EMS Chapter 3 - Medical, Legal, and Ethical Issues

Morality

A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

Negligence Per Se

A theory that may be used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute.

Durable Power of Attorney for Health Care

A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decision-making capacity.

Health Care Proxies

A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decision-making capacity. Also known as a durable power of attorney for health care.

Expressed Consent

A type of consent in which a patient gives verbal or nonverbal authorization for provision of care or transport.

Health Care Directive

A written document that specifies medical treatment for a competent patient, should he or she become unable to make decisions. Also known as an advance directive or a living will.

Tort

A wrongful act that gives rise to a civil lawsuit.

Where would you MOST likely find information regarding a patient's wishes to be an organ donor? Select one: A. Driver's license B. Voter registration card C. Social Security card D. Insurance card

A. Driver's license

The EMT's scope of practice within his or her local response area is defined by the: Select one: A. medical director. B. state EMS office. C. local health district. D. EMS supervisor.

A. medical director.

Maintaining the chain of evidence at the scene of a crime should include: Select one: A. not cutting through holes in clothing that were caused by weapons. B. quickly moving any weapons out of the patient's sight. C. placing the patient in a private area until the police arrive. D. making brief notes at the scene and then completing them later.

A. not cutting through holes in clothing that were caused by weapons.

While evaluating a noncritical patient in the field, you receive a call from dispatch regarding a serious four-car accident. You inform the patient you are treating to have someone take him to his doctor to get checked out before leaving to attend to the more seriously injured people. This is an example of what? Abandonment Implied consent Defamation Res ipso loquitor

Abandonment This would be abandonment, the unilateral termination of care by the EMT without the patient's consent and without making provisions for transferring care to another medical professional with the skills and training necessary to meet the needs of the patient.

Decision-Making Capacity

Ability to understand and process information and make a choice regarding appropriate medical care.

Competent

Able to make rational decisions about personal well-being.

Credentialing

An established process to determine the qualifications necessary to be allowed to practice a particular profession, or to function as an organization.

You respond to the home of a 59-year-old man who is unconscious; has slow, shallow breathing; and has a weak pulse. The family states that the patient has terminal brain cancer and does not wish to be resuscitated. They further state that there is a DNR order for this patient, but they are unable to locate it. You should: Select one: A. decide on further action once the DNR order is produced. B. begin treatment and contact medical control as needed. C. honor the patient's wishes and withhold all treatment. D. transport the patient without providing any treatment.

B. begin treatment and contact medical control as needed.

Putrefaction is defined as: Select one: A. blood settling to the lowest point of the body. B. decomposition of the body's tissues. C. profound cyanosis to the trunk and face. D. separation of the torso from the rest of the body.

B. decomposition of the body's tissues.

You and your partner arrive at the scene of a major motor vehicle crash. The driver, a young male, is severely entrapped in his car. He has an open head injury and massive facial trauma. He is unresponsive, is not breathing, and does not have a palpable carotid pulse. You should: Select one: A. ventilate the patient for 5 minutes and then stop if there is no response. B. have your partner check for a pulse to confirm that the patient is deceased. C. stop any active bleeding and advise dispatch to send a paramedic crew. D. request the fire department to extricate the patient so you can begin CPR.

B. have your partner check for a pulse to confirm that the patient is deceased.

You are called to attend to an elderly patient with an extensive medical history who is now in cardiac arrest. The patient's family tells you that the patient has a DNR order. There is no paperwork available but the patient does have a MedicAlert bracelet indicating Do Not Resuscitate. You should: Select one: A. transport with minimal care. B. initiate resuscitation in the absence of paperwork. C. confirm the patient identity and then confirm the DNR by calling the MedicAlert Foundation number on the bracelet. D. confirm the patient's identity and honor the DNR order.

C. confirm the patient identity and then confirm the DNR by calling the MedicAlert Foundation number on the bracelet.

When performing his or her duties, the EMT is generally expected to: Select one: A. contact medical control on every EMS call. B. consistently exceed the standard of care. C. function above his or her scope of practice. D. exercise reasonable care and act prudently.

