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ObjectivesObjectivesDefine the paramedicDefine the paramedic’’s responsibility to protect s responsibility to protect patient confidentiality responsibilitiespatient confidentiality responsibilities
Outline the process for obtaining consentOutline the process for obtaining consent
Describe legal complications related to consentDescribe legal complications related to consent
Describe actions in refusal of care situationDescribe actions in refusal of care situation
Your preceptor doesnYour preceptor doesn’’t flinch when the alert t flinch when the alert patient with chest pain says he doesnpatient with chest pain says he doesn’’t want t want to go to the hospital. He tells him, to go to the hospital. He tells him, ““You have You have no choice,no choice,”” and then forcibly transports him. and then forcibly transports him. During the struggle, the patientDuring the struggle, the patient’’s condition s condition worsens and he suffers a serious heart worsens and he suffers a serious heart attack.attack.
DiscussionDiscussionDoes this call meet any of the elements needed to prove Does this call meet any of the elements needed to prove negligence?negligence?
What type of consent should have been obtained on this What type of consent should have been obtained on this call?call?
Should this patient have been transported against his Should this patient have been transported against his wishes?wishes?
What criminal or civil laws may relate to this situation?What criminal or civil laws may relate to this situation?
Ethical ResponsibilitiesEthical ResponsibilitiesRespect for patientRespect for patient’’s physical and emotional needss physical and emotional needsMastery of skillsMastery of skillsContinuing educationContinuing educationReviewing performance Reviewing performance Reporting honestlyReporting honestlyRespecting confidentialityRespecting confidentialityWorking cooperatively with other professionalsWorking cooperatively with other professionalsStaying current with new concepts and modalitiesStaying current with new concepts and modalities
Legal and Ethical ResponsibilitiesLegal and Ethical Responsibilities
Civil or criminal liabilityCivil or criminal liability
Best legal protection:Best legal protection:Appropriate assessment and careAppropriate assessment and careAccurate and complete documentationAccurate and complete documentation
Laws differ from state to stateLaws differ from state to stateGet competent legal adviceGet competent legal advice
Regulations developed by a governmental Regulations developed by a governmental agency to provide details about the function agency to provide details about the function and process of the lawand process of the law
General requirements for paramedic licensureGeneral requirements for paramedic licensure
Regulatory agencies may revoke or suspend Regulatory agencies may revoke or suspend licenselicense
Common LawCommon LawCase or judgeCase or judge--made lawmade law
Derived from customs or norms over timeDerived from customs or norms over time
Based on decisions of state/federal judicial systemsBased on decisions of state/federal judicial systems
Court decisions may defineCourt decisions may defineAcceptable conductAcceptable conductNegligenceNegligenceInterpretation of EMS statutes and regulationsInterpretation of EMS statutes and regulations
Criminal LawCriminal LawGovernment prosecutes person for violating Government prosecutes person for violating laws designed to protect societylaws designed to protect society
Public complaintPublic complaint
Punishment by fine, imprisonment, or bothPunishment by fine, imprisonment, or both
How Laws Affect the ParamedicHow Laws Affect the ParamedicScope of practiceScope of practice
Duties/skills paramedic is allowed to performDuties/skills paramedic is allowed to performDictated by state law or regulationDictated by state law or regulation
Medical directionMedical directionOnOn--line or offline or off--lineline
Medical practice actMedical practice actLegislation governing practiceLegislation governing practice
Motor Vehicle LawsMotor Vehicle LawsStandards for equipping and operating Standards for equipping and operating emergency vehiclesemergency vehicles
Vary by stateVary by state
State codes regardingState codes regardingReckless drivingReckless drivingExcessive speedsExcessive speedsFailure to consider road and weather conditionsFailure to consider road and weather conditionsInappropriate use/nonuse of sirens and lightsInappropriate use/nonuse of sirens and lights
Defenses to Negligence ClaimsDefenses to Negligence Claims
TrainingTrainingCompetent patient care skillsCompetent patient care skillsThorough documentation of patient care Thorough documentation of patient care Good Samaritan lawsGood Samaritan laws
Limited protection for EMSLimited protection for EMS
Civil RightsCivil RightsCOBRA/EMTALA 1986: May not discriminate by COBRA/EMTALA 1986: May not discriminate by reason of race, color, gender, national origin, or, reason of race, color, gender, national origin, or, in some cases, ability to payin some cases, ability to pay
Rehabilitation Act of 1973: May not discriminate Rehabilitation Act of 1973: May not discriminate based on a handicap based on a handicap
Title II of the Americans with Disabilities Act: Title II of the Americans with Disabilities Act: Guarantees equal accessibilityGuarantees equal accessibility
ConfidentialityConfidentialityRelease of informationRelease of information
Requires written permissionRequires written permission
Legal exceptionsLegal exceptions
Improper release of information or release of Improper release of information or release of inaccurate information can result in liabilityinaccurate information can result in liability
Invasion of privacyInvasion of privacyDefamationDefamation
Conscious, competent patients have the right Conscious, competent patients have the right to decide what medical care and to decide what medical care and transportation to accepttransportation to accept
ConsentConsentMust inform patient ofMust inform patient of
Nature of illness or injuryNature of illness or injuryTreatment recommendedTreatment recommendedRisks and dangers of treatmentRisks and dangers of treatmentAlternative treatments possibleAlternative treatments possibleDangers of refusing treatment/transportDangers of refusing treatment/transport
Conscious, competent patient can revoke Conscious, competent patient can revoke consent at any time consent at any time
Usually 18, unless emancipatedUsually 18, unless emancipated
Unemancipated minors canUnemancipated minors can’’t give or withhold t give or withhold consentconsent
Consent by parent, legal guardian, or courtConsent by parent, legal guardian, or court--appointed custodian appointed custodian Emergency doctrine applies when parent or Emergency doctrine applies when parent or guardian cannot be contactedguardian cannot be contacted
•• Thoroughly document nature of emergencyThoroughly document nature of emergency
As a rule, incarceration does not deny a As a rule, incarceration does not deny a personperson’’s right to decide about medical s right to decide about medical treatment.treatment.
