EMS – Legal Considerations

Staying out of the Courtroom

Course Overview

Scope of Practice / Standard of Care Negligence Abandonment Good Samaritan Health Insurance Portability Protection Act Refusal and Consent

– Expressed– Implied– Informed– Refusal

Scope of Practice / Standard of Care

Scope of Practice– What your level of certification is

authorized to do This is determined both by state law and

by your medical director. Acting outside of your scope of practice

opens you to negligence and to providing care without a license.

Standard of Care– The level of care expected, within your

scope of practice, of someone with similar training and background.

Would another prudent EMT do the same thing in you shoes.

Negligence

Negligence has four components– You must have a duty to act– You must breach your duty in some

way– Your acts / omissions must cause

harm– The harm has do be directly related

to the breach of duty.

Abandonment

Leaving a patient without transfer of care

– Could be as subtle as leaving without attaining an AMA

– Leaving a patient to be treated by a lower standard of care than they need

– Leaving a patient who wants your help even if you get them to sign AMA.

Good Samaritan

Only applies when you are not here responding to an incident.

If you hear another district get a call and respond to help them you are mutual aid, not a good Samaritan

Good Samaritans are those who respond and provide aid without the duty to respond.

Health Insurance Portability Protection Act and Confidentiality

HIPPA imposes fines for release of medical information to those not involved in the treatment of the patient.

Breach of confidentiality can also result in a lawsuit if the breach causes some sort of harm.

Expressed Consent

Although most texts lump this in as informed consent it really isn’t

Expressed consent is essentially what really happens. Things like introducing yourself and asking what is wrong. The patient communicates and is cooperative and we take that as consent.

This form of consent will not always hold up in court, informed consent is what we really need to do.

Implied Consent

Consent that is assumed based on patient age or condition.

Implied consent essentially means that you as the provider imply that consent would normally be given because a normal patient or parent would want treatment.

We use this with minors or those who are unconscious or have a severely altered consciousness.

Informed Consent

Consent granted by the patient after being informed of what is going on, what you are doing and what is happening.

Informed consent should really be attained for each procedure as well as for just general treatment.

A good trick is to ask other questions like, “Which arm would you like me to check your blood pressure (start an IV, prick your finger for a glucose test)

Refusal

It is just like consent but backwards and may fall into all of the categories.

– Informed – you tell them and they would rather not.

– Implied – you arrive and find pulseless and apneic patient with a DNR (POST) bracelet.

– Expressed – They pull away from you when you try to treat them.

Refusal – (continued)

Any patient can refuse even if you don’t think they should.

They should be alert and oriented and you should get a signed AMA after informing the patient of the dangers of their refusal.

No means NO! Minors are messy in Idaho Law