Unit 1 Lesson 2: Legal and Ethical Issues in First Aid PDF

Unit 1 Prepare to Respond to a Medical Emergency Lesson 2 Legal and Ethical Issues Lesson Goal At the end of this lesson, you will be able to describe the legal guidelines associated with your responsibilities as a criminal justice first-aid provider, including your duty to act and the ro...

Unit 1 Prepare to Respond to a Medical Emergency Lesson 2 Legal and Ethical Issues Lesson Goal At the end of this lesson, you will be able to describe the legal guidelines associated with your responsibilities as a criminal justice first-aid provider, including your duty to act and the role of consent. Legal and Ethical Responsibilities Legal and ethical considerations significantly affect your roles and responsibilities as a criminal justice officer. Whether these responsibilities include asking for and receiving a patient’s consent, or documenting a patient’s refusal of treatment, the public expects—and the law requires—you to be competent with behavior that is always above reproach. Placing the public’s well-being first during an emergency will help you reduce your likelihood of acting unethically. ✅ HL212.1. Describe the legal and ethical responsibilities for a criminal justice first-aid provider Duty to Act According to Black Law’s Dictionary, a duty to act is “a duty to take some action to prevent harm to another, and for the failure of which one may be liable, depending on the relationship of the parties and the circumstances.” Breach of duty occurs when you either fail to act or act inappropriately. ✅ HL212.2. Describe how the duty to act applies to the criminal justice first-aid provider For criminal justice officers, duty to act refers to the contractual or legal obligation to provide care. If you are a correctional officer or a correctional probation officer, you have an obligation to provide care to a patient who needs and consents to care only when you are on duty. If you are a law enforcement officer, you have a duty to act 24/7 within your jurisdictional boundaries. You also have the duty to render first aid following a use of force incident when you know, or it is evident, that the person detained or in custody sustained injuries or requires medical attention. Provide first aid or seek additional medical assistance when it is reasonable, based on the total- ity of the circumstances, and without jeopardizing your health or safety. Keep in mind that your responsibility for a suspect’s welfare and security does not end once they are restrained. Do not ignore their need for first aid while maintaining security and control of the suspect before EMS arrives. Once a higher level of care arrives, such as a paramedic or EMT, assist as needed while maintaining security and control of the suspect. Chapter 2 First Aid for Criminal Justice Officers / 39 Standard of Care Black Law’s Dictionary defines the standard or scope of care as “the degree of care that a reason- able person should exercise.” Under the law of negligence, it is “the conduct demanded of a person in a given situation. Typically, this involves a person giving attention to possible dangers, mistakes, and pitfalls, and ways of minimizing those risks.” ✅ HL212.3. Describe how the standard of care applies to the criminal justice first-aid provider Standard of care is the care that you are expected to provide to the same patient under the same conditions as would any criminal justice first aid-provider who received the same level of training. For example, providing CPR is within your scope of care as a criminal justice officer but perform- ing open-heart surgery is not. Good Samaritan Act ✅ HL212.4. Describe how the Good Samaritan Act affects the criminal justice first-aid provider The Good Samaritan Act protects a first-aid provider from liability for emergency care or treat- ment performed in good faith or emergency care or treatment that would be expected of another first-aid provider with equal training. The Good Samaritan Act does not stop someone from filing a lawsuit; however, it may provide a defense if you performed according to the standard of care for a first-aid provider. Always provide care to the best of your ability. Do not go beyond the scope of and level of your training and maintain the patient’s best interest. The Good Samaritan Act may provide protection for law enforcement officers when they are acting outside their jurisdictions and it may also protect correctional officers and correctional probation officers when they are providing care while off-duty. Abandonment Abandonment is giving up a right or interest with the intention of never again claiming it. ✅ HL212.5. Describe the implications of abandonment for the criminal justice first-aid provider You abandon the patient when you stop providing care without ensuring that the patient continues or begins to receive the same or better care. Continue providing emergency first aid until another medi- cal professional with the same or higher-level training replaces you, or you are unable to continue. Negligence Negligence is defined in Black’s Law Dictionary as “the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation; any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregardful of other’s rights.” 40 / Florida Basic Recruit Training Program (HL): Volume 2 ✅ HL212.6. Describe the implications of negligence for the criminal justice first-aid provider Negligence occurs if all these conditions are present: duty to act—you had a legal duty to the patient (you were supposed to administer care to the patient) breach of standard of care—you had a legal duty to act or you failed to act in a certain way (you failed to act in a manner that a reasonable person with the same level of train- ing would act) causation—your action or inaction directly resulted in the patient’s injury (makes the distinction that a person’s negligent behavior actually caused the injury) damages—the patient was harmed as a result of your actions and the court is able to compensate the patient (usually monetarily) for their injuries Consent Before you begin treatment, gain the patient’s consent or permission, and fully explain the care you plan to provide and its possible related risks. ✅ HL212.7. Describe the role of consent when providing emergency first aid The following are three types of consent: Expressed consent is permission given for an action that is clearly and unmistakably stated or written by the patient or legal guardian. Expressed consent is positive confirmation, and can be supported by verbal communication such as “yes, I consent” or a physical gesture such as a nod in agreement to medical care. Implied consent is the assumption that a person has given permission for an action because of their actions, rather than explicitly expressed. An example is when a patient rolls up their sleeve for a blood sample or extends their arm for a blood pressure reading. Another example would be a situation where an unresponsive patient is at risk of death, disability, or deterioration of their condition and you assume that they would agree to life-saving care if able to consent. Implied consent may also apply to conscious patients who do not stop you from providing treatment. Informed consent is a person’s agreement to allow something to happen, made