Medical Legal and Ethical Issues in EMS

Scope of Practice

• Defines what EMTs are allowed to do.
• Determined by federal standards, state laws, and agency protocols.
• Varies at national, state, and agency levels.
  • Example: Epinephrine administration for anaphylaxis.
  • Careflight EMTs can start IVs under paramedic supervision.

Standard of Care

• Scope of Practice: What you can do.
• Standard of Care: How you should do it.
• Never exceed training or authorization.
• Perform all procedures to the standard of care.

Patient Consent and Refusal

Types of Consent

• Expressed Consent: Given verbally or in writing by a patient who is alert and oriented.
• Implied Consent: Assumed when a patient cannot consent (e.g., unconscious, severely disoriented, minors without available guardians).

Orientation Factors

• Person
• Place
• Time
• Event

Refusal of Care

• Patient must be alert and oriented times four.
• Inform patient of risks and assess thoroughly.
• Document the refusal and obtain a witness signature.
• Utilize resources like medical directors, family, and PD to influence patient decisions.

Legal Consequences

Assault and Battery

• Providing unwanted care is legally assault and battery.
• Transporting against a patient's will can be kidnapping.

Negligence

• Failure to act properly or at all when duty to act is present.
• Important terms: malpractice, non-feasance, proximate causation.
• Negligence can result in civil and criminal penalties, loss of certification, and employment.

Abandonment

• Leaving a patient without transferring care to an equal or higher medical provider.
• Can happen in hospitals if patients are left without proper transfer during prolonged waits.

Confidentiality

• Protect Personal Health Information (PHI) as mandated by HIPAA.
• Share patient information only with those involved in care or as required legally.
• Avoid discussing patient information on social media.

Special Situations

• Organ Donors: Identified on ID cards, can impact CPR decisions.
• Safe Haven Laws: Allow parents to leave infants at designated locations without penalty.
• Crime Scenes: Preserve evidence, prioritize patient care, report any findings to law enforcement.

Ethical Considerations

• Align actions with both personal morals and professional ethics.
• Respect patient rights, confidentiality, and act fairly and justly.
• Remain neutral on controversial issues (political, religious views).

Advanced Directives

• Legal documents that outline a patient's wishes (e.g., DNR orders, living wills).
• Follow unless the validity of documents is questionable.
• Consult with medical control if unsure.

Emergency Medical Treatment and Labor Act (EMTALA)

• Prevents patient dumping between hospitals.
• Enforces hospitals to provide emergency care within 250 yards of their entrance.

Review Points

• Define key terms (scope of practice, negligence, duty to act, abandonment, confidentiality).
• Steps for patient refusal: Verify orientation, inform risks, obtain signature, document thoroughly.
• Procedures to avoid disturbing evidence at crime scenes: Use paper bags, limit touch, inform law enforcement.
• Start CPR and prepare for transport if paperwork for DNR is not available.