Legal and Ethical issues

1. Legal and Ethical issues

2. Know Your Reporting Responsibilities! this applies to you!

3. Special Reporting Requirements(1 of 2) • Abuse of children, elderly, and spouse • Injury during the commission of a felony • Drug-related injury • Childbirth

4. Special Reporting Requirements(2 of 2) • Infectious disease exposure • Crime scene • Deceased

5. Reporting It is a misdemeanor to fail to report abuse. • report suspicion of child abuse, you do not need proof to report an incident.

6. What, When & Who WhatWhen • verbal report - immediately • written report - within 36 hours Who • law enforcement • protective services

7. Elder Abuse • Any person who takes advantage of person, property or emotional state • Victims are often hesitant or unable to report • Signs of abuse are often overlooked • Pt. often has multiple medical conditions and are dependent on others

8. Assessment of Elder Abuse (1 of 2) • Repeated visits to the emergency room • A history of being “accident-prone” • Soft-tissue injuries • Vague explanation of injuries • Psychosomatic complaints

9. Assessment of Elder Abuse (2 of 2) • Chronic pain • Self-destructive behavior • Eating and sleeping disorders • Depression or a lack of energy • Substance and/or sexual abuse

10. Signs of Physical Abuse • may be obvious or subtle. • Obvious signs include bruises, bites, and burns. • Look for injuries to the ears. • Consider injuries to the genitals or rectum as evidence of abuse.

11. Advance Directives • Specifies medical treatments desired if patient is unable to make decisions • Do not resuscitate (DNR) orders • Patients have the right to refuse resuscitative efforts.

12. Do Not Resuscitate • AKA - DNR or “no code” • supportive measures only - No CPR • family member can request resuscitation

13. Medical facility Vs. Home or Street There are different requirements

14. DNR- Nursing facilities • written order in patient's chart • no CPR • no code • DNR VERBAL ORDER FROM MD NOT VALID unless put in writing

16. DNR - home/street • L.A. County “Prehospital DNR” Form • California “Prehospital DNR” Form** • MEDIC ALERT TAG bracelet or necklace • no other type of DNR may be honored in Los Angeles County

19. Legal issues • Authority for patient care - most qualified at rendering emergency care • Physicians at the scene must show identification and agree to assume responsibility in order to direct care

20. Consent – three types • Expressed consent • Implied consent • Minors and mentally incompetent adults • “In loco parentis” • ALOC

21. Legal age of consent • Minor is under 18 years-old • Emancipated minor • Female - pregnancy related

22. Adults - Competence • Must be competent to refuse treatment or transport • hypotensive • hypoglycemic • under the influence • suicidal ideations or actions

23. Adults - Competence • Any EMT-1 or EMT-P can deem a patient incompetent • This is NOT a 5150

24. Refusal of Treatment Against Medical Advice • when a patient refuses care or transport • do not need if you believe patient is OK without treatment.

25. Valid AMA • Patient Alert and Oriented X3 • Competent • EMT-B should obtain a witnessed signature MUST advise pt : • Of need for treatment • Of consequences of refusal • That they may re-contact 911

26. 5150 (72 hour hold) Patients may be placed on a hold if... • danger to self • danger to others • gravely disabled due to mental disorder

27. 5150 (72 hour hold) who may place hold • Law Enforcement • PET or PMRT member • County “designated” doctors

28. Limited Legal Authority • As an EMT-B, you have limited legal authority to require or force a patient to undergo care. • Police may put a patient in protective custody to allow you to provide care. • Know your local laws and protocols.

29. Assault and Battery • Know when to force TX • Assault • Unlawfully placing a person in fear of immediate bodily harm without consent • Battery • Unlawfully touching a person

30. Duty to Act • Individual’s responsibility to provide patient care • Begins once an ambulance responds to a call or treatment is initiated

31. Standard of Care • The minimum level of care that a person can expect • Imposed by local protocol • Imposed by the law • Professional or institutional standards

32. Negligence • Failure to apply the standard of care • Failure to provide the same care that a person with similar training would provide • Act or omission of an act • Good Samaritan Act does not apply to on-duty personnel

33. Negligence Determination • Duty • Breech of duty • Damages • Cause

34. Abandonment • Termination of care without patient’s consent • Termination of care without provisions for continued care • Care cannot stop unless someone of equal or higher training takes over

35. Ethical Responsibilities • Make physical/emotional needs a priority • Practice/maintain skills • Critically review performances • Attend continuing education/refresher programs • Be honest in reporting

36. Confidentiality • Information received from or about a patient is considered confidential. • Disclosing information without permission is considered a breach of confidentiality. • Generally, information can only be disclosed if the patient signs a written release.

37. Records and Reports • Complete documentation is a safeguard against legal complications • If an action or procedure is not recorded, it was not performed • An incomplete or untidy report is evidence of incompetence

38. Standards Imposed by States • Medical Practices Act • Exempts EMT-Bs from licensure requirements • Certification • Process of evaluating and recognizing that EMT-B has met certain predetermined standards

39. Regulation updates • EMT-1 or EMT-B designation only • Titles that no longer exist • EMT-1(AA) • EMT-1 (D)

40. Certification Application Requirements Be 18 years old or older. Have valid Course Completion Certificate. Apply within 2 years of course completion.

41. Certification requirements Submit application and fees. Pass a written certification examination. And ..

42. Background Check Disqualifying convictions Violent crimes Sex related crimes Drug related crimes (including DUI)

43. Re-certification Requirements • Every two years • Complete refresher course Or • Obtain 24 hours of approved continuing education • Submit application and fees

44. Approved Continuing Education • BLS level • many methods to obtain CE • MANDATORY CPR & airway management course at least once every 2 years • YOU must find a CE Provider

45. End questions??