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Medical, Legal andMedical, Legal andEthical IssuesEthical Issues
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Medical ResponsibilitiesMedical Responsibilities
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Scope of PracticeScope of Practice
The range of duties and skills that The range of duties and skills that emergency medical technicians are emergency medical technicians are allowed and expected to perform.allowed and expected to perform.
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Scope of PracticeScope of Practice
Defined by state lawDefined by state law
Outlines care you can provideOutlines care you can provide
Further defined in protocols and Further defined in protocols and standing ordersstanding orders
Authorized through online and off-Authorized through online and off-line medical directionline medical direction
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Standard of CareStandard of Care
The degree of skill and judgment The degree of skill and judgment expected of an individual when expected of an individual when
caring for a patient and is defined caring for a patient and is defined by training, protocols, and the by training, protocols, and the expected actions of the care expected actions of the care providers with similar training providers with similar training
and experience, working under and experience, working under similar conditionssimilar conditions
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Standard of CareStandard of Care
Standard imposed by local customStandard imposed by local custom
Often based on locally accepted Often based on locally accepted protocolsprotocols
Standard imposed by the lawStandard imposed by the law
May be imposed by statutes, May be imposed by statutes, ordinances, administrative ordinances, administrative guidelines, or case lawguidelines, or case law
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Standard of CareStandard of Care
Professional or institutional Professional or institutional standardsstandards
Recommendations published by Recommendations published by organizations and societiesorganizations and societies
Specific rules and procedures of Specific rules and procedures of your service or organizationyour service or organization
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WA State Standards WA State Standards
Authorized care under RCW 246.976.182Authorized care under RCW 246.976.182
Medical Practices ActMedical Practices Act
Exempts EMT-Bs from licensure requirementsExempts EMT-Bs from licensure requirements
CertificationCertification
Process of evaluating and recognizing that EMT-B Process of evaluating and recognizing that EMT-B has met certain predetermined standardshas met certain predetermined standards
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Legal Issues and Legal Issues and LiabilityLiability
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Legal ProtectionLegal Protection EMS Immunity Act EMS Immunity Act Governmental (Sovereign) ImmunityGovernmental (Sovereign) Immunity ““Good Samaritan” Laws Good Samaritan” Laws
Do not prevent lawsuitsDo not prevent lawsuits Offer a defense for those who act in “Good Offer a defense for those who act in “Good
Faith” and meet the Standard of Care”Faith” and meet the Standard of Care” Do not protect against Gross NegligenceDo not protect against Gross Negligence
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NegligenceNegligence
Failure to provide the same care Failure to provide the same care that a person with similar training that a person with similar training
would providewould provide
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NegligenceNegligence
DutyDuty Responsibility to act reasonably based on standard of Responsibility to act reasonably based on standard of
carecare Breech of dutyBreech of duty
Failure to act within the expected and reasonable Failure to act within the expected and reasonable standard of carestandard of care
DamagesDamages Physical or mental harm created in a noticeable wayPhysical or mental harm created in a noticeable way
CauseCause Existence of reasonable cause and effect Existence of reasonable cause and effect
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Duty to ActDuty to Act
Individual’s responsibility to Individual’s responsibility to provide patient care.provide patient care.
Responsibility to provide care Responsibility to provide care comes from either statute or comes from either statute or function.function.
Legal duty to act begins once an Legal duty to act begins once an ambulance responds to a call or ambulance responds to a call or treatment is initiated.treatment is initiated.
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ConfidentialityConfidentiality
Information received from or about a Information received from or about a patient is considered confidential.patient is considered confidential.
Disclosing information without Disclosing information without permission is considered a breach of permission is considered a breach of confidentiality.confidentiality.
Generally, information can only be Generally, information can only be disclosed if the patient signs a written disclosed if the patient signs a written release.release.
