Medical-Legal Considerations PDF

MEDICAL-LEGAL CONSIDERATIONS REQUIREMENTS Review the presentation Medical-Legal Considerations found on Brightspace. Read the following textbook chapters. While the legislation and regulatory bodies discussed in these chapters are specific to the UK, the concepts are mirrored in Canadian...

MEDICAL-LEGAL CONSIDERATIONS REQUIREMENTS Review the presentation Medical-Legal Considerations found on Brightspace. Read the following textbook chapters. While the legislation and regulatory bodies discussed in these chapters are specific to the UK, the concepts are mirrored in Canadian law and practice. Chapter 2, pp 18-20 Chapter 3, pp 37-48 OBJECTIVES Identify the regulations under the Food and Drug Act and Food and Drug Regulations applicable to paramedics Identify the laws under which paramedics carry and dispense medication. Identify special regulations regarding the storage, transport, documentation, and administration of controlled substances under the Controlled Substances Act. Discuss the forms of medical delegation. Explain how physicians may delegate to paramedics. Discuss the structure of a medical directive or standing order.  Canadian legislation began in 1875 Two acts of Parliament form the underlying foundation for the drug laws CANADIAN The Food and Drug Act (1941) REGULATIONS The Controlled Drugs and Substances Act AND (1996) LEGISLATION Department of National Health and Welfare Responsible for drug control in Canada  CANADIAN REGULATIONS AND LEGISLATION Food and Drug Controlled Drugs and Food and Drug Act Regulation Substances Act To protect the An adjunct to the Food CDSA was passed in consumer from food and Drugs act. 1996. and drugs that are Clarifies terms used in The regulation contaminated, the act. addresses the adulterated or unsafe Covers the importing, possession, sale, for use. preparing, treating, manufacture, To address food and processing, labeling, distribution, production, drugs that are labelled advertising, and selling import, and export of falsely and those with foods, drugs, certain drugs, their misleading or deceptive cosmetics, natural precursors and other labelling. health products substances classified as Provides regulations for including herbal controlled. drug manufacture and products, and medical Describes procedures sale. devices. for record keeping, documentation, and dispensing.  CDSA CLASSIFICATION 8 categories based on safety risk of the drug, risk of dependence, and medical use. Schedule V & VI: Precursors required to produce controlled substances Schedule VII & VIII: Repealed Schedule IX: Pill making equipment  Subsection 56(1) Class Exemption for Primary Care Paramedics, Advanced Care Paramedics and Critical Care CDSA Paramedics in Ontario (Effective Date: May 16, 2019) Pursuant to subsection 56(1) of the Controlled Drugs and Substances EXEMPTION Act (CDSA), paramedics with the title of Primary Care Paramedic, S FOR Advanced Care Paramedic, or Critical Care Paramedic in the province of Ontario, employed by certified ambulance service operators under PARAMEDIC the Ambulance Act (Ontario) are exempted for medical purposes from the application of the following provisions of the CDSA and its S regulations: Subsection 4(1) of the CDSA (possession of a controlled substance) with respect to fentanyl, hydromorphone, ketamine, morphine and pethidine; Subsections 5(1) and 5(2) of the CDSA (selling, giving, transferring, sending, delivering, transporting, and administering controlled substances) with respect to diazepam, fentanyl, hydromorphone, ketamine, lorazepam, midazolam, morphine and pethidine; Subsection 2(1) of the Benzodiazepines and Other Targeted Substances Regulations (possession) with respect to diazepam, lorazepam and midazolam PARAMEDIC MEDICAL DELEGATIO N MEDICAL DELEGATION The only person who can prescribe medication in our setting is a licensed physician. Medical Paramedics have been delegated the director ability to administer certain medication given specific medical Medical criteria. control To administer a medication outside this scope is to practice medicine without a license. MDSO's MDSO = Medial directives and standing orders MDSO- OVERVIEW Outlines the conditions under which a paramedic MAY administer a medication. Medical directives will indicate if/when a patch to online medical control is required. ACUTE CORONARY SYNDROME (ORNGE) Indications Conditions that must be met to initiate. Contraindications to administration. Scope of practice Medication administration det ails (route, dose, frequency, maximum) Patch requirement CARDIAC