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Chapter 3Legal Responsibilities of the EMT
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
2
Overview
Knowledge of Standard of Care Legal Duty to Act Respect for Patients’ Rights Obtaining Patient Consent Documentation
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
3
Overview
Initiating Resuscitation Collaborating with Law Enforcement Reporting Abuse Common Allegations against EMTs Protection against Lawsuits
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
4
Knowledge of Standard of Care
The law requires that an EMT act within the guidelines that are recognized as appropriate for others within the same level of training
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
5
Legal Duty to Act
An EMT is under contractual obligation to respond to calls
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
6
Respect for Patients’ Rights
Right to confidentiality– As in any medical field we are bound to
confidentiality no matter what the case is; this is a trust between caregiver and patient in all aspects of medicine
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
7
Respect for Patients’ Rights
Health Insurance Portability and Accountability Act (HIPAA)
Sought to allow portability and continuity Standardization of administrative and
financial data exchange The protection of privacy, confidentiality, and
security of health care information
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
8
Respect for Patients’ Rights
Right to refuse care– To refuse care, the patient must be of sound mind – The patient must be an adult.– Base station contact must be made– There must be complete documentation– State and county protocols should be followed
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
9
Respect for Patients’ Rights
Against medical advice– Base station contact is mandatory– The patient should be told the risks of not being
transported and the benefits – A form should be filled out and signed by the
patient and a witness
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
10
Respect for Patients’ Rights
Do not resuscitate orders– An order written by a physician, after consultation
with the patient or family (if the patient is unable to discuss treatment options)
– Check your local protocols for specific documentation rules
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
11
Stop and Review
State the legal obligations of the EMT. What does duty to act mean? Explain the importance of the patient’s
right to confidentiality.
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
12
Obtaining Patient Consent
Expressed or informed consent– A patient verbally agrees to treatment
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
13
Obtaining Patient Consent
Expressed or informed consent– A patient verbally agrees to treatment
Implied consent– The condition where an otherwise competent
person would want to be treated
Children and consent– Children cannot give consent for themselves– Attempt contact with a parent or guardian– Use implied consent to treat the patient
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
14
Obtaining Patient Consent
Children and consent– Children cannot give consent for themselves– Attempt contact with a parent or guardian– Use implied consent to treat the patient
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
15
Obtaining Patient Consent
Prisoners and consent– Emergency doctrine: a legal principle that allows
for emergency treatment of prisoners– Law enforcement will likely ride with you
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
16
Obtaining Patient Consent
Mentally disturbed patients– These patients can be treated under
implied consent– May have to have law enforcement there
to aid in an involuntary commitment– A mental health professional can also
do an involuntary commitment
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
17
Stop and Review
Can an adolescent consent to care? Are there exceptions?
Who can consent for an adolescent? What if they are unavailable?
What is the difference about consent in the “Consent” case study?
Can an adolescent legally refuse care? Are there exceptions?
What duties does the EMT have for the teenager in the “Consent” case study?
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
18
Documentation
Be complete with documentation– Be sure you state why you use implied consent– If law enforcement or mental heath is involved,
document the official’s name
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
19
Initiating Resuscitation
Generally, resuscitation should be done unless:– The patient has a DNR– There are obvious signs of death: decapitation,
lividity, rigor mortis, decomposition
When in doubt resuscitate!
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
20
Collaborating with Law Enforcement
Some emergency responses are also crime scenes
It is important to know how to respond in these situations and to preserve evidence to the best of one’s ability
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
21
Collaborating with Law Enforcement
Motor vehicle collisions – You may be called to testify about scenes
involving drunk drivers; these are crime scenes– Carefully document all of your findings with the
scene and the patient
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
22
Collaborating with Law Enforcement
Threat of violence on scene– Your safety is first!– Stage away until you know it is safe– If you are on a scene that becomes unsafe for
you, leave immediately--without the patient if necessary
– Be aware of weapons or objects that may be used as weapons
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
23
Collaborating with Law Enforcement
Physical restraint of combative patients– Restraints may be used if the patient is
a threat to himself or others– Refer to local laws – Always restrain face up– Calling law enforcement is advised
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
24
Reporting Abuse
Child abuse – Any act of physical, sexual,
or psychological maltreatment
Domestic violence – Acts of violence against a spouse,
partner, or family member
Elder abuse – An act of violence toward or neglect
of an elderly person
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
25
Stop and Review
What is the legal importance of documentation?
Under what circumstances can resuscitation be withheld?
How does EMS collaborate with law enforcement?
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
26
Common Allegations against EMTs
In a 1999 study published in the Journal of Emergency Medicine – 72% of lawsuits were the result of
motor vehicle accidents involving an emergency vehicle
– 35% of lawsuits were related to medical negligence
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
27
Common Allegations against EMTs
Ambulance collisions and liability– When driving an emergency vehicle, the EMT
has a responsibility to the crew, patients, other motorists, and pedestrians to operate in a safe manner
– You can be held responsible for collisions in many cases
– Emergency vehicle accident prevention classes are available nationwide
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
28
Common Allegations against EMTs
Negligence– Duty to act– Breach of duty– Causation of injury– Damages occurred
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
29
Common Allegations against EMTs
Patient abandonment– Begin care and leave the patient– You must turn the patient over to someone
of equal or higher care
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
30
Common Allegations against EMTs
Breach of confidentiality– The EMT holds privileged information and is
expected to keep it in the strictest of confidence
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
31
Common Allegations against EMTs
Assault – A patient is afraid that he or she may be touched
without consent
Battery– The actual act of being touched without consent
Good Samaritan Act– The legislation to protect you in your off duty time
if you render care within your scope of practice; this is also known as immunity statutes
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
32
Protection against Lawsuits
Good Samaritan Act– The legislation to protect you in your off duty time
if you render care within your scope of practice; this is also known as immunity statutes
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
33
Protection against Lawsuits
Best practices– The best strategy to avoid litigation is to use
common sense in everyday practice
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
34
Stop and Review
What is necessary to prove a case of negligence?
What should be included in documentation to avoid a lawsuit claiming negligence?
What laws help protect the EMT against litigation?