Psychology Chapter 3: Medical, Legal, and Ethical Issues

Scope of Practice

• Refers to the actions and care that EMTs are legally allowed to perform by the state in which they are providing emergency medical care
• Defines the legal boundaries of EMT practice

Standard of Care

• The care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation
• Also known as the "Reasonable Person Standard"

Duty to Act

• The legal obligation to provide service while on duty, whether you think the patient needs an ambulance or not
• If off duty, no duty to act unless you stop and render aid, then you have created a duty to act

Duty to Patient

• Act as patient advocate
• Protect personal information
• Provide complete assessment and care
• Do no further harm

Duty to Yourself and Your Partner

• Maintain credentials and proficiency
• Maintain good mental health
• Maintain good physical health
• Ensure your partner does the same

Duty to Equipment

• Daily checkouts are vital
• Ensure all equipment is in proper working order

Good Samaritan Laws

• Protects a person who is not being paid for their services from liability for acts performed in good faith unless those acts constitute gross negligence
• Stay within your scope of practice
• Does not protect you from being sued

Medical Direction

• Provides policies and protocols approved by the county medical director
• Medical direction is placed on base hospitals to ensure and assist prehospital providers with patient care
• Contact medical direction for treatment, patient disposition, and other guidance

Base Hospitals

• Staffed with specially trained nurses to take reports and give medical direction
• Paramedics are assigned a single base hospital
• EMTs contact receiving hospital unless they need medical direction

Trauma Centers

• Palomar
• Sharp Memorial
• Scripps Memorial La Jolla
• Scripps Mercy
• UCSD Hillcrest
• Rady's Children's Hospital

Specialty Hospitals

• UCSD Hillcrest (burns, hyperbarics, children's backup)
• Rady's Children's Hospital (pediatrics)

Ethics and Morality

• Ethics refer to rules provided by an outside source
• Morals refer to your own principles about right and wrong
• "If you place the welfare of the patient above all else when providing medical care, you will rarely commit an unethical act"

Consents, Advanced Directives, and Refusals

• Conscious, competent, and rational patients have the right to accept or refuse emergency medical care
• Informed/Expressed Consent: patient consents to assessment and treatment
• Implied Consent: patient is unresponsive, disoriented, or a minor without guardian consent
• Consent to Treat a Minor: obtain consent from parent or legal guardian
• Emancipated Minors: married, pregnant, a parent, a member of the armed forces, financially independent, or emancipated by court decree
• Involuntary Consent: dealing with mentally incompetent adults or those in custody of law enforcement

Advanced Directives

• Instructions written in advance stating patient wishes about resuscitation
• Includes Do Not Resuscitate (DNR) orders, Living Wills, Durable Power of Attorney, and POLST (Physician Orders for Life Sustaining Treatment)

Patient Disposition

• Two possible outcomes on each call: transport or no transport
• No transport: Against Medical Advice (AMA), Patient Release, or Aid Unnecessary

Refusing Treatment (AMA)

• A patient who is competent to refuse care may legally do so
• Patient must be oriented and competent to refuse care
• Patient must fully understand the situation and consequences of refusal
• Patient must be advised to re-contact 911 if needed
• Patient must sign the AMA form

Legalities

• Negligence: breach of duty to act, leading to patient injury
• Intentional Tort: EMT knowingly commits wrongdoing
• Abandonment: failure to transfer patient to another competent professional
• Assault: willful threat to inflict harm on a patient
• Battery: unlawful touching of a patient without consent
• Kidnapping: taking a competent, rational patient to the hospital against their wishes

HIPAA/Confidentiality

• Health Insurance Portability and Accountability Act
• May only discuss patient-specific information with individuals with whom it is medically necessary
• Written release required before releasing confidential information

Special Situations

• Medical alert bracelets: confirming obvious death, 5150 regulations, and abuse reporting
• Determination of Death: obvious signs of death, such as rigor mortis, decapitation, decomposition, incineration, evisceration of heart or brain, and dependent lividity
• 5150: mandatory 72-hour psychiatric detention for danger to self, others, or gravely disabled
• Reporting Abuse: legal obligation to report suspected abuse, including child, adult/elder, sexual, emotional, or monetary abuse

