Medical, Legal andMedical, Legal andEthical IssuesEthical Issues

Medical ResponsibilitiesMedical Responsibilities

Scope of PracticeScope of Practice

The range of duties and skills that The range of duties and skills that emergency medical technicians are emergency medical technicians are allowed and expected to perform.allowed and expected to perform.

Scope of PracticeScope of Practice

Defined by state lawDefined by state law

Outlines care you can provideOutlines care you can provide

Further defined in protocols and Further defined in protocols and standing ordersstanding orders

Authorized through online and off-Authorized through online and off-line medical directionline medical direction

Standard of CareStandard of Care

The degree of skill and judgment The degree of skill and judgment expected of an individual when expected of an individual when

caring for a patient and is defined caring for a patient and is defined by training, protocols, and the by training, protocols, and the expected actions of the care expected actions of the care providers with similar training providers with similar training

and experience, working under and experience, working under similar conditionssimilar conditions

Standard of CareStandard of Care

Standard imposed by local customStandard imposed by local custom

Often based on locally accepted Often based on locally accepted protocolsprotocols

Standard imposed by the lawStandard imposed by the law

May be imposed by statutes, May be imposed by statutes, ordinances, administrative ordinances, administrative guidelines, or case lawguidelines, or case law

Standard of CareStandard of Care

Professional or institutional Professional or institutional standardsstandards

Recommendations published by Recommendations published by organizations and societiesorganizations and societies

Specific rules and procedures of Specific rules and procedures of your service or organizationyour service or organization

WA State Standards WA State Standards

Authorized care under RCW 246.976.182Authorized care under RCW 246.976.182

Medical Practices ActMedical Practices Act

Exempts EMT-Bs from licensure requirementsExempts EMT-Bs from licensure requirements

CertificationCertification

Process of evaluating and recognizing that EMT-B Process of evaluating and recognizing that EMT-B has met certain predetermined standardshas met certain predetermined standards

Legal Issues and Legal Issues and LiabilityLiability

Legal ProtectionLegal Protection EMS Immunity Act EMS Immunity Act Governmental (Sovereign) ImmunityGovernmental (Sovereign) Immunity ““Good Samaritan” Laws Good Samaritan” Laws

Do not prevent lawsuitsDo not prevent lawsuits Offer a defense for those who act in “Good Offer a defense for those who act in “Good

Faith” and meet the Standard of Care”Faith” and meet the Standard of Care” Do not protect against Gross NegligenceDo not protect against Gross Negligence

NegligenceNegligence

Failure to provide the same care Failure to provide the same care that a person with similar training that a person with similar training

would providewould provide

NegligenceNegligence

DutyDuty Responsibility to act reasonably based on standard of Responsibility to act reasonably based on standard of

carecare Breech of dutyBreech of duty

Failure to act within the expected and reasonable Failure to act within the expected and reasonable standard of carestandard of care

DamagesDamages Physical or mental harm created in a noticeable wayPhysical or mental harm created in a noticeable way

CauseCause Existence of reasonable cause and effect Existence of reasonable cause and effect

Duty to ActDuty to Act

Individual’s responsibility to Individual’s responsibility to provide patient care.provide patient care.

Responsibility to provide care Responsibility to provide care comes from either statute or comes from either statute or function.function.

Legal duty to act begins once an Legal duty to act begins once an ambulance responds to a call or ambulance responds to a call or treatment is initiated.treatment is initiated.

ConfidentialityConfidentiality

Information received from or about a Information received from or about a patient is considered confidential.patient is considered confidential.

Disclosing information without Disclosing information without permission is considered a breach of permission is considered a breach of confidentiality.confidentiality.

Generally, information can only be Generally, information can only be disclosed if the patient signs a written disclosed if the patient signs a written release.release.

HIPAAHIPAA

Health Insurance Portability and Health Insurance Portability and Accountability Act of 1996 Accountability Act of 1996

Amends IRC of 1986 to improve portability Amends IRC of 1986 to improve portability and continuity of health insurance and continuity of health insurance coverage in group and individual marketscoverage in group and individual markets

Federal law mandates privacy and Federal law mandates privacy and confidentiality in all issues regarding confidentiality in all issues regarding patient carepatient care

Adult ConsentAdult Consent Adult - Any person over 18 years of age Adult - Any person over 18 years of age

who is not under a court-ordered disabilitywho is not under a court-ordered disability Actual Consent (Informed, Expressed)Actual Consent (Informed, Expressed) Implied ConsentImplied Consent

Pt. is unconscious or unable to communicate Pt. is unconscious or unable to communicate and is suffering from what appears to be a and is suffering from what appears to be a life-threatening injury or illnesslife-threatening injury or illness

