3)Medico Legal And Ethical Issues

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3)Medico Legal And Ethical Issues

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

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