Scope of Practice

• Refers to the actions and care that EMTs are legally allowed to perform by the state in which they are providing emergency medical care
• Defines the legal boundaries of EMT practice

Standard of Care

• The care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation
• Also known as the "Reasonable Person Standard"

Duty to Act

• The legal obligation to provide service while on duty, whether you think the patient needs an ambulance or not
• If off duty, no duty to act unless you stop and render aid, then you have created a duty to act

Duty to Patient

• Act as patient advocate
• Protect personal information
• Provide complete assessment and care
• Do no further harm

Duty to Yourself and Your Partner

• Maintain credentials and proficiency
• Maintain good mental health
• Maintain good physical health
• Ensure your partner does the same

Duty to Equipment

• Daily checkouts are vital
• Ensure all equipment is in proper working order

Good Samaritan Laws

• Protects a person who is not being paid for their services from liability for acts performed in good faith unless those acts constitute gross negligence
• Stay within your scope of practice
• Does not protect you from being sued

Medical Direction

• Provides policies and protocols approved by the county medical director
• Medical direction is placed on base hospitals to ensure and assist prehospital providers with patient care
• Contact medical direction for treatment, patient disposition, and other guidance

Base Hospitals

• Staffed with specially trained nurses to take reports and give medical direction
• Paramedics are assigned a single base hospital
• EMTs contact receiving hospital unless they need medical direction

Trauma Centers

• Palomar
• Sharp Memorial
• Scripps Memorial La Jolla
• Scripps Mercy
• UCSD Hillcrest
• Rady's Children's Hospital

Specialty Hospitals

• UCSD Hillcrest (burns, hyperbarics, children's backup)
• Rady's Children's Hospital (pediatrics)

Ethics and Morality

• Ethics refer to rules provided by an outside source
• Morals refer to your own principles about right and wrong
• "If you place the welfare of the patient above all else when providing medical care, you will rarely commit an unethical act"

Consents, Advanced Directives, and Refusals

• Conscious, competent, and rational patients have the right to accept or refuse emergency medical care
• Informed/Expressed Consent: patient consents to assessment and treatment
• Implied Consent: patient is unresponsive, disoriented, or a minor without guardian consent
• Consent to Treat a Minor: obtain consent from parent or legal guardian
• Emancipated Minors: married, pregnant, a parent, a member of the armed forces, financially independent, or emancipated by court decree
• Involuntary Consent: dealing with mentally incompetent adults or those in custody of law enforcement

Advanced Directives

• Instructions written in advance stating patient wishes about resuscitation
• Includes Do Not Resuscitate (DNR) orders, Living Wills, Durable Power of Attorney, and POLST (Physician Orders for Life Sustaining Treatment)

Patient Disposition

• Two possible outcomes on each call: transport or no transport
• No transport: Against Medical Advice (AMA), Patient Release, or Aid Unnecessary

Refusing Treatment (AMA)

• A patient who is competent to refuse care may legally do so
• Patient must be oriented and competent to refuse care
• Patient must fully understand the situation and consequences of refusal
• Patient must be advised to re-contact 911 if needed
• Patient must sign the AMA form

Legalities

• Negligence: breach of duty to act, leading to patient injury
• Intentional Tort: EMT knowingly commits wrongdoing
• Abandonment: failure to transfer patient to another competent professional
• Assault: willful threat to inflict harm on a patient
• Battery: unlawful touching of a patient without consent
• Kidnapping: taking a competent, rational patient to the hospital against their wishes

HIPAA/Confidentiality

• Health Insurance Portability and Accountability Act
• May only discuss patient-specific information with individuals with whom it is medically necessary
• Written release required before releasing confidential information

Special Situations

• Medical alert bracelets: confirming obvious death, 5150 regulations, and abuse reporting
• Determination of Death: obvious signs of death, such as rigor mortis, decapitation, decomposition, incineration, evisceration of heart or brain, and dependent lividity
• 5150: mandatory 72-hour psychiatric detention for danger to self, others, or gravely disabled
• Reporting Abuse: legal obligation to report suspected abuse, including child, adult/elder, sexual, emotional, or monetary abuse

