Chapter 3: Medical, Legal, and Ethical Issues in Emergency Care

Overview

• This chapter covers the ethical responsibilities and medical-legal directives for Emergency Medical Technicians (EMTs).
• Key concepts include confidentiality, consent to treat, refusal of care, advance directives, organ donation, evidence preservation, and end-of-life issues.
• Basic principle of emergency care: Do no further harm.
• Legal exposure can be minimized if care is provided in good faith and according to standards.

Consent

• Consent: Permission to render care. A conscious, rational patient must give consent.
• Decision-Making Capacity: Patient's ability to understand information and make informed choices.
• Considerations include mental capacity, age, impairment, and communication barriers.

Types of Consent

• Express Consent: Patient acknowledges and requests care and transport.
  • Must be informed (risks, benefits, alternatives, consequences explained).
• Implied Consent: Assumes consent in life-threatening situations when the patient is unable to consent.
  • Only use if threat to life or limb; known as the emergency doctrine.
• Involuntary Consent: For mentally ill, in crisis, or developmentally delayed individuals.
  • Obtain consent from guardian; understand local laws.
• Minors: Generally need parental consent unless emancipated or in certain situations (married, military, parent).

Forcible Restraint

• Forcible Restraint: Used when patients are a threat to themselves or others.
  • Requires legal authorization; use law enforcement assistance.

Refusal of Care

• Patients with decision-making capacity can refuse treatment.
• Carefully document refusals and consult medical control.
• Ensure patient understands consequences; encourage reevaluation and call-back if condition worsens.

Confidentiality

• Patient information is confidential.
• HIPAA: Regulates patient information privacy.
  • Protected Health Information (PHI) includes identifiable medical data.

Advanced Directives

• Do Not Resuscitate (DNR): States patient wishes regarding resuscitation.
  • DNR does not mean "do not treat".
• Advance Directives: Specifies treatment preferences; often a living will or health care directive.
  • Valid must meet specific legal criteria.

Determining Death

• Presumptive Signs: Lack of response, pulse, chest movement, reflexes, blood pressure, profound cyanosis.
• Definitive Signs: Mortal damage, dependent lividity, rigor mortis, algor mortis, putrefaction.
• Medical examiner involvement required in specific cases (e.g., violent deaths, unattended deaths).

Organ Donation

• Donors' wishes documented via ID or driver's license.
• Priority is still to save the patient's life.

Scope of Practice

• Defined by state law, protocols, and medical director.
• Online Orders: Direct communication with medical professionals.
• Offline Orders: Pre-established protocols.

Standards of Care

• Defined by various sources: local customs, laws, professional standards, textbooks.
• Negligence: Failure to provide standard care.
  • Requires duty, breach of duty, damages, and causation.

Legal Concepts

• Abandonment: Terminating care without consent or transfer.
• Assault/Battery: Unlawful threat or touching without consent.
• Defamation: False information damaging reputation (libel – written, slander – spoken).

Good Samaritan Laws

• Protects from liability when assisting voluntarily, without compensation, within training, and not grossly negligent.

Records and Reports

• Accurate documentation is critical.
• NEMSIS: National EMS Information System standardizes data.

Mandatory Reporting

• Legal obligations to report certain incidents (e.g., abuse, communicable diseases).

Ethical Responsibilities

• EMTs adhere to ethical standards in decision-making.

EMT in Court

• Preparedness and legal representation in lawsuits.
• Understand statutes of limitations, governmental immunity, and discovery process.

These notes cover the major points discussed in the lecture for Chapter 3 on medical, legal, and ethical issues in emergency care.