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Medical, Legal and Ethical Issues. Medical Responsibilities. Scope of Practice. The range of duties and skills that emergency medical technicians are allowed and expected to perform. Scope of Practice. Defined by state law Outlines care you can provide
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Scope of Practice The range of duties and skills that emergency medical technicians are allowed and expected to perform.
Scope of Practice • Defined by state law • Outlines care you can provide • Further defined in protocols and standing orders • Authorized through online and off-line medical direction
Standard of Care The degree of skill and judgment expected of an individual when caring for a patient and is defined by training, protocols, and the expected actions of the care providers with similar training and experience, working under similar conditions
Standard of Care • Standard imposed by local custom • Often based on locally accepted protocols • Standard imposed by the law • May be imposed by statutes, ordinances, administrative guidelines, or case law
Standard of Care • Professional or institutional standards • Recommendations published by organizations and societies • Specific rules and procedures of your service or organization
WA State Standards • Authorized care under RCW 246.976.182 • Medical Practices Act • Exempts EMT-Bs from licensure requirements • Certification • Process of evaluating and recognizing that EMT-B has met certain predetermined standards
Legal Protection • EMS Immunity Act • 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
Negligence • Failure to provide the same care that a person with similar training would provide
Negligence • Duty • Responsibility to act reasonably based on standard of care • Breech of duty • Failure to act within the expected and reasonable standard of care • Damages • Physical or mental harm created in a noticeable way • Cause • Existence of reasonable cause and effect
Duty to Act • Individual’s responsibility to provide patient care. • Responsibility to provide care comes from either statute or function. • Legal duty to act begins once an ambulance responds to a call or treatment is initiated.
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.
HIPAA • Health Insurance Portability and Accountability Act of 1996 • Amends IRC of 1986 to improve portability and continuity of health insurance coverage in group and individual markets • Federal law mandates privacy and confidentiality in all issues regarding patient care
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 • Consent of the Mentally Ill
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 • Remember to document and obtain signatures of patient & 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 • Actual Consent (Informed, Expressed) • Parents • Guardian • Others Closely Related of Majority Age
Minor Consent • Emancipated Minors • Under 18, married, pregnant, a parent, member of the armed forces, financially independent and living away form home • 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 • Remember to document and obtain signatures of Parent/Guardian & witness
Refusal of Treatment • Mentally competent adults have the right to refuse care. • Patients must be informed of risks, benefits, treatments, and alternatives. • EMT-B should obtain a signature and have a witness present, if possible.
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
Assault & Battery • Assault • Unlawfully placing a person in fear of immediate bodily harm without consent • Battery • Unlawfully toughing a person
Libel and Slander • Libel • The act of injuring a person’s character, name, or reputation by false or malicious written statements • Slander • The act of injuring a person’s character, name, or reputation by false or malicious spoken statements
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. • Require a written order from one or more physicians • When in doubt, begin resuscitation.
Advance Directives • POLST Orders • WA State DNR Form • Living Wills or Advance Directives • Must be Presented upon Patient Contact • Specifics of care? • Determine validity • May not be witnessed by anyone who would benefit from the death of the patient
Special Situations • Organ donors • Medical identification insignia
Ethical Responsibilities • Make the physical/emotional needs of the patient a priority. • Practice/maintain skills to the point of mastery. • Critically review performances. • Attend continuing education/refresher programs. • Be honest in reporting.