ISCHEMIA PROTOCOL (ALS PCS) RESPONSIBILITI Maintain adequate, up-to-date information ES OF THE about all medications to be administered, PARAMEDIC including purpose, potential side effects, cautions and contraindications, and possible interactions. Gain wisdom and judgment to accurately assess the patient’s needs for medication, to evaluate the response to medications, and to plan appropriate interventions as indicated. Ensure skill in delivery of the medication accurately, in the best interests of the patient, and with adequate documentation. MEDICAL DELEGATION CASE STUDIES CASE 1 CASE 2 You are called to a doctor's office You are eating dinner when your for a patient having ischemic- neighbor rings the bell asking for type chest pain. The patient your help with their sick child. On does not meet your MDSO for your assessment, you note that the NTG. The doctor orders you to child has a fever. The child's parent administer NTG. What is your asks you what they should do for legal responsibility in this the child. What is your legal situation? responsibility in this situation? CONSENT FOR TREATMENT Except in emergency circumstances described below, paramedics must obtain the patient’s consent prior to initiating treatment. Consent may be informed or implied. Informed consent may be either verbal or written. Implied consent may be assumed where a person provides a physical indication that they consent to the treatment. The elements required for consent to treatment are: consent must be given by a person who is capable of giving consent with respect to treatment, consent must relate to the treatment, consent must be informed, consent must be given voluntarily, and consent must not be obtained through misrepresentation or fraud. DETERMINING COMPETENCE Valid consent requires that a person has the capacity to provide consent. A patient is capable with respect to treatment if the patient is: Able to understand the information that is relevant to making a decision about the treatment or alternatives being proposed; and Able to appreciate the reasonably foreseeable consequences of a decision or lack of decision with respect to treatment INFORMED CONSENT Consent to treatment is informed if, before it is given to the person, he or she has received the following information that a reasonable person in the same circumstances would require in order to make a decision about the treatment: the nature of the treatment, the expected benefits of the treatment, the material risks of the treatment, the material side effects of the treatment, alternative courses of action, the likely consequences of not having the treatment, and received responses to his or her requests for additional information about those matters. EMERGENCY CONSENT TO TREATMENT A paramedic may administer treatment to a person without consent in an emergency situation, if there is no other authorized person available to give or refuse consent, and, in the opinion of the paramedic: the person is not capable of giving a consent or refusal to treatment, and the delay required to obtain a consent or refusal on the person’s behalf will prolong the suffering that the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm. CARE OUTSIDE OF SCOPE A paramedic may assume patients or caregivers have knowledge about a technology or medication if they confirm that they were trained in its use and/or administration. A paramedic should advise the patient or caregiver to follow any specific steps or provide any advice about restarting/stopping the device or novel medication. A paramedic may only assist a patient within the authorized paramedic skill set. If a BHP directs a paramedic to perform an assessment or intervention that exceeds the paramedic’s scope of practice, the paramedic must advise the BHP of such and notify the physician that he or she cannot comply with the direction as it exceeds his or her scope of practice. In such cases, a paramedic should ask the BHP to provide alternative direction. MEDICAL DELEGATION CASE STUDIES CASE 3 CASE 4 You are tasked to pick up a patient You are called for an elderly and family escort at the airport. The patient with end-stage cancer. The patient is a child with complex family is insisting on transport to medical needs and is on a home the ED. The patient has a written ventilator. The patient's mother is DNR and is refusing transport, traveling with the patient to your stating that he'd like to die at home. Discuss your legal destination. Discuss your legal requirements in this situation. requirements in this situation. QUESTIONS? [email protected]