Upload
phant0m0o0o
View
10.817
Download
7
Tags:
Embed Size (px)
Citation preview
Medical/Legal and Ethical Issues
Confidentiality
• Confidential information• Pt. history• Assessment findings• Treatment rendered
• Releasing confidential information• Written release signed from pt/legal guardian
• Written release not needed…• Receiving facility,Transporting agencies • Continuation of care • 3rd party billing info• Continuing education (remove pt ID)• Sate law (rape, abuse, GSW)• Subpoena
12VAC5-31-950. Disclosure of patient information.
Reporting Requirements
• Vary from state to state • Abuse
• Child• Elderly• Spouse/family
• Crime• Wounds form violent crime• Sexual assault
• Infectious disease exposure• Pt. restraint laws• Mentally incompetent
• Intoxicated with injuries
Scope of PracticeWhat You Do…
• “Range of activities & limitations of a given medical provider”
• Defined by state legislation• References national curricula • May be enhanced by
• Medical direction• Protocols• Standing orders
• Va OEMS Scope of Practce
Standard of CareWhat You Know…
• “Body of knowledge, laws, policies, common practices, standards, and guidelines that provide the basis for prehospital care”
• Defined by protocols and
sate certification
Negligence
• “Deviation from standard of care that results in HARM to the pt.”
• 4 Elements of Negligence• Duty to act• Breach of duty• Damage• Causal connection
• ALL 4 must be proven
Components of Negligence
• Duty to Act• “Legal requirement to assess and treat a pt”• Est. pt-provider relationship• Implied
• Pt calls for ambulance and one is sent• Treatment is started
• Formal• Contracts
• Off duty EMT has NONE
Components of Negligence
• Breach of Duty• “Negligent action/omission that
has violated the standards of care expected for an EMT under the circumstances”
• Ex. Perform a procedure incorrectly
• Failing to act in a timely/appropriate manner
• Failing to act in the circumstances required
• Performing other skills deemed negligent
Components of Negligence
• Damage• Physical • Psychological
• No damage= No case
Components of Negligence
• Causal Connection• Clear connection from injury to EMT actions
Abandonment
• “Termination of pt care without assuring the continuation of care at the same level or higher”
Good Samaritan Laws
• Protects volunteers from litigation• Raises bar
• Negligence• Gross negligence
• “Willful & wanton recklessness that would be so careless as to be dangerous”
• Va Good Samaritan Law
Consent
• MUST be obtained before treatment • Types
• Expressed• Implied
Expressed Consent
• Verbal or other gesture• Characteristics
• Informed of risks/benefits • Legal age• Rational decisions• Conscious• Mentally competent
Implied Consent
• “Consent assumed from the unconscious pt requiring aid”
• Assumes a reasonable person would expect emergency care in the situation
ConsentSpecial Cases
• Children/Mentally incompetent people
• Consent from legal guardian/parent
• Treat as implied if none found• Emancipation
• 16 years old and:• Married• In armed forces • Lives independently of parents
• Financially self supporting• Is/was a parent • Code of Va § 16.1-331 - 334
Refusals
• Pt has right to• Refuse Care• Withdraw consent at any time
• Pt must be• Mentally competent• Informed of risks/consequences • Sing “release of liability” form
• Get a witness
• Complete PPCR • Narrative • Advice given• Planned treatments
Complications of Refusals
• False imprisonment • Transport pt against will
• Assault• Creating fear of injury
• Battery• Touching someone
without their permission
Do No Resuscitate (DNR)
• DNR• Legal order signed by doctor• Withholds lifesaving measures in event of
resp/cardiac arrest• HAVE TO SEE ORIGINAL
• OTHERWISE• Treat the pt• MUST TRANSPORT WITH PT
• Types• DNR Form• DNR jewelry • “Other DRN”
• Written order by doctor• Providers
• Cannot recognize DNR from other states• Va Durable DNR Fact Sheet
Advanced Directives
• Advance Directive• Withhold certain care but not others• Specific to the pt.
• Healthcare Proxy/POA• Legally empowered person other than pt• Makes medical decisions for pt• Mentally incompetent pt.
Special Situations
• Donor/Organ Harvesting• EMT role
• ID pt as possible donor• Est. communication with
medical direction• Provide care to maintain
viable organs
• Documentation• Donor card• Back of drivers license
Special Situations
• Medical ID insignia • Bracelets• Earrings • Charms/Pendants• Cufflinks • Ring
• ID pt with medical problems • Allergies• Epilepsy• Diabetes• DNR status• Etc…
Special Situations
• Crime Scenes • Ensure
personal/personnel/pt safety
• Notify police via dispatch if 1st responding
• Don’t disturb items • Don’t cut through
holes/stabs in clothing• Preserve chain of evidence• DOCUMENT!!!!!!
Risk Management
• SAFETY • Act according to Standard of Care• DOCUMENT!• Act in interest of the pt.
Take a beak!