D. exercise reasonable care and act prudently.

As an EMT, the standards of emergency care are often partially based on: Select one: A. a consensus among paramedic supervisors. B. the priorities of the medical director. C. the wishes of the general public. D. locally accepted protocols.

D. locally accepted protocols.

Compensatory Damages

Damages awarded in a civil lawsuit that are intended to restore the plaintiff to the same condition that he or she was in prior to the incident.

Punitive Damages

Damages that are sometimes awarded in a civil suit when the conduct of the defendant was intentional or constituted a reckless disregard for the safety of the public.

Putrefaction

Decomposition of body tissues; a definitive sign of death.

Negligence

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

Defamation that is spoken is known as libel. TrueFalse

False Correct. Defamation that is spoken is known as slander.

Consent

Permission to render care.

Bioethics

The study of ethics related to issues that arise in health care.

Assault

Unlawfully placing a patient in fear of bodily harm.

Contributory Negligence

A legal defense that may be raised when the defendant feels that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff.

Duty to Act

A medicolegal term relating to certain personnel who either by statute or by function have a responsibility to provide care.

Emancipated Minors

A person who is under the legal age in a given state but, because of other circumstances, is legally considered an adult.

Certification

A process in which a person, an institution, or a program is evaluated and recognized as meeting certain predetermined standards to provide safe and ethical patient care.

Emergency

A serious situation, such as injury or illness, that threatens the life or welfare of a person or group of people and requires immediate intervention.

Medicolegal

A term relating to medical jurisprudence (law) or forensic medicine.

To help protect patients, EMS agencies are required to have __________. Select one: A. a privacy officer to answer questions B. online access to patient records C. an anonymous reporting system D. public forums with their medical director

A. a privacy officer to answer questions

Protected Health Information (PHI)

Any information about health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.

Which type of consent is involved when a 39-year-old mentally competent female with a severe headache asks you to take her to the hospital? Select one: A. Formal B. Expressed C. Implied D. Informed

B. Expressed

During your monthly internal quality improvement (QI) meeting, you review several patient care reports (PCRs) with the staff of your EMS system. You identify the patient's name, age, and sex, and then discuss the treatment that was provided by the EMTs in the field. By taking this approach to the QI process, you: Select one: A. acted appropriately but must have each EMT sign a waiver stating that he or she will not discuss the cases with others. B. are in violation of HIPAA because you did not remove the PHI from the PCR beforehand. C. violated the patient's privacy because you should have discussed the information only with the EMTs involved. D. adequately safeguarded the patient's PHI because the cases were discussed internally.

B. are in violation of HIPAA because you did not remove the PHI from the PCR beforehand.

Dependent Lividity

Blood settling to the lowest point of the body, causing discoloration of the skin; a definite sign of death.

Which of the following general statements regarding consent is correct? Select one: A. Expressed consent is valid only if given in writing by a family member. B. Patients who are intoxicated are generally allowed to refuse treatment. C. A patient can consent to transport but can legally refuse to be treated. D. All patients older than 18 years can legally refuse treatment or transport.

C. A patient can consent to transport but can legally refuse to be treated.

Which aspect of the Health Insurance Portability and Accountability Act (HIPAA) MOST affects EMS personnel? Select one: A. Preventing insurance fraud B. Controlling insurance costs C. Protecting patient privacy D. Ensuring access to insurance

C. Protecting patient privacy

When is forcible restraint permitted? Select one: A. Only if law enforcement personnel have witnessed threatening behavior B. Anytime that the EMT feels threatened C. When the patient poses a significant threat to self or others D. Only if consent to restrain is given by a family member

C. When the patient poses a significant threat to self or others

Gross Negligence

Conduct that constitutes a willful or reckless disregard for a duty or standard of care.

