Transcript EMERGENCY MEDICAL TECHNICIAN

LEGAL ASPECTS OF
PRE-HOSPITAL CARE
Presented by:
Steven Jones, NREMT-P
Clear Lake Emergency Medical Corps
and
Elizabeth Bradley, EMT-P Student
College of the Mainland
Definitions
• Abandonment
– failure to provide care for the patient once it has been
initiated
• Assault
– an action that places a person in immediate fear of bodily
harm
• Battery
– touching another person without their consent
• Civil (tort) law
– deals with noncriminal matters such as contract disputes,
medical malpractice, and conflicts between two parties. The
parties sue each other
Definitions
• Confidentiality
– privacy of all patient related information
• Consent
– granting permission to treat
• Criminal law
– deals with crime and punishment. The state sues an
individual who is accused of committing a crime
• Emancipated Minor
– a minor (under 18 years) that is responsible for his/her own
maintenance and support
Definitions
• Expert Witness
– a witness that has special or extensive knowledge regarding
the subject about which they are called to testify
• Expressed Consent
– when a competent, adult patient gives permission to be
treated
• Implied Consent
– when a patient is unable to give expressed consent the law
assumes that they would desire to have life-saving
treatments rendered
• Lawsuit
– a legal action initiated by one party against another
Definitions
• Libel
– injuring a person’s character or reputation by false or
malicious writings
• Negligence
– failure to administer the same degree of care that a
reasonable person would exercise under the same
circumstances
• Rights
– liberties, allowed for under the law, for which each person is
entitled
Definitions
• Slander
– injuring a person’s character or reputation by false or
malicious words
• Standard of Care
– what a reasonable and prudent person would do under
similar circumstance
Scope of Practice
• Scope of Practice
– outlines the care EMT’s are able to provide
to the patient
• IN TEXAS . . . . . .
– There is no “defined” scope of practice
Scope of Practice
• Established by Medical Director
– Medical Practice Act
• Allows Physicians to delegate procedures to
EMS personnel
– Protocol
– On-Line
Standard of Care
• Local Custom
– Similar Training & Experience
– Protocol
– Other factors
• Location
• Hazards
• Crowds
Standard of Care
– “- - - how a reasonably prudent person with
similar training & experience would act
under similar circumstances, with similar
equipment, and in the same place.”
Standard of Care
• Law
– Constitutional
– Legislative
– Executive
– Judicial
Standard of Care
• Professional Standards
– American Heart Association (AHA)
– American Ambulance Association (AAA)
– National Association of Emergency
Medical Technicians (NAEMT)
– Texas Department of Health (TDH)
– Department of Transpiration
Standard of Care
• Institutional Standards
– Service
• Agency Specific Protocol
– Regional Systems
• Regional Trauma Systems / Guidelines
Negligence
• Simple (Ordinary) Negligence
• Gross Negligence
• Proving Negligence (4 Pillars of Negligence)
– Duty to Act
– Breach of Duty
– Damages
– Causation
Abandonment
• Failure to Continue Treatment:
– Termination of care without Pt’s consent
– Termination of care without provision for
continued care
• Failure to transport
Abandonment
• Handing Over Care
– EMT > EMT
– EMT > EMT-I
– EMT > EMT-P
– EMT > LVN
– EMT > RN
– EMT > Physician
Adult Consent
• Adult - Any person over 18 years of age
who is not under a court-ordered
disability
• Actual Consent (Informed, Expressed)
• Implied Consent
– Pt. is unconscious or unable to
communicate and is suffering from what
appears to be a life-threatening injury or
illness
Adult Consent
• Involuntary Consent
– An adult may be treated against his will
only if:
• Treatment is ordered by a magistrate
• Treatment is ordered by a peace officer or
corrections officer who has the patient under
arrest or in custody
Adult Consent
• Consent of the Mentally Incompetent As
Deemed by EMS
– Suicidal Ideations or Suicide Attempt
• Encourage patient to transport voluntarily
• Involve Law Enforcement
– Force Transport – have patient placed in custody
Adult Consent
• Right of Refusal of Treatment/Transport
– Mentally competent adults have the right to
refuse care
– the person must be informed of risks,
benefits, treatments, & alternatives
– Obtain signature & witness
Minor Consent
• Minor - any person under 18 years of
age who has never been married and
who has not had his/her minority status
changed by the court
– Pregnant Minor
– Emancipated Minor
– Minor Living Alone and Responsible for
50% of Personal Living Expenses
Minor Consent
• Actual Consent (Informed, Expressed)
– Parents
– Guardian
– Others Closely Related of Majority Age
Minor Consent
• Implied Consent
– Life or Limb Threatening
– No Parental Refusal
Minor Consent
• Right of Refusal of Treatment/Transport
– Mentally competent adults
(Parent/Guardian) have the right to refuse
care for their children
– the person (Parent/Guardian) must be
informed of risks, benefits, treatments, &
alternatives
– Obtain signature of Parent/Guardian &
witness
Assault & Battery
• Assault
– Unlawfully placing a person in fear of
immediate bodily harm without consent
• Battery
– Unlawfully touching a person
Immunity
• Governmental (Sovereign) Immunity
• “Good Samaritan” laws
– Do not prevent lawsuits
– Offer a defense for those who act in “Good
Faith” and meet the Standard of Care”
– Do not protect against Gross Negligence
Do Not Resuscitate
• What Is A OOHDNR?