If limbIf limb-- or lifeor life--threatening injury present, court threatening injury present, court or police who have custody may authorize or police who have custody may authorize emergency treatment (in some cases)emergency treatment (in some cases)
Terminating care needed by patient without Terminating care needed by patient without ensuring that care is provided by another ensuring that care is provided by another qualified providerqualified provider
May occur in the field or when a patient is May occur in the field or when a patient is delivered to emergency departmentdelivered to emergency department
AssaultAssaultThreatening, attempting, or causing fear of Threatening, attempting, or causing fear of offensive physical contact offensive physical contact
BatteryBatteryUnlawful touching without consentUnlawful touching without consent
Transportation of PatientsTransportation of Patients
Care must be continued untilCare must be continued untilPatient is transferred to appropriate personnelPatient is transferred to appropriate personnelPatient no longer requires carePatient no longer requires carePatient terminates relationshipPatient terminates relationship
““RightRight--ofof--wayway”” privilegesprivilegesTravel slightly faster than the posted speed limit Travel slightly faster than the posted speed limit (usually no more than 10 mph)(usually no more than 10 mph)Move safely from one lane into opposing trafficMove safely from one lane into opposing trafficSafely travel through redSafely travel through red--light intersectionslight intersectionsAppropriately use audible and visual warning Appropriately use audible and visual warning devicesdevicesPark in unauthorized areasPark in unauthorized areas
Payer ProtocolsPayer ProtocolsParamedics need basic understanding of Paramedics need basic understanding of reimbursement programs to help patients reimbursement programs to help patients determine what services are likely to be determine what services are likely to be covered by their insurance policiescovered by their insurance policies
In lifeIn life--threatening emergencies, payer threatening emergencies, payer protocols should not be a factorprotocols should not be a factor
Document patient care thoroughlyDocument patient care thoroughly
Resuscitation IssuesResuscitation IssuesWithholding or stopping resuscitationWithholding or stopping resuscitation
Obvious signs of irreversible death Obvious signs of irreversible death Resuscitation would place the EMS provider at Resuscitation would place the EMS provider at risk of personal injuryrisk of personal injuryPatient or surrogate has indicated resuscitation is Patient or surrogate has indicated resuscitation is not desirednot desiredEstablished by local protocolsEstablished by local protocolsRole of medical direction should be clearly Role of medical direction should be clearly delineateddelineated
State laws and local protocolsState laws and local protocols
Written patient statementsWritten patient statementsLiving willLiving willDurable power of attorney for health Durable power of attorney for health carecareDo not resuscitate (DNR) ordersDo not resuscitate (DNR) orders
Medical direction policies Medical direction policies
Potential Organ DonationPotential Organ DonationIdentify potential donorIdentify potential donor
Notify medical directionNotify medical direction
Care to help maintain viable organsCare to help maintain viable organsAirway managementAirway managementFluid resuscitation to maintain perfusionFluid resuscitation to maintain perfusionEye careEye care
Death in the FieldDeath in the FieldDetermined byDetermined by
No spontaneous cardiac electrical activity (confirmed No spontaneous cardiac electrical activity (confirmed by ECG in two leads)by ECG in two leads)No spontaneous respirationsNo spontaneous respirationsAbsent cough and gag reflexAbsent cough and gag reflexNo spontaneous movementNo spontaneous movementNo response to painful stimuliNo response to painful stimuliFixed and midpoint pupilsFixed and midpoint pupilsDependent lividityDependent lividityRigor mortisRigor mortis
Death in the FieldDeath in the FieldParamedic shouldParamedic should
Contact medical direction for guidanceContact medical direction for guidanceFollow protocolsFollow protocolsDocument observations or unusual findingsDocument observations or unusual findingsNotify appropriate authorities Notify appropriate authorities Disturb the scene as little as possibleDisturb the scene as little as possibleProvide emotional supportProvide emotional support