You belong to a small volunteer EMS company and are treating a patient with chest pain, and you feel that the administration of aspirin is indicated. You ask the patient if he is allergic to aspirin and he says no. Shortly after you administer the aspirin, the patient develops signs and symptoms of a severe allergic reaction. Later in the hospital, the doctor advises you that the patient's medical history indicates that the patient has an allergy to aspirin. The patient later sues you. Which of the following is your best defense strategy? Statute of limitations Governmental immunity Contributory negligence Gross negligence

Contributory negligence Contributory negligence is a legal defense that may be raised when the defendant feels that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff.

In which of the following situations does a legal duty to act clearly exist? Select one: A. A bystander encounters a victim who is not breathing. B. The EMT witnesses a vehicle crash while off duty. C. The EMT hears of a cardiac arrest after his or her shift ends. D. A call is received 15 minutes prior to shift change.

D. A call is received 15 minutes prior to shift change.

Which of the following components are needed to prove negligence? Select one: A. Abandonment, breach of duty, damages, and causation B. Breach of duty, injury/damages, abandonment, and causation C. Duty to act, abandonment, breach of duty, and causation D. Duty to act, breach of duty, injury/damages, and causation

D. Duty to act, breach of duty, injury/damages, and causation

You arrive at the scene of a motor vehicle-versus-pedestrian accident. The patient, a 13-year-old male, is unconscious and has multiple injuries. As you are treating the child, a law enforcement officer advises you that the child's parents will be at the scene in approximately 15 minutes. What should you do? Select one: A. Treat the child at the scene and wait for the parents to arrive and give consent. B. Withhold treatment until the parents arrive and give you consent for treatment. C. Begin transport at once and have the parents meet you en route to the hospital. D. Transport the child immediately and have the parents meet you at the hospital.

D. Transport the child immediately and have the parents meet you at the hospital.

An obvious sign of death caused by discoloration of the body from pooling of the blood to the lower parts of the body is called what? Rigor mortis Dependent lividity Putrefaction A presumptive sign

Dependent lividity Dependent lividity is an obvious sign of death caused by discoloration of the body from pooling of the blood to the lower parts of the body.

Breach of Confidentiality

Disclosure of information without proper authorization.

Which of the following gives surrogates the right to make decisions for patients regarding their health care in the event that the patient is incapacitated and unable to make such decisions? Do not resuscitate (DNR) order Advance directive Durable power of attorney for health care Emergency doctrine

Durable power of attorney for health care Durable power of attorney for health care: A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decision-making capacity

Once your ambulance is dispatched to an emergency, you have an obligation to respond. What is this called? Scope of practice Duty to act Breach of duty Mandatory reporting

Duty to act is a medicolegal term relating to certain personnel who either by statute or by function have a responsibility to provide care.

What is the best way to care for your patient once he tells you he does not want to go to the hospital? Get the police involved. Ask him to sign a refusal form, releasing you from liability. Order him to go to the hospital against his wishes. Encourage him to call 9-1-1 again if his condition worsens.

Encourage him to call 9-1-1 again if his condition worsens. Since the patient is competent to refuse care, the best thing you can do is to encourage him to call 9-1-1 again if his condition worsens.

You arrive at the scene of a call to find an elderly man complaining of chest pain. You introduce yourself and ask permission to examine him. He nods and extends his arm. Which type of consent is this? Mature consent Implied consent Informed consent Expressed consent

Expressed consent Expressed consent is a type of consent in which a patient gives verbal or nonverbal authorization for provision of care or transport.

The manner in which principles of ethics are incorporated into professional conduct is known as bioethics. TrueFalse Correct. Bioethics addresses issues that arise in the practice of health care.

False Correct. Bioethics addresses issues that arise in the practice of health care.

Criminal lawsuits for battery are common in health care. TrueFalse

False Correct. Civil lawsuits for battery are common in health care but criminal suits are rare.

Slander

False and damaging information about a person that is communicated by the spoken word.

Libel

False and damaging information about a person that is communicated in writing.

You have responded to a vehicle accident call. Initially, the male patient allows you to splint his broken arm and complete a primary assessment. However, he rescinds consent during transport and demands to be let out of the ambulance. If you refuse, which of the following might you be charged with? Assault Battery Kidnapping False imprisonment

False imprisonment

Emergency Medical Care

Immediate care or treatment.

