Medical, Ethical, and Legal Issues 2023.pptx

r n ia alifo intiff o fC Pla - t ate e S Th Vs da n t...

r n ia alifo intiff o fC Pla - t ate e S Th Vs da n t en u ef Yo -D CHAPTER 3: MEDICAL, LEGAL, AND ETHICAL ISSUES How To Keep Your Butt Out of Court!  CHAPTER 3 OBJECTIVES Scope of Practice Consents and Refusals Legal Aspects of EMS  SCOPE OF PRACTICE The actions and care that EMT’s are legally allowed to perform by the state in which they are providing emergency medical care  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 The “Reasonable Person Standard”  DUTY TO ACT Your legal obligation to provide service while on duty, whether you think the patient needs an ambulance or not  DUTY TO ACT No duty to act if off duty, unless… You do stop and render aid. Then you have created a duty to act.  DUTY TO YOUR PATIENT Act as patient advocate Protect personal information Provide complete assessment and care DO NO FURTHER HARM  DUTY TO YOURSELF AND YOUR PARTNER You must Maintain credentials and proficiency Maintain good mental health Maintain good physical health Ensure your partner does the same  DUTY TO YOUR EQUIPMENT Daily checkouts are vital! You have the legal responsibility to: Ensure all equipment is in proper working order  GOOD SAMARITAN L AWS Protects a person who is not being paid for his 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  MEDICAL DIRECTION Your policies and protocols are approved by the county medical director Medical direction is placed on base hospitals to ensure and assist prehospital providers with patient care Provide: Standing orders / Offline medical direction Base Hospital Orders / Online medical direction Base Hospital Physician Orders / Online medical direction  MEDICAL DIRECTION Must be able to contact medical direction: Mobile or handheld radio Cell Phone or landline  MEDICAL DIRECTION Contact for: Treatment Patient disposition  SAN DIEGO COUNTY HOSPITALS 3 types Basic Emergency Facilities (BEF) Trauma Centers Specialty Hospitals  BASE HOSPITALS Staffed with a specially trained nurse to take reports and give medical direction Paramedics are assigned a single base hospital EMT’s contact receiving hospital unless they need medical direction  BASE HOSPITALS Palomar Hospital Tri-City Medical Center Sharp Memorial Scripps Memorial La Jolla Scripps Mercy Hospital UCSD Hillcrest Sharp Grossmont  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 Umm…pediatrics? ETHICS AND MORALITY  ETHICS VS MORALS Sometimes used interchangeably, but… Ethics refer to rules provided by an outside source Morals refer to your own principles about right and wrong  ETHICS AND MORALS “If you place the welfare of the patient above all else when providing medical care, you will rarely commit an unethical act” Refers to Patient needs Skill mastery Quality improvement Honest documentation CONSENTS, ADVANCED DIRECTIVES, AND REFUSALS When you can touch someone and what to do when they say NO.  CONSENT By law, the conscious, competent, and rational patient has the right to accept or refuse emergency medical care  INFORMED / EXPRESSED CONSENT A conscious, rational patient who consents to your assessment and treatment  IMPLIED CONSENT Your assumption that a patient who is Unresponsive - Disoriented - A minor without guardian consent -  Would accept care if he could Also applies to a patient who initially refuses care then becomes unresponsive  CONSENT TO TREAT A MINOR Minors are not legally competent to accept or refuse care Consent must be obtained from a parent or legal guardian If a parent cannot be reached, may treat under implied consent  EMANCIPATED MINORS A minor who is Married Pregnant A parent A member of the armed forces Financially independent Emancipated by court decree  INVOLUNTARY CONSENT Dealing with A mentally incompetent adult In custody of law enforcement Patient cannot refuse care ADVANCED DIRECTIVES  ADVANCED DIRECTIVES Instructions written in advance stating patients wishes about resuscitation  DO NOT RESUSCITATE ORDERS AKA DNR A legal document or order that most often