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

Key Objectives

• Understand ethical responsibilities, medical legal directives, and guidelines pertinent to an EMT.
• Confidentiality, consent to treat, refusal of care, advance directives.
• Organ donor policies, evidence preservation, and end-of-life issues.

Basic Principles of Emergency Care

• Do No Further Harm: Avoid legal exposure by acting in good faith and following appropriate standards.
• Lawsuits: Patients may sue despite appropriate care.

Consent Types

General Consent

• Definition: Permission to render care.
• Decision-making capacity is crucial for patient consent.

Express Consent

• Definition: Patient acknowledges and agrees to receive care.
• Must be informed consent (explanation of risks, benefits, alternatives).

Implied Consent

• Applicability: Patients who are unconscious or incapable.
• Emergency Doctrine: Assumes consent if life-threatening.
• Use caution and seek consent from relatives if possible.

Involuntary Consent

• Applicability: Mentally ill or developmentally delayed.
• Guardian consent required; local laws vary.

Minors

• Typically require parent/guardian consent.
• Exceptions for emancipated minors.

Forcible Restraint

• When Needed: Combative patients posing danger.
• Requires medical control authorization, law enforcement assistance.

Right to Refuse Treatment

• Eligibility: Adults with decision-making capacity.
• Requires cautious documentation and consultation with medical control.

Confidentiality

• All communication between EMT and patient is confidential.
• HIPAA: Protects patient information; breaches can result in legal action.

Social Media and Conduct

• Maintain professionalism, respect patient privacy.

Advance Directives

• DNR Orders: Permission to withhold resuscitation but still provide supportive care.
• Living Wills/Healthcare Directives: Specify treatment preferences when patient is unable.

Determination of Death

• Signs of Death: Presumptive (e.g., unresponsive, no pulse) and definitive (e.g., rigor mortis).
• Medical examiner involvement in certain death scenarios.

Special Situations

• Organ Donors: Treated as any patient, maintain organ viability.
• Medical ID Insignia: Bracelets/cards indicating medical conditions.

Scope of Practice

• Defined by state law and medical director protocols.
• Standing Orders: Offline protocols from medical director.

Standards of Care

• Manner of acting defined by local customs, laws, professional standards, and textbooks.

Legal Concepts

• Duty to Act: Obligation to provide care once initiated.
• Negligence: Failure to provide expected care; requires four elements (duty, breach, damage, causation).

Legal Terms

• Res Ipsa Loquitur: Injury suggests negligence.
• Negligence Per Se: Clear violation of statute.
• Torts: Civil wrongs like defamation.

Abandonment and Assault/Battery

• Abandonment: Ending care without ensuring continuation by another competent provider.
• Assault/Battery: Unlawful threat or physical contact.

Good Samaritan Laws

• Protects providers offering care in good faith without compensation.

Records and Reports

• Complete documentation necessary for legal protection.

Mandatory Reporting

• Includes child abuse, elder abuse, violent deaths, etc.

Ethical Responsibilities

• Incorporate ethical standards into professional conduct.

EMT in Court

• Possible roles as witness or defendant; prepare thoroughly and seek legal counsel if needed.

Review Questions

• Examples of consent, abandonment, legal duties, and record-keeping discussed to reinforce learning.