Governmental Immunity

Legal doctrine that can protect an EMS provider from being sued or which may limit the amount of the monetary judgement that the plaintiff may recover; generally applies only to EMS systems that are operated by municipalities or other governmental entities.

Scope of Practice

Most commonly defined by state law; outlines the care the EMT is able to provide for the patient.

Depositions

Oral questions asked of parties and witnesses under oath.

The right of a patient to make decisions concerning his or her health is known as what? Competence Implied consent Patient autonomy Decision-making capacity

Patient autonomy Patient autonomy is the right of a patient to make informed choices regarding his or her health care.

Informed Consent

Permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained.

In Loco Parentis

Refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent.

Good Samaritan Laws

Statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care, unless there is wanton, gross, or willful negligence.

Rigor Mortis

Stiffening of the body muscles; a definitive sign of death.

Forcible Restraint

The act of physically preventing an individual from initiating any physical action.

Defamation

The communication of false information about a person that is damaging to that person's reputation or standing in the community.

False Imprisonment

The confinement of a person without legal authority or the person's consent.

Applied Ethics

The manner in which principles of ethics are incorporated into professional conduct.

Discovery

The phase of a civil lawsuit where the plaintiff and defense obtain information from each other that will enable the attorneys to have a better understanding of the case and which will assist in negotiating a possible settlement or in preparing for trial. Discovery includes depositions, interrogatories, and demands for production of records.

Ethics

The philosophy of right and wrong, of moral duties, and of ideal professional behavior.

Emergency Doctrine

The principle of law that permits a health care provider to treat a patient in an emergency situation when the patient is incapable of granting consent because of an altered level of consciousness, disability, the effects of drugs or alcohol, or the patient's age.

Licensure

The process whereby a competent authority, usually the state, allows people to perform a regulated act.

Patient Autonomy

The right of a patient to make informed choices regarding his or her health care.

Kidnapping

The seizing, confining, abducting, or carrying away of a person by force, including transporting a competent adult for medical treatment without his or her consent.

Statute of Limitations

The time within which a case must be commenced.

Immunity laws, which vary from state to state, do not provide immunity when injury or damage is caused by gross negligence or willful misconduct. TrueFalse

True Correct. Immunity laws, which vary from state to state, do not provide immunity when injury or damage is caused by gross negligence or willful misconduct.

Implied Consent

Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment.

Abandonment

Unilateral termination of care by the EMT without the patient's consent and without making provisions for transferring care to another medical professional with the skills and training necessary to meet the needs of the patient.

Battery

Unlawfully touching a patient or providing emergency care without consent.

Proximate Causation

When a person who has a duty abuses it, and causes harm to another individual, the EMT, the agency, and/or the medical director may be sued for negligence.

Res Ipsa Loquitor

When the EMT or an EMS service is held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred.

Do Not Resuscitate (DNR) Orders

Written documentation by a physician giving permission to medical personnel to not attempt resuscitation in the event of cardiac arrest.

Advance Directive

Written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions; also called a living will or health care directive.

Interrogatories

Written questions that the defense and plaintiff send to one another.

Standard of Care

Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.

Which of the following statements about the patient care report is correct? Select one: a. Incomplete reports are common and accepted in EMS. b. It is difficult to prove actions were performed if they are not included on the report. c. Patient care cannot be discredited based on poor documentation. d. EMTs are not liable for any actions that are accurately documented.

b. It is difficult to prove actions were performed if they are not included on the report.

Which of the following describes a code of conduct that can be defined by society, religion, or a person, affecting character and conscience? Ethics Morality Bioethics Applied ethics

morality Ethics is the philosophy of right and wrong, of moral duties, and of ideal professional behavior.

In which of the following circumstances can the EMT legally release confidential patient information? Select one: A. The family requests a copy for insurance purposes B. The patient is competent and signs a release form C. A media representative inquires about the patient D. A police officer requests a copy to place on file

signs a release form