Chapter 3: Medical, Legal, and Ethical Issues

Cognitive Objectives

1-3.1 Define the First Responder scope of care.

1-3.2 Discuss the importance of Do Not Resuscitate [DNR] (advance directives) and local or state provisions regarding EMS application.

1-3.3 Define consent and discuss the methods of obtaining consent.

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Cognitive Objectives

1-3.4 Differentiate between expressed and implied consent.

1-3.5 Explain the role of consent of minors in providing care.

1-3.6 Discuss the implications for the First Responder in patient refusal of transport.

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Cognitive Objectives

1-3.7 Discuss the issues of abandonment, negligence, and battery and their implications to the First Responder.

1-3.8 State the conditions necessary for the First Responder to have a duty to act.

1-3.9 Explain the importance, necessity, and legality of patient confidentiality.

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Cognitive Objectives

1-3.10 List the actions that a First Responder should take to assist in the preservation of a crime scene.

1-3.11 State the conditions that require a First Responder to notify local law enforcement officials.

1-3.12 Discuss issues concerning the fundamental components of documentation.

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Affective Objectives

1-3.13 Explain the rationale for the needs, benefits, and usage of advance directives.

1-3.14 Explain the rationale for the concept of varying degrees of DNR.

There are no psychomotor objectives.

Knowledge and Attitude Objectives

1. Define “duty to act” as it relates to a first responder.

2. Describe the standard of care and the scope of care for a first responder.

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Knowledge and Attitude Objectives

3. Describe and compare the following types of consent:

• Expressed consent

• Implied consent

• Consent for minors

• Consent of mentally ill patients

• Refusal of care

4. Explain the purpose of living wills and advance directives.

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Knowledge and Attitude Objectives

5. Describe the importance of the following legal concepts:

• Abandonment

• Death on the scene

• Negligence

• Confidentiality

6. Explain the purpose of Good Samaritan laws.

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Knowledge and Attitude Objectives

7. Describe the federal, state, and local regulations that apply to first responders.

8. Describe reportable events in your local area.

9. Describe the steps to be taken at a crime scene.

10.Explain the reasons for documentation.

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Medical, Legal, and Ethical Issues

• Basic legal principles govern the way first responders provide care.

• Laws differ from one location to another.

– Know your state or jurisdiction laws.

Duty to Act

• Legal responsibility to:– Respond promptly to an emergency. – Provide care.

• Failure to respond or render care may lead to legal action.

Standard of Care

• Treat patient to best of your ability. • Provide care that reasonable, prudent

person with similar training would provide in the situation.

Scope of Care

• Defined by:

– National Curriculum for First Responders, developed by U.S. DOT

– State scope of care laws may modify parts of DOT specifications

– Medical protocols or standing orders

– Online medical direction

Ethical Responsibilitiesand Competence

• Conform to accepted professional standards of conduct.

• Maintain up-to-date skills and knowledge.

• Review your performance.

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Ethical Responsibilitiesand Competence

• Continuing education and refresher courses

• Participate in quality-improvement activities.

• Ethical behavior requires honesty.

• Give complete, correct reports.

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Consent for Treatment

• Expressed consent

– Permission given by patient to treat

• Implied consent

– Assumed consent when patient does not refuse care as a result of being unconscious, under age, or unable to respond

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Consent for Treatment

• Consent for minors

– Not capable of legally speaking for themselves

• Consent of mentally ill

– May involve law enforcement; check local protocols

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Patient Refusal of Care

• Competent

– Able to make rational decisions about personal well-being

• A competent person has the legal right to refuse care.

Advance Directives

• Legal document with specific instructions

– Patient does not want to be resuscitated or kept alive by mechanical support systems.

• Examples:

– Advance directives to physicians

– Durable power of attorney for health care

– Do not resuscitate (DNR) orders

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Advance Directives

• If unable to determine legal validity of advance directive, begin appropriate medical care.

• Some states have systems in place to identify patients with advance directives.

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Abandonment

• A situation in which a trained person begins emergency care and leaves patient before another person of equal or higher training arrives to take over

Persons Dead at the Scene

• Decapitation: Head separated from body

• Rigor mortis: Temporary stiffening of muscles

• Tissue decomposition: Flesh decay

• Dependent lividity: Red or purple color in parts

of body closest to ground

Negligence

• Occurs when patient suffers injury or harm due to care that did not meet standards

• For negligence to occur, four conditions must exist:

1. Duty to act

2. Breach of duty

3. Resulting injuries

4. Proximate cause

Confidentiality

• Most patient information is confidential.

• Information should be shared with other medical personnel only.

HIPAA

• Health Insurance Portability and Accountability Act of 1996

• Section most affecting EMS relates to patient privacy.

• Provides guidance on protected information, health care provider responsibilities, and penalties for noncompliance

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HIPAA

• Most personal health information is protected.

• When unsure, do not release information except to other medical providers.

• Expect further training.

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Good Samaritan Laws

• Laws intended to minimize liability for any errors or omissions in rendering care in good faith.

• Legal experts agree they provide little or no legal protection for a rescuer.

Regulations

• Be familiar with federal, state, local, and agency regulations affecting your job.

• Certification or registration may be required to work as a first responder.

• You are responsible for keeping certifications current.

Reportable Events

• State and federal agencies have reporting requirements for certain crimes:

– Assault (knife, gunshot wounds)

– Auto collisions

– Suspected child/elder abuse

– Domestic violence

– Dog bites

– Rape

Crime Scene Operations

• Consider the following at a crime scene:– Protect yourself.– If scene is unsafe, wait for law enforcement.– Your first priorities are your safety and patient care.

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Crime Scene Operations

• Move patient only if necessary.

• Touch only what you need to gain access to patient.

• Preserve scene for further investigation.

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Crime Scene Operations

• Be careful where you place equipment.

• Keep nonessential personnel away.

• Write a report about incident including a sketch of the scene.

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Documentation

• Initial accounting describing patient’s condition

• Legal record of treatment

• Basis for evaluating quality of care

• Should be clear, concise, accurate, and readable

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Documentation

• Condition of patient when found

• Patient’s description of injury or illness

• Initial and repeat vital signs

• Treatment given

• Agency/personnel who took over care

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Documentation

• Any other helpful facts

• Any reportable conditions present

• Any infectious disease exposure

• Anything unusual regarding the case

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