SIDS, DNR, LEGAL

Legal and Ethical issues

SIDS, DNR, LEGAL

Know Your Reporting Responsibilities!

this applies to you!

SIDS, DNR, LEGAL

Special Reporting Requirements (1 of 2)

Abuse of children, elderly, and spouse

Injury during the commission of a felony

Drug-related injury

Childbirth

SIDS, DNR, LEGAL

Special Reporting Requirements (2 of 2)

Infectious disease exposure

Crime scene

Deceased

SIDS, DNR, LEGAL

Reporting

It is a misdemeanor to fail to report abuse.

report suspicion of child abuse, you do not need proof to report an incident.

SIDS, DNR, LEGAL

What, When & Who

What When verbal report - immediately written report - within 36 hours

Who law enforcement protective services

SIDS, DNR, LEGAL

Elder Abuse

Any person who takes advantage of person, property or emotional state

Victims are often hesitant or unable to report

Signs of abuse are often overlooked Pt. often has multiple medical

conditions and are dependent on others

SIDS, DNR, LEGAL

Assessment of Elder Abuse (1 of 2)

Repeated visits to the emergency room

A history of being “accident-prone” Soft-tissue injuries Vague explanation of injuries Psychosomatic complaints

SIDS, DNR, LEGAL

Assessment of Elder Abuse (2 of 2)

Chronic pain Self-destructive behavior Eating and sleeping disorders Depression or a lack of energy Substance and/or sexual abuse

SIDS, DNR, LEGAL

Signs of Physical Abuse

may be obvious or subtle. Obvious signs include bruises, bites,

and burns. Look for injuries to the ears. Consider injuries to the genitals or

rectum as evidence of abuse.

SIDS, DNR, LEGAL

Advance Directives

Specifies medical treatments desired if patient is unable to make decisions

Do not resuscitate (DNR) orders

– Patients have the right to refuse resuscitative efforts.

SIDS, DNR, LEGAL

Do Not Resuscitate

AKA - DNR or “no code” supportive measures only - No CPR family member can request

resuscitation

SIDS, DNR, LEGAL

Medical facility Vs. Home or Street

There are different requirements

SIDS, DNR, LEGAL

DNR- Nursing facilities

written order in patient's chart

– no CPR

– no code

– DNR

VERBAL ORDER FROM MD NOT VALID unless put in writing

SIDS, DNR, LEGAL

SIDS, DNR, LEGAL

DNR - home/street

L.A. County “Prehospital DNR” Form California “Prehospital DNR” Form** MEDIC ALERT TAG bracelet or necklace

No other type of DNR may be honored in Los Angeles County

SIDS, DNR, LEGAL

SIDS, DNR, LEGAL

SIDS, DNR, LEGAL

Legal issues

Authority for patient care - most qualified at rendering emergency care

Physicians at the scene must show identification and agree to assume responsibility in order to direct care

SIDS, DNR, LEGAL

Consent – three types

Expressed consent

Implied consent

Minors and mentally incompetent adults

– “In loco parentis”

– ALOC

SIDS, DNR, LEGAL

Legal age of consent

Minor is under 18 years-old

Emancipated minor Female - pregnancy related

SIDS, DNR, LEGAL

Adults - Competence

Must be competent to refuse treatment or transport

hypotensive hypoglycemic under the influence suicidal ideations or actions

SIDS, DNR, LEGAL

Adults - Competence

Any EMT-B or EMT-P can deem a patient incompetent

This is NOT a 5150

SIDS, DNR, LEGAL

Refusal of Treatment

Against Medical Advice

when a patient refuses care or transport

do not need if you believe patient is OK without treatment.

SIDS, DNR, LEGAL

Valid AMA Patient Alert and Oriented X3 Competent EMT-B should obtain a witnessed

signature MUST advise pt : Of need for treatment Of consequences of refusal That they may re-contact 911

SIDS, DNR, LEGAL

5150 (72 hour hold)

Patients may be placed on a hold if...

– danger to self

– danger to others

– gravely disabled due to mental disorder

SIDS, DNR, LEGAL

5150 (72 hour hold)

who may place hold

– Law Enforcement

– PET or PMRT member

– County “designated” doctors

SIDS, DNR, LEGAL

Limited Legal Authority

As an EMT-B, you have limited legal authority to require or force a patient to undergo care.

Police may put a patient in protective custody to allow you to provide care.

Know your local laws and protocols.

SIDS, DNR, LEGAL

Assault and Battery

Know when to force TX

Assault

– Unlawfully placing a person in fear of immediate bodily harm without consent

Battery

– Unlawfully touching a person

SIDS, DNR, LEGAL

Duty to Act

Individual’s responsibility to provide patient care

Begins once an ambulance responds to a call or treatment is initiated

SIDS, DNR, LEGAL

Standard of Care

The minimum level of care that a person can expect

Imposed by local protocol

Imposed by the law

Professional or institutional standards

SIDS, DNR, LEGAL

Negligence

Failure to apply the standard of careFailure to provide the same care

that a person with similar training would provide

Act or omission of an act Good Samaritan Act does not apply to

on-duty personnel

SIDS, DNR, LEGAL

Negligence Determination

DutyBreech of dutyDamagesCause

SIDS, DNR, LEGAL

Abandonment

Termination of care without patient’s consent

Termination of care without provisions for continued care

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

SIDS, DNR, LEGAL

Ethical Responsibilities

Make physical/emotional needs a priority Practice/maintain skills Critically review performances Attend continuing education/refresher

programs Be honest in reporting

SIDS, DNR, LEGAL

Confidentiality

Information received from or about a patient is considered confidential.

Disclosing information without permission is considered a breach of confidentiality.

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

SIDS, DNR, LEGAL

Records and Reports

Complete documentation is a safeguard against legal complications

If an action or procedure is not recorded, it was not performed

An incomplete or untidy report is evidence of incompetence

SIDS, DNR, LEGAL

Standards Imposed by States

– Medical Practices Act

Exempts EMT-Bs from licensure requirements

– Certification

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

SIDS, DNR, LEGAL

Regulation updates

EMT-1 or EMT-B designation only

Titles that no longer exist– EMT-1(AA)– EMT-1 (D)

SIDS, DNR, LEGAL

Certification Application Requirements

Be 18 years old or older.Be 18 years old or older.

Have valid Course Completion Have valid Course Completion Certificate.Certificate.

Apply within 2 years of course Apply within 2 years of course completion.completion.

SIDS, DNR, LEGAL

Certification requirements

Submit application and feesSubmit application and fees..

Pass a written certification Pass a written certification examination.examination.

And .. And ..

SIDS, DNR, LEGAL

Background Check

Disqualifying convictions

Violent crimes

Sex related crimes

Drug related crimes (including DUI)

SIDS, DNR, LEGAL

Re-certification Requirements

Every two years– Complete refresher course

Or– Obtain 24 hours of approved continuing

education Submit application and fees

SIDS, DNR, LEGAL

Approved Continuing Education

BLS level many methods to obtain CE MANDATORY CPR & airway

management course at least once every 2 years

YOU must find a CE Provider

SIDS, DNR, LEGAL

End

questions??