governs resuscitation issues Must be signed by patient and physician May be a copy, not the original  LIVING WILLS Covers general health care issues  DURABLE POWER OF ATTORNEY Legally empowers a person to make health care decisions for the signer of the document if he is unable to do so  POLST Physician Orders for Life Sustaining Treatment Patients with terminal illness not expected to live more than one year Allows a patient to choose a level of treatment before resuscitation  WHAT IF TH ERE IS A P ROBLE M WI TH THE ADVANCE D DIRECTI VE ? !? ! Provide care and treatment until you can figure out the situation Contact medical direction  PATIENT DISPOSITION There are generally two (2) outcomes on each call: Transport No transport What defines a patient? See – duty to act. Any patient who requests or requires treatment and/or transport  NO TRANSPORT Against Medical Advice When the EMT advises the patient that they need to go to the hospital, but the patient refuses Patient Release Where the EMT and patient both agree that the patient does not need to be transported Aid unnecessary There is no patient on scene  REFUSING TREATMENT (AMA) A patient who is competent to refuse care may legally do so Competent means  Oriented to person, place, time, and event  Not under the influence of drugs or alcohol  18+ years of age AMA CHECKLIST PATIENT IS ORIENTED AND COMPETENT TO REFUSE CARE PATIENT IS NOT UNDER THE INFLUENCE OF DRUGS OR ALCOHOL  PATIENT FULLY UNDERSTANDS THE SITUATION CONSEQUENCES HAVE BEEN EXPLAINED UP TO AND INCLUDING DEATH PATIENT HAS BEEN ADVISED TO RE-CONTACT 911 IF NEEDED HAVE THE PATIENT SIGN THE AMA FORM LEGALITIES  NEGLIGENCE Liabilities are created when an EMT breaches their duty to act. The liability can be criminal or civil. Civil actions are known as a tort, which negligence falls under. If there was not intent to harm the patient  NEGLIGENCE The plaintiff must prove that the EMT: Had a duty to act Breached that duty to act The patient suffered an injury The injury was due to the breach of duty (proximate cause or causation) Deviation of standard of care INTENTIONAL TORT Where the EMT knowingly committed the wrongdoing  ABANDONMENT Failure to transfer patient to another competent professional of equal or higher level of training  ASSAULT Willful threat to inflict harm on a patient  BATTERY The act of touching a patient unlawfully without consent  KIDNAPPING Taking the competent, rational patient to the hospital against his wishes  HIPA A/CONFIDENTIALITY Health Insurance Portability and Accountability Act May only discuss patient specific information with individuals with whom it is medically necessary A written release is required before releasing confidential information  CONFIDENTIALITY Who You Can Talk To Who You Can’t Talk To Another health care Other family members worker to continue without permission medical care Your friends and family Mandatory reporting The press Law Enforcement Patient’s neighbors Billing agencies By legal subpoena SPECIAL SITUATIONS Medical alert bracelets, confirming obvious death, 5150 regulations, and abuse reporting  MEDICAL ALERT BRACELETS Some patients with medical problems may choose to wear an insignia Esp if their condition may result in unconsciousness Epilepsy Diabetics Allergies  DETERMINATION OF DEATH Must provide care to a patient in cardiac arrest if: The patient does not show signs of obvious death The patient does not have a DNR or advanced directive  OBVIOUS SIGNS OF DEATH Rigor Mortis Decapitation Decomposition Incineration Evisceration of heart or brain Dependent lividity (not in SD County!)  5150 Mandatory 72-hour psychiatric detention Physicians or law enforcement may place a person on a 5150 hold Must be  Danger to self  Danger to others  Gravely disabled (unable to care for oneself)  REPORTING ABUSE If you suspect abuse Child Adult/elder Sexual Emotional Monetary  You have a LEGAL obligation to report it  REPORTING ABUSE Per SD protocol You must contact the proper authority ASAP You MUST follow up with the proper paperwork within 36 hours