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Chapter 3

Chapter 3. Medical, Legal, and Ethical Issues. Topics. 3. Legal responsibilities Issues of patient consent and refusal Other legal aspects of emergency care Special situations. Legal Responsibilities. 3. Scope of practice Defines actions and/or care that are legally allowed

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Chapter 3

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  1. Chapter 3 Medical, Legal, and Ethical Issues Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  2. Topics 3 • Legal responsibilities • Issues of patient consent and refusal • Other legal aspects of emergency care • Special situations Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  3. Legal Responsibilities 3 • Scope of practice • Defines actions and/or care that are legally allowed • National EMS scope of practice http://www.jems.com/data/pdf/SOPFinal4.0.pdf Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  4. Legal Responsibilities 3 • Standard of care • Right assessment and care • Properly performed assessment and care • Sources influencing standard of care vary Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  5. Legal Responsibilities 3 • Duty to act • Refers to your legal obligation to provide care to a patient • Implied • Formal • Legal duty may not exist in certain situations Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  6. Legal Responsibilities 3 • Good samaritan laws • Protection from liability • Performed in good faith • Willful or wanton harm • Sovereign immunity Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  7. Legal Responsibilities 3 • Medical direction • Your ability to function is contingent on medical direction • Use approved standing orders • Consult with medical direction when necessary Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  8. Ethical Responsibilities 3 • Ethical responsibilities • Describe rules of ideal conduct for the EMT • Keep the patient as your priority • Remain professional and efficient in your skills Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  9. Issues of Patient Consent and Refusal 3 • Treating a patient can only occur after you gain permission • If the EMT-B does not follow this criteria, he may be found liable for negligence Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  10. Issues of Patient Consent and Refusal 3 • Types of consent • Informed • Expressed • Implied • Children and mentally incompetent adults Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  11. Advanced Directives 3 • Do Not Resuscitate (DNR) orders • DNAR • Living will • Health care proxy Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  12. Refusals 3 Do Not Resuscitate form Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  13. Refusals 3 • Refusals • The patient may refuse care • The patient may withdraw from care • The patient must be informed of the risks Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  14. Issues of Patient Consent and Refusal 3 Common style of refusal form Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  15. Other Legal Aspects ofEmergency Care 3 • Negligence • Act of deviating from an accepted standard of care • Simple • Gross Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  16. Other Legal Aspects ofEmergency Care 3 • Four elements to show negligence • The EMT had a duty to act • The EMT breached that duty • The patient sustained injury • Proximate cause Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  17. Other Legal Aspects ofEmergency Care 3 • Intentional tort • Civilly wrong action committed by an individual • Abandonment • Assault • Battery Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  18. Other Legal Aspects ofEmergency Care 3 • Intentional tort (con’t.) • Civilly wrong action committed by an individual • False imprisonment • Defamation • Slander and libel Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  19. Confidentiality 3 • Confidentiality • Confidential information • Releasing confidential information • Health Insurance Portability and Accountability Act (HIPAA) Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  20. Confidentiality 3 • COBRA and EMTALA • Federal regulations for access to emergency health care Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  21. Special Situations 3 • Special situations in EMS • Donors and organ harvesting • Medical identification insignia Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  22. Special Situations 3 • Special situations in EMS • Recognizing death in the field • Presumptive signs • Obvious signs Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  23. Potential Crime Scene 3 • Potential crime scenes are those in which police investigation may be warranted • Be aware of EMT responsibilities while on scene Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

  24. Special Reporting Situations 3 • Special reporting situations vary state to state • Abuse • Crime • Infectious disease exposure • Patient restraint • Suicide Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

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