Legal and Ethical Principles of Emergency Care

2

LEGAL DUTIES

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

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)

ETHICS

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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CONSENT

Consent

• Competence Being adequately or well qualified to

make decisions both physically and intellectually

Consent

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

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

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.

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

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

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.

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.

ADVANCE DIRECTIVES

Advance Directives

• Designation of agent to make decisions on your behalf

• Do Not Resuscitate (DNR) order• Living Will

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

NEGLIGENCE

Negligence

• Failure to provide expected standard of care

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

ABANDONMENT

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

CONFIDENTIALITY

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.

REPORTABLE EVENTS

Reportable Events

• May include: Crimes resulting in knife or gunshot

wounds Child and elder abuse Domestic violence Rape

SPECIAL SITUATIONS