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