emergency medical responder first on scene chapter tenth edition copyright © 2016, 2011, 2009 by...

Emergency Medical ResponderEmergency Medical ResponderFirst on SceneFirst on Scene

CHAPTER

TENTH EDITION

Copyright © 2016, 2011, 2009by Pearson Education, Inc.

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Emergency Medical Responder: First on Scene, 10/eChristopher J. Le Baudour | J. David Bergeron

Legal and Ethical Principles of Emergency Care

2


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Objectives

1. Define the following terms:a. Abandonment b. Advance directivec. Batteryd. Breach of dutye. Civil law (tort)f. Competenceg. Competenth. Confidentiality

continued on next slide


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Objectives

1. Define the following terms:i. Consentj. Criminal lawk. Dutyl. Duty to actm.Emancipated minorn. Ethicso. Expressed consent



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Objectives

1. Define the following terms:p. Good Samaritan law q. Health Insurance Portability

Accountability Act (HIPAA)r. Implied consents. Informed consentt. Mandated reporter



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Objectives

1. Define the following terms:u. Negligence v. Standard of care w. Unresponsivex. Values



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Objectives

2. Explain the concepts of "duty" and "breach of duty" as they relate to the Emergency Medical Responder.

3. Explain the term ethics and how it relates to the Emergency Medical Responder.

4. Explain the term Good Samaritan law and how these laws relate to the Emergency Medical Responder.



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Objectives

5. Explain the term mandated reporter and how it relates to the Emergency Medical Responder.

6. Differentiate the terms scope of practice and standard of care.

7. Compare and contrast the various types of consent utilized by the Emergency Medical Responder.



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Objectives

8. Explain the role of the Emergency Medical Responder for patients who refuse care.

9. Differentiate civil and criminal litigation.

10.Explain the common elements of an advance directive.



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Objectives

11.Explain the role of the Emergency Medical Responder when confronted with an advanced directive.

12.Explain the role of the Emergency Medical Responder with regards to patient confidentiality.



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Objectives

13.Explain the role of the Emergency Medical Responder with respect to evidence preservation when working in or around an actual or potential crime scene.

14.Consistently model ethical behavior in all aspects of Emergency Medical Responder training and job performance.



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Objectives

15.Demonstrate compassion and empathy toward all classmates, coworkers, and simulated patients.

16.Participate willingly as a team member in all class/training activities.

17.Value the importance of maintaining patient confidentiality.

18.Demonstrate a desire to always do what is right for the patient.


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Topics

Legal DutiesConsentAdvance DirectivesNegligenceAbandonmentConfidentialityReportable EventsSpecial Situations


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LEGAL DUTIES


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Legal Duties

• Good Samaritan laws Minimize exposure to liability Encourage bystanders to provide

emergency care No compensation Remain within scope of practice

• Duty Moral and legal obligation to provide

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Legal Duties

• Scope of Practice What is legally permitted to be done by

individuals trained or licensed at a particular level

Does not define what must be done for patient or in a particular situation

Based on EMS education standards



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Legal Duties

• Standard of Care Varies from county to county, state to

state, region to region Based on level of training and

experience working under similar conditions

Expected to follow approved standing orders/protocols for your EMS system


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Figure 2.1 Different emergency personnel may be assisting during an emergency, including police, firefighters, and EMTs. Each must practice the standard of care expected of his own level of training.(Mark C. Ide/CMSP)


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Legal Duties

• Ethics Study of principles that define behavior

as right, good, and proper EMS values• Integrity• Compassion• Accountability• Respect• Empathy



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Legal Duties

• Ethical Responsibilities Patient's needs before responder's own,

so long as safe to do so Patient receives appropriate medical

care. Maintain an open mind.



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Legal Duties

• Ethical Responsibilities Develop understanding of differences. Treat all people equally. Provide the highest standard of care. Maintain and practice skills and

knowledge. Attend continuing education.



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Legal Duties

• Ethical Responsibilities Be honest in reporting care provided. Errors should be reported immediately. Values are core beliefs that you hold to

be true.


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Think About It

• How can understanding legal/ethical issues help the EMR make better decisions?

• How does scope of practice and standard of care differ?

• How can embracing ethical values help the EMR serve as a better patient advocate?


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CONSENT


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Consent

• Legal term for giving formal permission for something to happen

• EMRs must receive permission from patients before legally providing care.


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Consent

• Competence Being adequately or well qualified to

make decisions both physically and intellectually


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Consent

• Patient may not be competent to make medical decisions. Being a minor Intoxication Drug ingestion Serious injury Mental illness


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Consent

• Expressed Consent Competent adult's informed decision to

accept emergency care provided by an EMR (informed consent)

By law, only a parent or guardian of a child may give consent or refuse care.



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Consent

• Expressed Consent Advise patient of:• Your level of training• Why you think care may be necessary• What care you plan to provide• Any consequences related to refusing

care


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Figure 2.2a Once the scene is safe, you must obtain consent to care for the patient.



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Figure 2.2b Always show respect when obtaining consent.


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Consent

• Implied Consent Legal position assumes that

unresponsive or incompetent adult patient would consent to receiving emergency care if he/she could.

Law assumes parents would want care to be provided for their child.


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Figure 2.3 Implied consent is used when the patient is a minor.


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Consent

• Emancipated Minor Legally allowed to make their own

decisions regarding medical care• Married• Pregnant• Parent• Member of armed forces• Financially independent• Living away from home


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Consent

• Refusal of Care Alert and competent adults have the

right to refuse care. Restraining or threatening to restrain

patient against his/her wishes could result in violation of criminal law.

