
      • The EMT had a duty to act
      • The EMT breached that duty
      • The patient sustained injury
      • Proximate cause

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide17

Other Legal Aspects ofEmergency Care

3

  • Intentional tort
    • Civilly wrong action committed by an individual
      • Abandonment
      • Assault
      • Battery

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide18

Other Legal Aspects ofEmergency Care

3

  • Intentional tort (con’t.)
    • Civilly wrong action committed by an individual
      • False imprisonment
      • Defamation
        • Slander and libel

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide19

Confidentiality

3

  • Confidentiality
    • Confidential information
    • Releasing confidential information
    • Health Insurance Portability and Accountability Act (HIPAA)

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide20

Confidentiality

3

  • COBRA and EMTALA
    • Federal regulations for access to emergency health care

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide21

Special Situations

3

  • Special situations in EMS
    • Donors and organ harvesting
    • Medical identification insignia

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

slide22

Special Situations

3

  • Special situations in EMS
    • Recognizing death in the field
      • Presumptive signs
      • Obvious signs

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

potential crime scene
Potential Crime Scene

3

  • Potential crime scenes are those in which police investigation may be warranted
    • Be aware of EMT responsibilities while on scene

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen

special reporting situations
Special Reporting Situations

3

  • Special reporting situations vary state to state
    • Abuse
    • Crime
    • Infectious disease exposure
    • Patient restraint
    • Suicide

Prehospital Emergency Care, 8th Ed.

Mistovich/Karren/Hafen