Transcript Objectives

Chapter 3
Medical, Legal, and Ethical
Issues
Prehospital Emergency Care, Ninth Edition
Joseph J. Mistovich • Keith J. Karren
Copyright ©2010 by Pearson Education, Inc.
All rights reserved.
Objectives
1.
2.
3.
4.
5.
Define key terms introduced in this chapter.
Differentiate between the concepts of scope of practice
and standard of care (slides 14-16)
Given a scenario, determine whether you would have
a duty to act (slides 17-18).
Explain your duties with respect to patients, your
partner, yourself, and your equipment (slide 18).
Describe the intent of Good Samaritan laws
(slides 19-20).
Objectives
6.
Explain each of the following legal protections for
EMTs (slides 21-22):
a. Sovereign immunity
b. Statutes of limitations
c. Contributory negligence of the patient
7.
8.
9.
Explain the EMT’s legal obligations with respect to
medical direction (slides 23-24).
Differentiate between the concepts of ethics and
morals (slide 25).
Describe the ethical responsibilities of EMTs
(slides 25-26).
Objectives
10. Given a scenario presenting an ethical dilemma,
discuss the consequences of various decisions and
actions (slides 25-26).
11. Explain each of the following types of consent
(slides 27-29).
a.
b.
c.
d.
e.
Informed consent
Expressed consent
Implied consent
Consent to treat minors
Involuntary consent
Objectives
12. Compare and contrast the typical provisions and
prehospital applications of each of the following types
of advance directives (slides 30-32):
a.
b.
c.
d.
Do not resuscitate order
Living will
Durable power of attorney
Physican orders for life-sustaining treatment
13. Given a scenario in which a patient has an advance
directive, determine the appropriate action to be taken
(slides 30-32).
14. Given a scenario in which a patient refuses care,
discuss the actions you should take (slides 33-36).
15. Differentiate between criminal and civil liability
(slide 39).
Objectives
16. Explain the concept of negligence (slides 37-48).
17. Give examples of ways you can avoid each of the
following tort claims (slides 49-58):
a.
b.
c.
d.
e.
Abandonment
Assault
Battery
False imprisonment/kidnapping
Defamation
18. Explain patients’ rights and your legal and ethical
responsibilities concerning confidentiality and privacy
(slides 59-62).
19. Describe COBRA and EMTALA provisions as they
apply to EMS (slides 63-64).
Objectives
20. Give examples of ways you can protect yourself legally
in transport and transfer situations (slides 65-66).
21. Describe special considerations for patients who are
potential organ donors (slides 67-68).
22. Identify presumptive signs of death (slides 71-73).
23. Identify situations in which law enforcement or the
medical examiner’s/coroner’s office should be
contacted.
Objectives
24. Discuss special considerations in responding to
potential crime scenes (slides 74-75).
25. Describe situations in which the EMT may be
mandated to make a report, such as suspected abuse,
crimes, and infectious diseases (slides 76-77).
Topics
The Scope of Practice
Issues of Patient Consent and Refusal
Other Legal Aspects of Emergency Care
CASE STUDY
Dispatch
EMS Unit 105
Proceed to 733 East Third Street for an elderly
male with abdominal pain.
Time out 1430
Upon Arrival
• You find an elderly female at the door
• The house is so cluttered you can barely pass
through
• Male lying on bed moaning; undergarments
stained
• Room is very cold
How would you proceed?
The Scope of Practice
Back to Topics
Legal Duties
Back to Objectives
• Scope of practice
• Standard of care
(© Craig Jackson/In the Dark Photography)
Legal Duties
Duty to Act
Back to Objectives
•
•
•
•
•
Duty to act
Duty to patient
Duty to self
Duty to your partner
Duty for your equipment
Back to Objectives
(© Sun Herald/Corbis)
Legal Duties
Good Samaritan Laws
Back to Objectives
• Enacted in 1959 in California
• For unpaid services
• Does not prevent you from being sued
(© Mark C. Ide)
Legal Duties
Other Legal Protections
Back to Objectives
•Sovereign
immunity
•Statute of
limitations
•Contributory
negligence
Legal Duties
Medical Direction
Back to Objectives
• Follow standing
orders as
approved by
medical direction
• Establish
communication
with medical
direction as
needed
Ethical Responsibilities
Back to Objectives
• Ethics
• Morals
• Code of ethics
Back to Objectives
Issues of Patient
Consent and Refusal
Back to Topics
Types of Consent
Back to Objectives
• Informed consent
• Expressed
consent
• Implied consent
• Consent to treat a
minor
• Involuntary
consent
Advance Directives
Back to Objectives
•
•
•
•
Do not resuscitate order (DNR)
Living will
Durable power of attorney
Physician order for life-sustaining treatment (POLST)
• Know your state’s
laws and
protocols
• DNR must be
present
• Make sure it is
valid
• If there are any
questions, start
resuscitation
Refusing Treatment
Competency
Back to Objectives
• Patient must be
lucid and
capable of
making an
informed
decision
• You must make
patient fully
aware of the
consequences
Refusing Treatment
Protecting Yourself In
Refusal Situations
•
•
•
•
•
Try again to persuade the patient
Make sure the patient is competent
Any questions, contact medical direction
Encourage the patient to seek help later
Document, document, document
Other Legal Aspects of
Emergency Care
Back to Topics
Negligence
Back to Objectives
•
•
•
•
Criminal
Civil
Tort
Negligence
Back to Objectives
Four Elements to Prove
•
•
•
•
The EMT had a duty to act
The EMT breached that duty to act
The patient suffered injury or harm
The injuries were the result of the breach of
the duty
Negligence
Duty to Act
Obligation to respond to the scene and
provide emergency care to patient
Negligence
Breach of Duty to Act
• Negligence
• Simple negligence
• Gross negligence
Negligence
Damages
Damages refers to injuries that are real,
demonstrable, and recognizable by the law.
