EMT: Chapter 3 = Medical, Legal and Ethical Issues

5. Discuss the EMT's role and obligations if a patient refuses treatment or transport. (pp 88-90)

It is a competent patient's right to refuse treatment. If a patient refuses treatment or transportation the EMT must 1st involve medical control and note the patient's decision and why on your report. The patient will need to sign a refusal form and have a witness signature, if and only if no witnesses are available your partner may sign the form. Finally, prior to leaving the scene the EMT must try and explain treatment again to get the patient to agree to care

12. Describe the EMT's legal duty to act. (pp 97-98)

- An EMT's legal duty to act is an individuals responsibility to provide patient care.

14. Explain the reporting requirements for special situations, including abuse, drug- or felony-related injuries, childbirth, and crime scenes. (pp 101-102)

- Be familiar and follow legal requirements in your state.

6. Describe the relationship between patient communications, confidentiality, and the Health Insurance Portability and Accountability Act (HIPAA). (p 90)

- Considers all patient information that you obtain in the course of providing medical treatment to a patient to be Protected Health information (PHI)

4. Describe local EMS system protocols for using forcible restraint. (p 88)

- Forcible restraint is sometimes necessary when dealing with a combative patient that is at risk of harming themselves or others. It is recommended to contact medical control prior to restraint of a patient most states require a law officer or another authorized official to be present during the process. If all else fails be sure you have a witness available.

7. Discuss the importance of do not resuscitate (DNR) orders and local protocols as they relate to the EMS environment. (pp 90-92)

- If you arrive on scene and a valid written document cannot be provided you must begin care until it can be produced or medical control gives you permission to stop. A competent patient can ask you to stop and if they become incompetent and have an advanced directive that specifies treatment and non-treatments you can stop.

3. Discuss consent by minors for treatment or transport. (p 87)

- Parents or guardians give minor consent unless the minor is emancipated. If a minor is under care of a school or camp those officials have the right to grate consent, which is known as in loco parentis.

10. Recognize the importance of medical identification devices in treating the patient. (p 94)

- Should be read thoroughly and all instructions on the identification should be abided by.

11. Discuss the scope of practice and standards of care. (pp 94-97)

- The scope of practice is the state determined care you are able to provide to a patient, standards of care is the manner in which you act or behave to prevent further harm to a patient.

9. Explain how to manage patients who are identified as organ donors. (p 94)

- Treat the organ donor patient like any other patient - Use all necessary means to keep the patient alive (give O2)

13. Discuss the issues of negligence, abandonment, assault and battery, and kidnapping and their implications for the EMT. (pp 98-99)

All of these can put an EMT in the courts • Negligence: When you fail to provide the same care that a person with the same or similar training would provide in the same or similar situation • Abandonment: When an EMT terminates care without transfer to an individual with equal or great training • Assault: When you unlawfully place a person in fear of bodily harm. • Battery: Unlawfully touching someone and kidnapping is when you seize, confine, abduct or carry a patient away against their will.

1. Define consent and how it relates to decision making. (p 85)

Consent: The permission to render care. The foundation of consent is decision making capacity, which is the ability of a patient to understand the information you are providing to him or her, coupled with the ability to process the information to make an informed choice regarding medical care that is appropriate for him or her.

8. Describe the physical, presumptive, and definitive signs of death. (pp 92-93)

Physical signs of death are to be determined by a physician. • Presumptive signs of death are: unresponsive to painful stimuli lack of a carotid pulse or heartbeat absence of breath sounds no deep tendon or corneal reflexes absence of eye movement no systolic blood pressure profound cyanosis and lowered or decreased body temperature. • Definitive signs of death: decapitation dependent lividity rigor mortis decomposition of the body.

16. Describe the roles and responsibilities of the EMT in court. (pp 103-105)

You can be either a: 1. Witness 2. Defendant • Whenever you are subpoenaed to testify in any court proceeding, you should immediately notify your service director/legal counsel.

15. Define ethics and morality and their implications for the EMT. (pp 102-103)

• Ethics: The philosophy of right and wrong. • Morality: The code of conduct determined by society.

2. Compare expressed consent, implied consent, and involuntary consent. (pp 86-87)

• Expressed consent/actual consent: Given verbally or nonverbally that they want treatment or transportation. • Implied consent: Consent in which a patient who is unable to give consent but given treatment under the legal assumption that he or she would want treatment. • Involuntary consent: Consent given/granted by the court. Common for patients who are held for mental health evaluation, or patients by law enforcement who are in protective custody. Also, used on patient who have disease which threatens a community at large