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HIPAAHIPAA
Health Insurance Portability and Health Insurance Portability and Accountability Act of 1996 Accountability Act of 1996
Amends IRC of 1986 to improve portability Amends IRC of 1986 to improve portability and continuity of health insurance and continuity of health insurance coverage in group and individual marketscoverage in group and individual markets
Federal law mandates privacy and Federal law mandates privacy and confidentiality in all issues regarding confidentiality in all issues regarding patient carepatient care
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Adult ConsentAdult Consent Adult - Any person over 18 years of age Adult - Any person over 18 years of age
who is not under a court-ordered disabilitywho is not under a court-ordered disability Actual Consent (Informed, Expressed)Actual Consent (Informed, Expressed) Implied ConsentImplied Consent
Pt. is unconscious or unable to communicate Pt. is unconscious or unable to communicate and is suffering from what appears to be a and is suffering from what appears to be a life-threatening injury or illnesslife-threatening injury or illness
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Adult ConsentAdult Consent
Involuntary ConsentInvoluntary Consent An adult may be treated against his will only An adult may be treated against his will only
if:if: Treatment is ordered by a magistrateTreatment is ordered by a magistrate Treatment is ordered by a peace officer or Treatment is ordered by a peace officer or
corrections officer who has the patient under arrest corrections officer who has the patient under arrest or in custodyor in custody
Consent of the Mentally IllConsent of the Mentally Ill
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Adult ConsentAdult Consent
Right of Refusal of Treatment/TransportRight of Refusal of Treatment/Transport Mentally competent adults have the right to Mentally competent adults have the right to
refuse carerefuse care The person must be informed of risks, The person must be informed of risks,
benefits, treatments, & alternativesbenefits, treatments, & alternatives Remember to document and obtain Remember to document and obtain
signatures of patient & witnesssignatures of patient & witness
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Minor ConsentMinor Consent
Minor - any person under 18 years of age Minor - any person under 18 years of age who has never been married and who has who has never been married and who has not had his/her minority status changed by not had his/her minority status changed by the courtthe court
Actual Consent (Informed, Expressed)Actual Consent (Informed, Expressed) ParentsParents GuardianGuardian Others Closely Related of Majority AgeOthers Closely Related of Majority Age
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Minor ConsentMinor Consent
Emancipated MinorsEmancipated Minors Under 18, married, pregnant, a parent, Under 18, married, pregnant, a parent,
member of the armed forces, financially member of the armed forces, financially independent and living away form homeindependent and living away form home
Implied Consent Implied Consent Life or Limb ThreateningLife or Limb Threatening No Parental RefusalNo Parental Refusal
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Minor ConsentMinor Consent
Right of Refusal of Treatment/TransportRight of Refusal of Treatment/Transport Mentally competent adults (Parent/Guardian) Mentally competent adults (Parent/Guardian)
have the right to refuse care for their childrenhave the right to refuse care for their children The person (Parent/Guardian) must be The person (Parent/Guardian) must be
informed of risks, benefits, treatments, & informed of risks, benefits, treatments, & alternativesalternatives
Remember to document and obtain Remember to document and obtain signatures of Parent/Guardian & witnesssignatures of Parent/Guardian & witness
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Refusal of TreatmentRefusal of Treatment
Mentally competent adults have the Mentally competent adults have the right to refuse care.right to refuse care.
Patients must be informed of risks, Patients must be informed of risks, benefits, treatments, and benefits, treatments, and alternatives.alternatives.
EMT-B should obtain a signature and EMT-B should obtain a signature and have a witness present, if possible.have a witness present, if possible.
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AbandonmentAbandonment
Termination of care without Termination of care without patient’s consentpatient’s consent
Termination of care without Termination of care without provisions for continued careprovisions for continued care
Care cannot stop unless Care cannot stop unless someone of equal or higher someone of equal or higher training takes overtraining takes over
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Assault & BatteryAssault & Battery
AssaultAssault Unlawfully placing a person in fear of Unlawfully placing a person in fear of
immediate bodily harm without consentimmediate bodily harm without consent BatteryBattery
Unlawfully toughing a personUnlawfully toughing a person
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Libel and SlanderLibel and Slander
LibelLibel The act of injuring a person’s character, The act of injuring a person’s character,
name, or reputation by false or malicious name, or reputation by false or malicious written statementswritten statements
SlanderSlander The act of injuring a person’s character, The act of injuring a person’s character,
name, or reputation by false or malicious name, or reputation by false or malicious spoken statementsspoken statements
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Advance DirectivesAdvance Directives
Specifies medical treatments desired if Specifies medical treatments desired if patient is unable to make decisionspatient is unable to make decisions
Do not resuscitate (DNR) ordersDo not resuscitate (DNR) orders Patients have the right to refuse resuscitative Patients have the right to refuse resuscitative
efforts.efforts.
Require a written order from one or more Require a written order from one or more physiciansphysicians
When in doubt, begin resuscitation.When in doubt, begin resuscitation.
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Advance DirectivesAdvance Directives POLST OrdersPOLST Orders WA State DNR FormWA State DNR Form Living Wills or Advance DirectivesLiving Wills or Advance Directives Must be Presented upon Patient ContactMust be Presented upon Patient Contact Specifics of care?Specifics of care? Determine validityDetermine validity
May not be witnessed by anyone who would May not be witnessed by anyone who would benefit from the death of the patientbenefit from the death of the patient
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Special SituationsSpecial Situations
Organ donorsOrgan donors
Medical Medical identification identification insigniainsignia
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EMT EthicsEMT Ethics
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Ethical ResponsibilitiesEthical Responsibilities
Make the physical/emotional needs of Make the physical/emotional needs of the patient a priority. the patient a priority.
Practice/maintain skills to the point of Practice/maintain skills to the point of mastery. mastery.
Critically review performances.Critically review performances. Attend continuing education/refresher Attend continuing education/refresher
programs. programs. Be honest in reporting.Be honest in reporting.