Parent/legal guardian can refuse to let you care for a child.



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Consent

• Refusal of Care When care is refused• Stay calm and professional.• Inform patient of potential dangers of

refusal.• Use aid of someone the patient trusts.• Carefully document refusal of care.


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Think About It

• What must the EMR receive from a patient in order to provide care?

• How can the EMR determine competence of a patient to refuse care?

• EMRs must not leave a patient refusing care until someone with higher training assumes care.


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ADVANCE DIRECTIVES


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Advance Directives

• Document that allows a patient to define in advance what an individual wishes are in the case of becoming incapacitated due to medical illness or severe injury


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Advance Directives

• Designation of agent to make decisions on your behalf

• Do Not Resuscitate (DNR) order• Choice to prolong or not prolong life• Pain relief options• Donation of organs


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Advance Directives

• Do Not Resuscitate (DNR) Orders Written legal document, signed by

patient and physician States patient has terminal illness and

does not wish to prolong life through resuscitative efforts

Does not mean "do not care"


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Figure 2.4 A DNR order is one example of an advance directive. Other examples include POLSTs and living wills.


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Think About It

• What is the benefit of having an Advance Directive?

• EMRs must be familiar with their state's regulations and forms in use.

• You respond to a nursing home where an elderly female is having difficulty breathing. She has a valid DNR. Is it acceptable to withhold oxygen?


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NEGLIGENCE


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Negligence

• Failure to provide expected standard of care

• Four elements to determine negligence Duty to act Breach of duty Damages Causation


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Negligence

• EMRs have a legal duty to act. A legal duty to act has been established

if care is offered and accepted by the patient.

Provide care according to agency's standard operating procedures.

Laws vary from state to state.


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Negligence

• General rule Advise patient to accept treatment by

EMTs.

• State "Good Samaritan" laws may offer protection from civil liability. Be familiar with your own state's laws.


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Think About It

• What are the four elements required to prove negligence?

• By what standard will the EMR be judged?


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ABANDONMENT


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Abandonment

• To leave sick or injured patient before equal or more highly trained personnel can assume responsibility for care

• Could include failure to provide patient information during transfer to more highly trained personnel Facts gathered Assessment findings Care rendered


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Figure 2.5 Once care is initiated, the Emergency Medical Responder assumes responsibility for the patient until relieved by more highly trained personnel.


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Think About It

• You are on scene with an adult who has fallen and is complaining of only ankle pain. The ambulance has not arrived yet. A "child not breathing" call is dispatched in your immediate vicinity but the other EMR unit responding is across town. What do you do?


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CONFIDENTIALITY


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Confidentiality

• Treatment of information that individual has disclosed in relationship of trust and with expectation that it will not be divulged to others

• Protect the patient's right to privacy.• Information only released if patient has

authorized to do so in writing


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Confidentiality

• Authorization not required for you to pass on patient information to other health care providers

• Health Insurance Portability and Accountability Act (HIPAA) gives patients more control over their health care information and limits ways that information is stored and shared.


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Think About It

• How might an EMR unwittingly reveal confidential information?

• You respond to a duplex where a 30-year-old male appears to have over-dosed. The EMTs arrive on scene and assume care. The patient's parents who live next door enter the room and ask you what happened. What do you tell them?


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Reportable Events

• All 50 states have laws that define mandatory reporters and what types of events they must report.

• May include: Exposures to infectious diseases Suspicious burns Vehicle crashes Drug-related injuries


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Think About It

• Understand the reporting requirements for your state.

• Keep report forms and phone numbers needed in a readily available location.

• Do not assume someone else on scene will handle the report.


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Special Situations

• Organ Donors Patient completed legal document that

allows for donation of organs and tissues in event of death.

Care must not differ in any way from care of patient who is not a donor.

Oxygen delivered to body cells by CPR will help preserve the organs.


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Special Situations

• Medical Identification Devices Necklace, arm/ankle bracelet, or card

meant to alert EMS personnel that patient has particular medical condition• Such as a heart problem, allergies,

diabetes, epilepsy May provide important medical

information



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Special Situations

• Medical Identification Devices Some areas use "Vial of Life" program. • Special vial where important medical

information is stored.• Window sticker alerts EMS to vial kept in

patient's refrigerator.


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Special Situations

• Crime Scenes Location where crime has been

committed or place where evidence relating to crime may be found.

Do not enter scene until instructed to do so by law enforcement.

Make as little impact on scene as possible to preserve evidence.


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Think About It

• Organ donors receive the same care as those who are not donors. True or False?

• Aside from medical alert tags, where else might you find health information?

• Minimize impact on crime scenes (e.g., touch/move little, don't cut through holes in clothing from GSW or stabbing).


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Summary

• Legal duty to provide care and must do so within scope of practice

• Must maintain high degree of integrity as well as ethical and moral standards when caring for patients

• Have a responsibility to keep both knowledge and skills up-to-date



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Summary

• Must obtain consent from every victim and be able to apply principles of expressed and implied consent

• Properly manage and document all patients who refuse care and enlist law enforcement when necessary.



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Summary

• Could be accused of negligence if you do not provide acceptable level of care or if you abandon patient

• Must respect privacy and confidentiality of all patients and refrain from sharing information about patients unless legally allowed or required to do so


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Review Questions

1. Explain the concepts of:a. Duty to actb. Breach of dutyc. Ethics

2. What is the difference between scope of practice and standard of care?

3. How does the Good Samaritan law in your area relate to the EMR?


emergency medical responder first on scene chapter tenth edition copyright © 2016, 2011, 2009 by...

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