with full knowledge of the facts, benefits, risks, and alternatives. The information given to the patient must be fully understood by the patient or their legal guardian. A patient chooses a treatment or a procedure after a physician or other health-care provider discloses the information regarding the risks involved. Informed consent involves additional information exchange between the medical provider and the patient than expressed consent does. Remember that, in order to refuse medical care, a patient must be competent. A competent adult is one who can make an informed decision about medical care. The patient must understand your Chapter 2 First Aid for Criminal Justice Officers / 41 question and the implications of your medical care decisions. Consider an adult incompetent if they are under the influence of alcohol or drugs and have impaired judgement, or if they have a serious illness, an injury that affects judgment, a mental disorder that affects judgement, or a developmental disability. Competent adults have the right to refuse treatment verbally or non-verbally by shaking their head in a negative manner. Competent adults also have the right to withdraw from treatment after it begins. This is true for patients who consent and then change their minds. It also applies to a patient who is unconscious when treatment begins, regains consciousness and mental competence, and asks you to stop. Make every effort to persuade the patient to consent to treatment. Sometimes obtaining consent can be a collaborative effort between officers and EMS to render emergency care for a patient who needs it. If you do not obtain consent, this can result in a criminal charge of battery, which is unlawful touch or strike without the person’s consent. A person involved in a traumatic incident, such as an auto accident, may be emotionally, intellectu- ally, or physically impaired. If the person continues to refuse treatment, keep them under observa- tion until EMS arrives. If the patient loses consciousness and you believe a life-threatening situation exists, immediately begin first aid. Consent and Minors In Florida, children younger than 18 years of age are minors. You must have a parent or legal guard- ian’s permission before providing care. However, if the parent or legal guardian is not available in life-threatening emergencies or emergencies that could result in disability, provide emergency first aid based on the principle of implied consent. An emancipated minor can be someone who is either financially independent, married, an active member of the military, or someone who does not live with a parent or caregiver. You do not need a parent or legal guardian’s permission to treat an emancipated minor. The emancipated minor’s consent is enough. Competent adults have the right to refuse treatment for their children. For situations involving minors in life-threatening emergencies that need medical care and the parents will not consent, refer to your agency’s policies and procedures for guidance. As this may be child abuse or neglect, notify the Department of Children and Families by calling the Florida abuse hotline, 1-800-962-2873. Do Not Resuscitate/Advance Directive A terminally ill patient may have a directive in place, written in advance, and signed by both the patient and a physician. Commonly known as a do-not-resuscitate order (DNR/DNRO) or an advance directive. The DNR/DNRO documents the terminally or chronically ill patient’s wish to refuse cardio- pulmonary resuscitation (CPR) if they stop breathing or if their heart stops beating. An advance directive documents the patient’s request to withhold specific medical care. 42 / Florida Basic Recruit Training Program (HL): Volume 2 ✅ HL212.8. Describe the role of a do-not-resuscitate order (DNR/DNRO) for a criminal justice first-aid provider Licensed medical professionals, EMTs, or paramedics, can be legally bound to honor a DNR/DNRO or advance directive; this however, does not apply to criminal justice officers. As a criminal justice first-aid provider, you have a duty to act, regardless of a DNR/DNRO. You cannot withhold CPR or first aid. Make sure to further consult your agency’s policies on DNR/DNROs. Medical Alert You may have a patient who wears an identification bracelet or necklace, carries a card in their wallet, or has a medical alert tattoo that alerts you to a specific medical condition, such as an allergy, epilepsy, or diabetes. ✅ HL212.9. Describe the role of medical alerts or notifications for a criminal justice first- aid provider On the jewelry or card, you may find a telephone number to call for detailed information about the patient. This bracelet, necklace, or card is known as a medical alert. If the patient can gain access to their phone, ask them for the name of their ICE (In Case of Emergency) contact person who may be able to provide medical alert information. Be aware that the medical emergency you are responding to and what the patient is experienc- ing may not always be related to the medical condition on the medical alert. For example, if the patient’s medical alert indicates that they are diabetic and the patient is experiencing seizure-like symptoms, do not assume that the patient is experiencing a seizure related to diabetes. They could be experiencing a stroke, or could have head trauma resulting in seizure. HIPAA A patient’s privacy, medical history, condition, and health-care treatment is, by law, confidential information. The patient or a legal guardian must sign a written release before the release of any medical information, except when relaying information to EMS. ✅ HL212.10. Describe the legal and ethical considerations of HIPAA for the criminal justice first-aid provider The Health Insurance Portability and Accountability Act (HIPAA) protects the rights of patients and the release of patient information. Do not release patient health information without a patient signature unless another health-care provider needs patient information to continue medical care or you receive a request to provide patient information as part of a criminal investigation, such as child abuse, elder abuse, or spouse abuse. If you make the report in good faith, related laws often grant immunity from liability for libel, slander, or defamation of character. A legal subpoena may require you to provide patient information in court. Chapter 2 First Aid for Criminal Justice Officers / 43 Be careful when discussing a case with anyone to avoid unintentionally providing protected health information about the patient. Scene Evidence ✅ HL212.11. Recognize that every call for emergency medical care can be a crime scene You may respond to a call that could be both a crime scene and a medical emergency. Examples may include any scene involving suicide, homicide, suspected drug overdose, domestic dispute, abuse, hit-and-run, or robbery. Additionally, any scene involving battery, gunfire, or a weapon, can potentially be a crime scene and medical emergency. Remember that any item on the scene may be evidence. If you suspect sexual assault or battery, advise the person not to bathe or wash. Explain the importance of preserving evidence. Always show empathy to a victim, as they have just undergone a traumatic event. 44 / Florida Basic Recruit Training Program (HL): Volume 2