ch03 (Lecture) - Legal and Etical Considerations of Providing Care

EMT COMPLETE
A Comprehensive Worktext
SECOND EDITION
CHAPTER 3
Legal and Ethical
Considerations of
Providing Care
EMT Complete: A Comprehensive Worktext, 2nd Ed.

Copyright © 2014, 2007 Pearson Education, Inc.
Le Baudour | Batsie | Dickinson
Learning Readiness
• EMS Education Standards, text p. 47

• Objectives, text p. 47
• Key terms, text p. 48

Setting the Stage
• Overview of Lesson Topics

 Scope of Practice
 Legal Aspects of Providing Care
 Advance Directives
 Negligence, Abandonment, Assault and
Battery
 Patient Transfers
 Patient Confidentiality
 Special Reporting Situations
EMERGENCY DISPATCH
• Chapter 3 Emergency Dispatch, text p. 48

EMERGENCY DISPATCH
• Discussion Questions
 How should Brandon and Jewel respond
to the caretaker?
 Are the EMTs obligated to do an
assessment, given that the caretaker
has said she only needs assistance in
getting Mr. Flowers back to bed?
continued on next slide

EMERGENCY DISPATCH
• Discussion Questions
 What potential legal and ethical issues
are involved in this situation?
 How would you approach this situation?
What questions would you ask? What
actions would you take?

Introduction
• Lawsuits are commonplace

 Much of EMS work takes place in the
public eye
 Choices and actions influence risk of
being sued
 Know how the law affects EMS providers

Scope of Practice and Standard of
Care
• Scope of Practice
• What EMTs are allowed to do
• Defined by national standards, state
legislation, medical direction
• Communicated in protocols, standing
orders

Scope of Practice and Standard of
Care
• Standard of Care
• What EMTs should, and are expected to,
do
• Prudent person criterion
• Defined by stakeholders
• Communicated in protocols, standing
orders

Medical Direction
• EMTs are extensions of medical director

 Must adhere to protocols, standing
orders, standard of care
• Physician medical director required for
all EMS systems
 Oversees all aspects of patient care
 Continuous quality improvement

Ethical Responsibilities
• Study of morals and moral choices;

rules of right and wrong conduct
• Ethical issues can pose dilemmas

• EMT Code of Ethics

 Provide care based on need without
regard to nationality, race, creed, color,
or religion
 Protect patient confidentiality
 Respect patient dignity

• EMT Code of Ethics

 Promote high standard of care
 Take responsibility for actions and
conduct
 Uphold standards of practice and
education

Quality training promotes a high standard of care for your patients.

Core Values
• People act and decide according to

values and beliefs
• Core values
 Integrity
 Compassion
 Accountability
 Responsibility
 Empathy

Legal Aspects of Providing Care
• Duty to act
 Implied or contractual
 Off-duty responders generally do not
have duty to act
• However, once care is begun, a duty is
created
• Failure to continue care until patient care
is transferred can result in claims of
negligence or abandonment

Legal Aspects of Providing Care
• Good Samaritan Laws

 Intended to protect passersby from
liability if they stop to render aid
 Applies to those responding in good
faith and without compensation
 Prudent person standard applies

Stop, Review, Remember

Obtaining Consent and Patient
Refusal
• Expressed consent
 Patient must be alert, competent adult
 Verbal, nonverbal, written
 Must determine
• Competence
• Capacity

Refusal
Obtaining consent from an adult patient.

Refusal
• EMTs must have consent before
treating patients
• Several forms of consent
• Patient can withdraw consent at any
time

Refusal
Patients who are unresponsive can be cared for based on implied consent.

Refusal
• Implied consent
 Consent is assumed when someone
cannot consent
 Minors
 Unresponsive
 Mentally incompetent
• Includes intoxication
• Involve law enforcement if needed

Refusal
• Patients who refuse care
 Competent adults have the right to
refuse care
 Legal guardian or parent can refuse care
for dependents
 Patients can withdraw consent

Refusal
• When a patient refuses care
 Try to convince patient to allow care;
explain risks and consequences
 Determine patient's understanding of
information

Refusal
 If conditions of protocols are met, have
patient sign a release
 If patient refuses to sign, have a
witness

Refusal
 When in doubt, err on the side of
treatment
 Involve law enforcement in extreme
cases
 Use detailed documentation