(© David Handschuh)
Negligence
Proximate Cause
Injuries a direct result of EMT negligence
Intentional Tort
Back to Objectives
Action knowingly committed by an
individual that is considered to be civilly
wrong according to the law
Intentional Tort
Abandonment
Stopping treatment without transferring
care to another professional of equal or
higher training
Intentional Tort
Assault and Battery
• Assault
• Battery
Intentional Tort
False Imprisonment or
Kidnapping
Transporting a competent patient
without his consent
Intentional Tort
Defamation
• Defamation
• Slander
• Libel
Confidentiality
Back to Objectives
• Know your jurisdiction's laws
• Release information only in specific cases
Health Insurance Portability
and Accountability Act (HIPAA)
Federal law that protects the privacy of
patient health care information
COBRA and EMTALA
Back to Objectives
• Consolidated Omnibus Budget Reconciliation
Act (COBRA)
• Emergency Medical Treatment and Active
Labor Act (EMTALA)
Protecting Yourself in
Transport and Transfer
Situations
Back to Objectives
(©Maria A.H. Lyle)
• Get a full report
about the patient’s
condition
• Ensure you can
provide appropriate
level of care
• Obtain signed
informed consent
form
• Obtain written
certification of
transfer from
physician
• Know where you
are going; take the
quickest possible
route
Special Situations
Donors and Organ
Harvesting
Back to Objectives
• Identify patient
as potential
donor
• Relay
information to
hospital
• Provide
emergency
care
Special Situations
Medical Identification
Insignia
• Look for tags identifying medical
conditions
• Look on wrist, around neck, or on a card
Special Situations
Recognizing Death in
the Field
Back to Objectives
• No pulse, breathing,
or breath sounds
• Complete
unresponsiveness
• No pupil response
• Absence of a blood
pressure
• No reflexes
Presumptive Signs of
Death
Obvious Signs
•
•
•
•
Decapitation
Rigor mortis
Decomposition
Dependent
lividity
Special Situations
Crime Scenes
Back to Objectives
• Observe and
document the
unusual
• Do not cut through
holes from bullet or
stab wounds
• Scene safety
• Take one way in
and out
• Touch only what
you have to
• Tell police if you
move or touch
anything
(© Craig Jackson/In the Dark Photography)
Special Situations
Special Reporting
Situations
Back to Objectives
• Abuse
• Crime
• Drug-related injuries
(© Robert A. Felter, M.D.)
CASE STUDY
Follow-Up
CASE STUDY
Assessment
• S: conscious but disoriented;
complains of abdominal pain; no
signs of acute distress
• AMPLE: unable to obtain from
patient or wife
CASE STUDY
Assessment
• Wife appears not to understand
situation
• No change in condition during
transport
CASE STUDY
An Ethical Obligation
• After transfer to hospital personnel,
you contact social services; believe
it is elderly neglect
• Two weeks later you are told patient
was diagnosed with a gastric ulcer
and organic brain syndrome
CASE STUDY
An Ethical Obligation
• Mrs. Schuman, wife, diagnosed
with Alzheimer’s disease
• Both are now residents of
extended-care nursing home
Critical Thinking Scenario
• 34-year-old female patient complaining of
abdominal pain
• Upon arrival, you find the patient lying in
bed
• She is alert and holding her abdomen
• She states that she is having bad “belly
pain”
• Pain began about an hour ago
Critical Thinking Scenario
• You perform an assessment, place the
patient on oxygen, and prepare for
transport
• The patient suddenly states, “I don’t want
to go to the hospital”
Critical Thinking Questions
1. How would you initially gain consent from
this patient?
2. How would you manage the patient’s
refusal to be transported?
3. What legal issues may you face if you
continue with treatment and transport?
Reinforce and Review
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