Scope of Practice

• Refers to the actions and care that EMTs are legally allowed to perform by the state in which they are providing emergency medical care
• Defines the legal boundaries of EMT practice

Standard of Care

• The care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation
• Also known as the "Reasonable Person Standard"

Duty to Act

• The legal obligation to provide service while on duty, whether you think the patient needs an ambulance or not
• If off duty, no duty to act unless you stop and render aid, then you have created a duty to act

Duty to Patient

• Act as patient advocate
• Protect personal information
• Provide complete assessment and care
• Do no further harm

Duty to Yourself and Your Partner

• Maintain credentials and proficiency
• Maintain good mental health
• Maintain good physical health
• Ensure your partner does the same

Duty to Equipment

• Daily checkouts are vital
• Ensure all equipment is in proper working order

Good Samaritan Laws

• Protects a person who is not being paid for their services from liability for acts performed in good faith unless those acts constitute gross negligence
• Stay within your scope of practice
• Does not protect you from being sued

Medical Direction

• Provides policies and protocols approved by the county medical director
• Medical direction is placed on base hospitals to ensure and assist prehospital providers with patient care
• Contact medical direction for treatment, patient disposition, and other guidance

Base Hospitals

• Staffed with specially trained nurses to take reports and give medical direction
• Paramedics are assigned a single base hospital
• EMTs contact receiving hospital unless they need medical direction

Trauma Centers

• Palomar
• Sharp Memorial
• Scripps Memorial La Jolla
• Scripps Mercy
• UCSD Hillcrest
• Rady's Children's Hospital

Specialty Hospitals

• UCSD Hillcrest (burns, hyperbarics, children's backup)
• Rady's Children's Hospital (pediatrics)

Ethics and Morality

• Ethics refer to rules provided by an outside source
• Morals refer to your own principles about right and wrong
• "If you place the welfare of the patient above all else when providing medical care, you will rarely commit an unethical act"

Consents, Advanced Directives, and Refusals

• Conscious, competent, and rational patients have the right to accept or refuse emergency medical care
• Informed/Expressed Consent: patient consents to assessment and treatment
• Implied Consent: patient is unresponsive, disoriented, or a minor without guardian consent
• Consent to Treat a Minor: obtain consent from parent or legal guardian
• Emancipated Minors: married, pregnant, a parent, a member of the armed forces, financially independent, or emancipated by court decree
• Involuntary Consent: dealing with mentally incompetent adults or those in custody of law enforcement

Advanced Directives

• Instructions written in advance stating patient wishes about resuscitation
• Includes Do Not Resuscitate (DNR) orders, Living Wills, Durable Power of Attorney, and POLST (Physician Orders for Life Sustaining Treatment)

Patient Disposition

• Two possible outcomes on each call: transport or no transport
• No transport: Against Medical Advice (AMA), Patient Release, or Aid Unnecessary

Refusing Treatment (AMA)

• A patient who is competent to refuse care may legally do so
• Patient must be oriented and competent to refuse care
• Patient must fully understand the situation and consequences of refusal
• Patient must be advised to re-contact 911 if needed
• Patient must sign the AMA form

Legalities

• Negligence: breach of duty to act, leading to patient injury
• Intentional Tort: EMT knowingly commits wrongdoing
• Abandonment: failure to transfer patient to another competent professional
• Assault: willful threat to inflict harm on a patient
• Battery: unlawful touching of a patient without consent
• Kidnapping: taking a competent, rational patient to the hospital against their wishes

HIPAA/Confidentiality

• Health Insurance Portability and Accountability Act
• May only discuss patient-specific information with individuals with whom it is medically necessary
• Written release required before releasing confidential information

Special Situations

• Medical alert bracelets: confirming obvious death, 5150 regulations, and abuse reporting
• Determination of Death: obvious signs of death, such as rigor mortis, decapitation, decomposition, incineration, evisceration of heart or brain, and dependent lividity
• 5150: mandatory 72-hour psychiatric detention for danger to self, others, or gravely disabled
• Reporting Abuse: legal obligation to report suspected abuse, including child, adult/elder, sexual, emotional, or monetary abuse

Scope of Practice

• Refers to the actions and care that EMTs are legally allowed to perform by the state in which they are providing emergency medical care
• Defines the legal boundaries of EMT practice