Adult ConsentAdult Consent

Involuntary ConsentInvoluntary Consent An adult may be treated against his will only An adult may be treated against his will only

if:if: Treatment is ordered by a magistrateTreatment is ordered by a magistrate Treatment is ordered by a peace officer or Treatment is ordered by a peace officer or

corrections officer who has the patient under arrest corrections officer who has the patient under arrest or in custodyor in custody

Consent of the Mentally IllConsent of the Mentally Ill

Adult ConsentAdult Consent

Right of Refusal of Treatment/TransportRight of Refusal of Treatment/Transport Mentally competent adults have the right to Mentally competent adults have the right to

refuse carerefuse care The person must be informed of risks, The person must be informed of risks,

benefits, treatments, & alternativesbenefits, treatments, & alternatives Remember to document and obtain Remember to document and obtain

signatures of patient & witnesssignatures of patient & witness

Minor ConsentMinor Consent

Minor - any person under 18 years of age Minor - any person under 18 years of age who has never been married and who has who has never been married and who has not had his/her minority status changed by not had his/her minority status changed by the courtthe court

Actual Consent (Informed, Expressed)Actual Consent (Informed, Expressed) ParentsParents GuardianGuardian Others Closely Related of Majority AgeOthers Closely Related of Majority Age

Minor ConsentMinor Consent

Emancipated MinorsEmancipated Minors Under 18, married, pregnant, a parent, Under 18, married, pregnant, a parent,

member of the armed forces, financially member of the armed forces, financially independent and living away form homeindependent and living away form home

Implied Consent Implied Consent Life or Limb ThreateningLife or Limb Threatening No Parental RefusalNo Parental Refusal

Minor ConsentMinor Consent

Right of Refusal of Treatment/TransportRight of Refusal of Treatment/Transport Mentally competent adults (Parent/Guardian) Mentally competent adults (Parent/Guardian)

have the right to refuse care for their childrenhave the right to refuse care for their children The person (Parent/Guardian) must be The person (Parent/Guardian) must be

informed of risks, benefits, treatments, & informed of risks, benefits, treatments, & alternativesalternatives

Remember to document and obtain Remember to document and obtain signatures of Parent/Guardian & witnesssignatures of Parent/Guardian & witness

Refusal of TreatmentRefusal of Treatment

Mentally competent adults have the Mentally competent adults have the right to refuse care.right to refuse care.

Patients must be informed of risks, Patients must be informed of risks, benefits, treatments, and benefits, treatments, and alternatives.alternatives.

EMT-B should obtain a signature and EMT-B should obtain a signature and have a witness present, if possible.have a witness present, if possible.

AbandonmentAbandonment

Termination of care without Termination of care without patient’s consentpatient’s consent

Termination of care without Termination of care without provisions for continued careprovisions for continued care

Care cannot stop unless Care cannot stop unless someone of equal or higher someone of equal or higher training takes overtraining takes over

Assault & BatteryAssault & Battery

AssaultAssault Unlawfully placing a person in fear of Unlawfully placing a person in fear of

immediate bodily harm without consentimmediate bodily harm without consent BatteryBattery

Unlawfully toughing a personUnlawfully toughing a person

Libel and SlanderLibel and Slander

LibelLibel The act of injuring a person’s character, The act of injuring a person’s character,

name, or reputation by false or malicious name, or reputation by false or malicious written statementswritten statements

SlanderSlander The act of injuring a person’s character, The act of injuring a person’s character,

name, or reputation by false or malicious name, or reputation by false or malicious spoken statementsspoken statements

Advance DirectivesAdvance Directives

Specifies medical treatments desired if Specifies medical treatments desired if patient is unable to make decisionspatient is unable to make decisions

Do not resuscitate (DNR) ordersDo not resuscitate (DNR) orders Patients have the right to refuse resuscitative Patients have the right to refuse resuscitative

efforts.efforts.

Require a written order from one or more Require a written order from one or more physiciansphysicians

When in doubt, begin resuscitation.When in doubt, begin resuscitation.

Advance DirectivesAdvance Directives POLST OrdersPOLST Orders WA State DNR FormWA State DNR Form Living Wills or Advance DirectivesLiving Wills or Advance Directives Must be Presented upon Patient ContactMust be Presented upon Patient Contact Specifics of care?Specifics of care? Determine validityDetermine validity

May not be witnessed by anyone who would May not be witnessed by anyone who would benefit from the death of the patientbenefit from the death of the patient

Special SituationsSpecial Situations

Organ donorsOrgan donors

Medical Medical identification identification insigniainsignia

EMT EthicsEMT Ethics

Ethical ResponsibilitiesEthical Responsibilities

Make the physical/emotional needs of Make the physical/emotional needs of the patient a priority. the patient a priority.

Practice/maintain skills to the point of Practice/maintain skills to the point of mastery. mastery.

Critically review performances.Critically review performances. Attend continuing education/refresher Attend continuing education/refresher

programs. programs. Be honest in reporting.Be honest in reporting.