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Medical/Legal and Ethical Issues

Confidentiality

Confidential information

Releasing confidential information

Pt. history
Assessment findings
Treatment rendered
Written release signed from pt/legal guardian

Written release not needed

Receiving facility,Transporting agencies


Continuation of care
3rd party billing info
Continuing education (remove pt ID)
Sate law (rape, abuse, GSW)
Subpoena

12VAC5-31-950. Disclosure of patient information.

Reporting Requirements

Vary from state to state


Abuse

Crime

Child
Elderly
Spouse/family
Wounds form violent crime
Sexual assault

Infectious disease exposure


Pt. restraint laws
Mentally incompetent

Intoxicated with injuries

Scope of Practice
What You Do

Range of activities &


limitations of a given medical
provider
Defined by state legislation
References national curricula
May be enhanced by
Medical direction
Protocols
Standing orders

Va OEMS Scope of
Practce

Standard of Care
What You Know

Body of knowledge, laws,


policies, common practices,
standards, and guidelines
that provide the basis for
prehospital care

Defined by protocols and


sate certification

Negligence

Deviation from standard of


care that results in HARM to
the pt.
4 Elements of Negligence

Duty to act
Breach of duty
Damage
Causal connection

ALL 4 must be proven

Components of Negligence

Duty to Act

Legal requirement to assess and treat a pt


Est. pt-provider relationship
Implied

Formal

Pt calls for ambulance and one is sent


Treatment is started
Contracts

Off duty EMT has NONE

Components of Negligence

Breach of Duty

Negligent action/omission that


has violated the standards of
care expected for an EMT
under the circumstances
Ex. Perform a procedure
incorrectly
Failing to act in a
timely/appropriate
manner
Failing to act in the
circumstances
required
Performing other
skills deemed
negligent

Components of Negligence

Damage

Physical
Psychological

No damage= No case

Components of Negligence

Causal Connection

Clear connection from injury to EMT actions

Abandonment

Termination of pt care without assuring the


continuation of care at the same level or higher

Good Samaritan Laws

Protects volunteers from litigation


Raises bar

Negligence
Gross negligence

Willful & wanton recklessness that


would be so careless as to be
dangerous

Va Good Samaritan Law

Consent

MUST be obtained before treatment


Types

Expressed
Implied

Expressed Consent

Verbal or other gesture


Characteristics

Informed of risks/benefits
Legal age
Rational decisions
Conscious
Mentally competent

Implied Consent

Consent assumed
from the unconscious pt
requiring aid
Assumes a reasonable
person would expect
emergency care in the
situation

Consent
Special Cases

Children/Mentally incompetent
people

Consent from legal


guardian/parent
Treat as implied if none found

Emancipation

16 years old and:

Married
In armed forces
Lives independently of parents

Financially self supporting

Is/was a parent
Code of Va 16.1-331 - 334

Refusals

Pt has right to

Refuse Care
Withdraw consent at any time

Pt must be

Mentally competent
Informed of risks/consequences
Sing release of liability form

Get a witness

Complete PPCR

Narrative
Advice given
Planned treatments

Complications of Refusals

False imprisonment

Assault

Transport pt against will


Creating fear of injury

Battery

Touching someone
without their permission

Do No Resuscitate (DNR)

DNR

Legal order signed by doctor

Withholds lifesaving measures in event of


resp/cardiac arrest

HAVE TO SEE ORIGINAL


OTHERWISE

Treat the pt

MUST TRANSPORT WITH PT


Types

DNR Form

DNR jewelry

Other DRN
Written order by doctor
Providers

Cannot recognize DNR from other states


Va Durable DNR Fact Sheet

Advanced Directives

Advance Directive

Withhold certain care but not others


Specific to the pt.

Healthcare Proxy/POA

Legally empowered person other than pt


Makes medical decisions for pt
Mentally incompetent pt.

Special Situations

Donor/Organ Harvesting

EMT role

ID pt as possible donor
Est. communication with
medical direction
Provide care to maintain
viable organs

Documentation

Donor card
Back of drivers license

Special Situations

Medical ID insignia

Bracelets
Earrings
Charms/Pendants
Cufflinks
Ring

ID pt with medical problems

Allergies
Epilepsy
Diabetes
DNR status
Etc

Special Situations

Crime Scenes

Ensure
personal/personnel/pt
safety
Notify police via dispatch if
1st responding
Dont disturb items
Dont cut through
holes/stabs in clothing
Preserve chain of evidence
DOCUMENT!!!!!!

Risk Management

SAFETY
Act according to Standard of Care
DOCUMENT!
Act in interest of the pt.

Take a beak!