Standard of Care

• The care that is expected to be provided by an EMT with similar training when managing a patient in a similar situation
• Also known as the "Reasonable Person Standard"

Duty to Act

• The legal obligation to provide service while on duty, whether you think the patient needs an ambulance or not
• If off duty, no duty to act unless you stop and render aid, then you have created a duty to act

Duty to Patient

• Act as patient advocate
• Protect personal information
• Provide complete assessment and care
• Do no further harm

Duty to Yourself and Your Partner

• Maintain credentials and proficiency
• Maintain good mental health
• Maintain good physical health
• Ensure your partner does the same

Duty to Equipment

• Daily checkouts are vital
• Ensure all equipment is in proper working order

Good Samaritan Laws

• Protects a person who is not being paid for their services from liability for acts performed in good faith unless those acts constitute gross negligence
• Stay within your scope of practice
• Does not protect you from being sued

Medical Direction

• Provides policies and protocols approved by the county medical director
• Medical direction is placed on base hospitals to ensure and assist prehospital providers with patient care
• Contact medical direction for treatment, patient disposition, and other guidance

Base Hospitals

• Staffed with specially trained nurses to take reports and give medical direction
• Paramedics are assigned a single base hospital
• EMTs contact receiving hospital unless they need medical direction

Trauma Centers

• Palomar
• Sharp Memorial
• Scripps Memorial La Jolla
• Scripps Mercy
• UCSD Hillcrest
• Rady's Children's Hospital

Specialty Hospitals

• UCSD Hillcrest (burns, hyperbarics, children's backup)
• Rady's Children's Hospital (pediatrics)

Ethics and Morality

• Ethics refer to rules provided by an outside source
• Morals refer to your own principles about right and wrong
• "If you place the welfare of the patient above all else when providing medical care, you will rarely commit an unethical act"

Consents, Advanced Directives, and Refusals

• Conscious, competent, and rational patients have the right to accept or refuse emergency medical care
• Informed/Expressed Consent: patient consents to assessment and treatment
• Implied Consent: patient is unresponsive, disoriented, or a minor without guardian consent
• Consent to Treat a Minor: obtain consent from parent or legal guardian
• Emancipated Minors: married, pregnant, a parent, a member of the armed forces, financially independent, or emancipated by court decree
• Involuntary Consent: dealing with mentally incompetent adults or those in custody of law enforcement

Advanced Directives

• Instructions written in advance stating patient wishes about resuscitation
• Includes Do Not Resuscitate (DNR) orders, Living Wills, Durable Power of Attorney, and POLST (Physician Orders for Life Sustaining Treatment)

Patient Disposition

• Two possible outcomes on each call: transport or no transport
• No transport: Against Medical Advice (AMA), Patient Release, or Aid Unnecessary

Refusing Treatment (AMA)

• A patient who is competent to refuse care may legally do so
• Patient must be oriented and competent to refuse care
• Patient must fully understand the situation and consequences of refusal
• Patient must be advised to re-contact 911 if needed
• Patient must sign the AMA form

Legalities

• Negligence: breach of duty to act, leading to patient injury
• Intentional Tort: EMT knowingly commits wrongdoing
• Abandonment: failure to transfer patient to another competent professional
• Assault: willful threat to inflict harm on a patient
• Battery: unlawful touching of a patient without consent
• Kidnapping: taking a competent, rational patient to the hospital against their wishes

HIPAA/Confidentiality

• Health Insurance Portability and Accountability Act
• May only discuss patient-specific information with individuals with whom it is medically necessary
• Written release required before releasing confidential information

Special Situations

• Medical alert bracelets: confirming obvious death, 5150 regulations, and abuse reporting
• Determination of Death: obvious signs of death, such as rigor mortis, decapitation, decomposition, incineration, evisceration of heart or brain, and dependent lividity
• 5150: mandatory 72-hour psychiatric detention for danger to self, others, or gravely disabled
• Reporting Abuse: legal obligation to report suspected abuse, including child, adult/elder, sexual, emotional, or monetary abuse

This quiz covers the medical, legal, and ethical issues in psychology discussed in Chapter 3. It tests your understanding of the concepts and principles related to psychology, law, and ethics.