– Out Of Hospital Do Not Resuscitate
• An order that allows patients to direct health care
professionals in the out-of-hospital setting to
withhold or withdraw specific life-sustaining
treatments in the event of respiratory or cardiac
arrest.
Do Not Resuscitate
• “Living Will”/ “Advance Directives” must
be Presented upon Patient Contact
• Determine validity
– May Not be Witnessed by Anyone Who
would Benefit from the Death of the Patient
Do Not Resuscitate
• Texas Law Allows:
– OOHDNR – Original Document
– OOHDNR – Copies of Original Document
– Medallions (DNR Device)
• Medical ID Bracelets / Necklaces
• Laminated Wallet Cards
Do Not Resuscitate
• Can Include (Any or All)
– Cardiopulmonary resuscitation (CPR)
– Transcutaneous Cardiac
– Defibrillation
– Advanced Airway Management
– Artificial Ventilation
Do Not Resuscitate
• Determine Specificity as to Levels of
Care to Render
– Usually Comfort Measures Only
– Pain Management is SPECIFICALLY
Allowed
• If Transporting the Patient
– A copy of the OOHDNR or DNR Device
must accompany the patient
Do Not Resuscitate
• Once Treatment Begins:
– If a Valid OOHDNR is Discovered / Presented
• Cease using CPR, transcutaneous cardiac
pacing, defibrillation, advanced airway
management and artificial ventilation on the
patient
• Provided supportive care as necessary
SPECIFICALLY comfort care
– Pain Management
Do Not Resuscitate
• Conditions To Dishonor a OOHDNR
– The patient is pregnant
– There are unnatural or suspicious circumstances
surrounding the death
– The form is not signed twice by all who need to
sign it or is filled out incorrectly and no DNR
device is present
– An IMMEDIATE family member is protesting the
DNR on scene
Do Not Resuscitate
• A DNR can be revoked at any time by the
patient or the person who acted on behalf of
the agent. Revocation can be in the form of
communication to responding health care
professionals, destruction of the form, or
removal of devices
• Consider Family Reaction
Do Not Resuscitate
IN DOUBT ??
TREAT!!
Records & Reports
• Complete & Accurate
• Legible & Neat
– An untidy or incomplete report is evidence
of incomplete or inexpert care.
• Legal Document
– If it wasn’t written down, it didn’t happen!
Patient Confidentiality
• Patient Confidentiality must be Kept:
– To Ensure the Patient’s Right to Privacy
– To Maintain the EMT’s Reputation of
Professionalism
– To Maintain the Service’s Reputation of
Professionalism
– It is No One else’s Business!
Patient Confidentiality
• Patient Information May Only be
Released:
– It is necessary to ensure continuity of care
– It is requested by Law Enforcement
– It is required for billing purposes
– It is Subpoenaed
– When the Patient Signs an Information
Release Form
Special Reporting
Requirements
• Childbirth
• Child Abuse
– Report to:
• Law Enforcement
• Physician - Emergency Department
• Child Protective Services (CPS)
– Don’t Accuse - Report Observations Only
– Immunity - Good Faith
Special Reporting
Requirements
• Elder Abuse
• Injury During the Commission of a
Felony
• Drug Related Injuries
Special Reporting
Requirements
• Crime Scene
– Scene Survey
– Document
– Preserve
– Report to Law Enforcement
Special Reporting
Requirements
• Sexual Assault
– Report to Law Enforcement
• MUST OBTAIN PATIENT’S PERMISSION)
– Retain Evidence
Special Reporting
Requirements
• Dead on Scene
– Document Absence of Vital sign
– Contact Law Enforcement
– Do Not Disturb or Move Body
– Additional Documentation
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All EMS Personnel Present
Where EMS Stepped
What EMS Touched
General Scene Appearance