Opening Case

1. Opening Case

2. Case • A 15-year-old female complains of a severe headache. • Upon arrival, you smell marijuana. • Several teenagers tried to give the patient Tylenol. • There are no adults present.

3. Case (continued) • Patient denies any trauma. • In the ambulance, she admits to taking a hit of marijuana prior to the headache. • She also tells you that she is three months pregnant and has not told her parents.

4. Mom and Dad arrive on scene: • Can you tell them what is going on with this patient? • Should you? • Can you or should you tell them that the patient is pregnant?

5. Introduction

6. Introduction EMS is regulated at the local, state, and federal government levels Topics to be covered: • HIPAA • EMTALA • Medicare

7. Street Secret • It is in your best interest to know the pertinent laws and regulations that govern your practice • Ignorance of the law is never a good defense strategy

8. Introduction • Categories of laws that pertain to EMS • Administrative law • Civil law (torts) • Criminal law

9. State Laws and Regulations

10. State Laws and Regulations • The regulatory agency sets the minimum educational requirements utilized to certify EMTs at all levels • All states require that a physician oversee the quality of medical care

11. The Standard of Care and Scope of Practice • Standard of care • Legally explains the behaviors expected of similarly trained, competent individuals within a profession • Scope of practice • Range of skills and duties the paramedic may perform

12. Medical Direction and Oversight

13. Medical Direction and Oversight • The categories defined as • Prospective • Concurrent • Retrospective

14. Patient Decision-Making and Self-Determination

15. Patient Decision-Making and Self-Determination • The principles of consent, refusal of care, and advance directives

16. Consent • Informed permission given by a competent patient, or the patient’s legally responsible decision-maker, for care or transportation by EMS providers • Can be expressed or implied

17. Consent of Minors Who can give consent • “Emancipated minor” • Legal guardian • Government with temporary custody of a child • Child welfare

18. Legal Representatives • Power of attorney • Agent • Legal guardians • Family members

19. Refusal of Care • A competent patient who is properly informed of the risks of nontreatment and the benefits of treatment is permitted to refuse medical care and/or transportation

20. Abandonment • Ending of paramedic-patient relationship • Before transferring care properly • Transferring care to lesser-trained person • Potential consequences

21. Advance Directives/DNRs • Advance directive • Health care choice if patient is incapacitated • Honored in EMS? • DNR • Do not resuscitate • How far can you go in treating the patient?

22. Patient Destination and Hospital Diversion Issues

23. Patient Destination and Hospital Diversion Issues • Patient Destination • Patient choice of hospital • Problems with choices • Protocols about special situation patients • Diversion Issues • What is it? • Frequency • EMTALA

24. Privacy and Confidentiality

25. Privacy and Confidentiality • HIPAA—The Health Insurance Portability and Accountability Act • PHI or Protected Health Information • What is considered PHI? • When can it be discussed?

26. Negligence

27. Negligence • The failure to act as a reasonably prudent and careful person would act under similar circumstances

28. Negligence Four elements required to prove negligence: • Duty to act existed • Breach of duty occurred • Damages resulted • Damages caused by breach of duty

29. Duty • What defines duty? • Legal relationship formed when dispatched

30. Breach of Duty • Paramedic must be found to have violated a legal duty to the patient • Breached the standard of care

31. Standard of Care Breach • Failure to do what a similar, reasonably prudent paramedic would do under similar circumstances. • Evidence of the standard of care comes from: • Protocols or applicable policies or procedures • National standard curriculum • EMS textbooks

32. Damages (Harm or Injury) • Definition • Harm or losses sustained • What can be awarded if it is found true?

33. Causation • Prove the provider’s breach caused the damage

34. Intentional Torts

35. Intentional Torts • The defendant meant to cause the harmful action • Most common types of intentional torts: • Assault • Battery • False imprisonment • Defamation

36. Defenses and Immunity Laws

37. Immunity Laws • Immunity • Offers protection • Must act in good faith • Good Samaritan laws vary from state to state • “Professional liability” insurance

38. Criminal Law

39. Criminal Law • Types of criminal cases EMS are becoming involved in: • Ambulance crashes • Drug abuse/addiction

40. Reporting Requirements • Some situations that typically require additional reporting requirements include: • Violent actions against others • Discriminatory or harassing behaviors • Suspicion of communicable infections or sexually transmitted diseases

41. Reporting Requirements • Situations requiring additional reporting: • Criminal activity • Perceived threats to homeland security • Animal attacks and bites

42. Use of Restraints • When this can occur • What are the potential implications in placing restraints?

43. Summary • Laws govern EMS providers like all other professions • Any person who plans to work as an EMS provider or paramedic should make themselves aware of laws that govern the profession

44. The END