Chapter 3 Objectives

List presumptive signs of death

Absence of a pulse, breathing, and breath sounds Complete unresponsiveness to any stimuli No eye movement or pupil response' No reflexes

Identify crime situations or others in which EMTs may be mandated to make special reports.

Abuse Crime Drug Related Injuries

Discuss the actions an EMT should take when a patient refuses care.

Complete a thorough physical assessment on the patient. Try again to persuade the patient to accept treatment of transport to the hospital. Make sure the patient has the capacity to understand and make a rational, informed decision. Consult medical direction as needed, or as required by local protocol. If the patient still refuses, clearly document what was told to the patient, their response, and have them sign a refusal form. Before you leave the scene, encourage the patient to seek help if certain symptoms develop. If you are unsure whether the patient can make a rational decision, contact medical direction for a consultation about whether to treat and transport.

Describe COBRA and EMTALA provisions as they apply to EMS

Consolidated Omnibus Budget Reconciliation Act (COBRA) and the Emergency Medical Treatment and Active Labor Act (EMTALA) are federal regulations that ensure the public's access to emergency health care regardless of ability to pay. EMTALA is also known for "anti-patient dumping statue".

Discuss potential consequences of various decisions and actions (8)

Criminal or civil/tort liability cases (being sued) Breach of duty to act Proximate cause - injuries suffered are caused by EMTs negligence. Abandonment - stopping treatment of patient without transferring the care to another competent professional of equal or higher training. Assault - a willful threat to inflict harm on a patient Battery - the act of touching the patient unlawfully without consent False imprisonment or kidnapping Defamation or slander

Compare and contrast the various types of advance directives used in health care

Do Not Resuscitate (DNR) order - a legal document or order that most often governs resuscitation issues only. A living will - a legal document specifying certain long term life support equipment usage and other general health care issues. Durable power of attorney (health care proxy) - a designated person who is legally empowered to make health care decisions for the patient if they are unable to do so. Physician order for life-sustaining treatment (POLST) or Medical orders for life-sustaining treatment (MOLST) - the terminally ill patient chooses level of treatment in case of deterioration before the need of resuscitation.

Explain the duties of EMTs with respect to themselves, their partners, their patients, and their equipment.

Duty to yourself-obtaining necessary credentials to practice as an EMT, maintain a certain level of proficiency, and maintain mental and physical health. Duty to partner - Ensure they are mentally and physically fit to provide care, and to report if partner is unfit for duty. Duty to patient - Respect their rights, serve as the patient's advocate, maintain privacy and confidentiality, lessen the patient's emotional and physical pain, do no harm, provide complete and competent care for patient. Duty to equipment - Ensure equipment is in proper working order before your shift starts.

Differentiate between the concepts of ethics and morals.

Ethics is a branch oh philosophy specifically directed toward the study of morality. Morals are the concepts of "right and wrong".

List and describe each type of consent as it relates to prehospital care.

Expressed - consent obtained from a patient of legal age, has the capacity to understand and make rational decisions, and is informed of the assessment and procedures you will be performing. Implied - consent that would be obtained from a patient had not be for (or later becomes) unresponsiveness or inability to make a rational decision ... if they could, they would. Minor - consent to treat a minor obtained by a parent, legal guardian, or other person who has been granted rights to make the decision. Involuntary - consent obtained from a legal third party on the patient's behalf, because of mental incompetency or even incarceration.

Explain how an EMT should interpret and apply these advance directives.

First, one should determine to the best of their ability whether it is a valid form and should interpret it in a manner in which the directive should be followed. One should ensure that all directions are clear, concise, and unambiguous.

Describe ways EMTs can protect themselves legally in transport and transfer situations.

Get a full and clear report about the patient's condition. Ensure that you can provide the level of care necessary during transport and it is within your scope of practice. Obtain the written certification of transfer that inclues the transferring physician's name and address, the facility receiving the patient, and the reason for transferring the patient. Know where you are going and take the quickest possible route.

Explain each of the legal protections for EMTs that are provided by state regulations.

Good Samaritan Laws - (see "GSL" notecard) Sovereign immunity - prevents persons treated by governmentally operated EMS systems from suing the government for civil liability. Statue of limitations - The patient only has a certain amount of time to file a negligence claim follow either the event that caused the injury or illness for point of discovering that the problem existed. Contributory negligence - when the patient contributes in any manner or even caused their own injury or illness while under EMS treatment.

Describe the intent of Good Samaritan Laws.

Good Samaritan Laws protect a person who is not being paid for their services from liability for acts performed in good faith unless those acts constitute gross negligence.

Discuss situations in which law enforcement or the medical examiner/coroner's office should be contacted.

Homicides Suicides Violent deaths (including suspected child or elderly abuse) Crash related deaths Unusual scene characteristics Sudden infant death syndrome Dead on arrival

Differentiate between criminal and civil liability.

In criminal liability cases, the government, on behalf of the public, brings legal action against the EMT. In civil action cases, an individual files a lawsuit against an individual EMT, an EMS agency/company, or others indirectly involved in the care of the patient.

Explain patients' rights and the EMT's legal and ethical responsibilities concerning confidentiality and privacy.

It is the EMTs job to keep the patient's information and information pertaining to their treatment private -- unless very specific situations present themselves.

Explain the concept of negligence.

Negligence is a type of tort in which there is no intent to do any harm to the patient, but in which a breach in the duty to act has occurred.

Explain how to avoid tort claims.

Provide emergency care to the best of your ability and to be sure that you understand clearly your scope of practice and the expected standard of care.

List and describe the various types of tort claims applicable to EMS.

Proximate cause - injuries suffered are caused by EMTs negligence. Abandonment - stopping treatment of patient without transferring the care to another competent professional of equal or higher training. Assault - a willful threat to inflict harm on a patient Battery - the act of touching the patient unlawfully without consent False imprisonment or kidnapping Defamation or slander

Differentiate between the concepts of scope of practice and standard of care.

Scope of practice is the actions and care that EMTs are legally allowed to perform by the state in which they are providing emergency medical care. Standard of care is the care that is expected to be provided by an EMT with similar training when managing a patient in a similar position.

Describe the ethical responsibilities of EMTs

Serve the needs of the patient regardless of any contributing factor Maintain skill of mastery. Demonstrate respect for the competence of other medical professionals. Keep abreast of changes in EMS that affect patient care. Critically review performances and seek ways to improve in overall care. Report with honesty besides all information obtained in work Work together with other health care professionals

Discuss special considerations for responding to potential crime scenes

Take one way into and out of the crime scene. Touch only what you need to touch and remember to tell a police officer if you moved or touched anything. Move only what you need to move to protect the patient and to provide proper emergency care. Do not use crime scene telephone unless the police give you permission to do so. In the absence of police permission, move the patient only if the patient is in danger or must be removed for you to provide care. Do not cut through holes in clothing -- any possible evidence. Do not cut through any know in a rope or tire -- any possible evidence. If the crime is rape, do not wash the patient or allow the patient to wash up, change clothing, use the bathroom, eat or drink-- any possible evidence.

Identify common ethical dilemmas encountered in EMS

When advanced directives prohibit you from working Rationed or limited medical care in mass causality events or other areas that inhibit efficient care

Recognize situations in which you have a duty to act.

Your duty to act refers to the legal obligation to provide medical service, whether you think the patient needs an ambulance or not. Typically, this occurs only when you are on the clock and when the patient consents to treatment.