Additional Legal Concepts
• Statute of limitations
• Contributory negligence
• Sovereign immunity

Advance Directives
• Legal statement of patient's wishes

regarding health care
• Different types
 Living will
 Do not resuscitate order
 Durable power of attorney for health
care
 Physician's orders for life-sustaining
treatment

Negligence
• Criminal and civil laws apply to EMS

providers
• Torts are civil cases based on
wrongdoing by the defendant
• Negligence is an omission or neglect of
reasonable care, precaution, or action

Negligence
• Four elements necessary to prove

negligence
 EMT had a duty to act
 EMT breached the duty to act by not
living up to his legal obligations
 Patient suffered damages
 EMT's breach of duty was the cause of
the patient's damages

Abandonment
• EMT with duty to act leaves a patient in

need of care without turning care over
to a person of equal or higher training
• Always formally turn over patient care
with a verbal report and, usually,
written patient care report

Assault and Battery
• Assault
 Threat of force against another person;
including threatening physical contact
against a patient's wishes
• Battery
 Carrying out the threat, including
providing care a patient does not
consent to

Assault and Battery
• Use of restraints
 Can be legally risky
• False imprisonment
• Kidnapping
 Use only when patient is imminent risk
to self or others
 Involve law enforcement if possible
 Document all aspects of situation

Patient Transfers
• Emergency Medical Treatment and

Active Labor Act (EMTALA)
• Issues with transporting patients and
transferring care
 Closest hospital is often best; follow
protocols
 For transfers, make sure patient's needs
are in your scope of practice
 Excellent communication needed to
safely transfer care
Patient Confidentiality
• Health Care Insurance Portability and

Accountability Act (HIPAA)
 Restrictions on sharing patient
information

Patient Confidentiality
To maintain patient confidentiality, discuss your patient only with those who will be
continuing patient care.

Special Reporting Situations
• State laws identify specific situations

that EMS providers must report
• Issues include abuse and neglect

Crime Scenes
A law enforcement officer should be requested at a suspected crime scene.

Crime Scenes
• Follow law enforcement directions

• If law enforcement is not present, do
not place yourself at risk
 Retreat, if necessary
 Request law enforcement

Crime Scenes
• Primary responsibility is patient care

• Be observant, disturb scene as little as
possible
• Document in detail

Potential Organ Donors
• Donors identified by card or notation on

driver's licenses
• Continue resuscitation according to
protocols
• Advise medical direction/receiving
hospital of donor status

Medical Identification Jewelry
• Provides information about patients

with altered mental status
• Usually necklace or bracelet
• Common conditions
 Diabetes
 Allergies
 Epilepsy
 Heart conditions

Medical Identification Jewelry
The Medic Alert bracelet is one example of medical identification jewelry (front
shown).


Lesson Summary
• Scope of practice and standard of care

• Ethical and moral obligations
• Patient confidentiality
• Legal issues
 Duty to act
 Advance directives
 Assault, battery
 Abandonment
 Negligence
Lesson Summary
• Other issues
 Organ donor status
 Crime scenes
 Mandatory reporting


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EMT COMPLETE

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• EMS Education Standards, text p. 47

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Overview of Lesson Topics

• Chapter 3 Emergency Dispatch, text p. 48

EMT Complete: A Comprehensive Worktext, 2nd Ed.

continued on next slide

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Lawsuits are commonplace

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• EMTs are extensions of medical director

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Study of morals and moral choices;

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• EMT Code of Ethics

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• EMT Code of Ethics

EMT Complete: A Comprehensive Worktext, 2nd Ed.

Quality training promotes a high standard of care for your patients.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• People act and decide according to

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Good Samaritan Laws

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

Obtaining consent from an adult patient.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Legal statement of patient's wishes

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Criminal and civil laws apply to EMS

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Four elements necessary to prove

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• EMT with duty to act leaves a patient in

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Emergency Medical Treatment and

• Health Care Insurance Portability and

EMT Complete: A Comprehensive Worktext, 2nd Ed.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• State laws identify specific situations

EMT Complete: A Comprehensive Worktext, 2nd Ed.

A law enforcement officer should be requested at a suspected crime scene.

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Follow law enforcement directions

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Primary responsibility is patient care

EMT Complete: A Comprehensive Worktext, 2nd Ed.

• Donors identified by card or notation on