3. REGULATIONS
Federal, state, and local laws/regulations
govern practice of emergency medicine
Requirements vary for
registering/becoming certified First
Responder
Laws state what First Responders
can/can’t do
4. SCOPE OF PRACTICE
Level of care healthcare professional
provides with specified level of training
Defined by the U.S. DOT’s First Responder:
National Standard Curriculum
State laws may modify scope of practice
Further defined through medical oversight,
including protocols, standing orders,
direct oversight
5. STANDARD OF CARE
How you provide care and what specific care you give
Same care as First Responder with similar training would give patient in
similar circumstances
National standard of care based on DOT National Standard Curriculum
What you are taught in First Responder training = standard of care
Give care as you have been taught, and you cannot be held legally liable for
a negative patient outcome
Neglecting to follow standard of care may make you liable for negligence
6. ETHICAL RESPONSIBILITIES
To provide the best patient care possible
Make patient’s physical and emotional needs
your highest priority
Practice care giving skills until mastered
Regularly attend continuing
education/refresher programs
Review your performances after each patient
care episode
Be honest in reporting and documentation
7. CONSENT
Patients have right to decide emergency care
they will accept
Obtain person’s consent before providing care
Consent based on information you provide
A competent adult has right to refuse care
8. COMPETENCE
Determine whether adult victim is competent to consent
Competent person can understand what is happening and implications of
receiving/refusing care
Victim may not be competent because of intoxication, drug use or altered
mental status caused by severe injury
Parent or legal guardian gives consent for children or mentally incompetent
adults
If parent or guardian cannot be reached , consent is implied
9. EXPRESSED
CONSENT
Patient explicitly grants permission for
care
Usually a verbal agreement or a nod
Must be obtained from every
responsive, competent adult before
giving care
10. TO OBTAIN EXPRESSED CONSENT
1. Identify yourself to patient
2. State your level of training
3. Explain what you think may be
wrong
4. Describe care you will give and its
benefits
5. Explain any risks related to care
12. REFUSAL OF CONSENT
Competent adult victims have right to refuse medical care
You must honor their wishes
May be verbal or indicated by shaking head or pulling away
Person should fully understand all risks and consequences of refusing care
After treatment begins, patient still has right to withdraw
13. WHEN A VICTIM REFUSES CONSENT
When in doubt, err in favor of providing care
Do not argue with victim or question victim’s personal beliefs
Allow responding EMS units to evaluate situation
Have victim sign refusal form or have witness hear victim’s refusal
14. WHILE AWAITING ADDITIONAL
EMS RESOURCES
Try again to persuade victim to accept care
Determine whether victim is competent
Inform victim again why care is needed
and what may happen if care is refused
Consult medical oversight as directed by
local protocol
Consider calling for assistance from law
enforcement
Report assessment findings and
emergency medical care you have
provided
15. ASSAULT AND BATTERY
Assault = crime of verbally or physically
threatening to touch another person
without consent
Battery = crime of touching another person
without consent
Caring for a competent victim who refuses
care may make you guilty of assault or
battery
Victim may file lawsuit against you
16. ADVANCE DIRECTIVES
Legal document
Signed while the person is competent
Durable power of attorney for healthcare
Do Not Resuscitate (DNR) order
Generally must be signed and witnessed, and may require a physician’s signature
17. IF YOU ENCOUNTER AN
ADVANCE DIRECTIVE
Follow local protocol
DNR refers only to resuscitative care for victim whose heart has
stopped—not other treatment
If any doubt, or if written directive is not present, give care as usual
Other adults/family members cannot refuse care for victim without
formal advance directive
If family members ask you to provide care, even when DNR order is
present, give care until responding EMS professionals arrive
18. ABANDONMENT
Once you have begun emergency care, you have legal obligation to
continue
Obligation to render care ends when EMTs take over
Failing to continue care before EMTs take over makes you guilty of
abandonment, a form of negligence
Assessing also is considered care:
If you assess and release patient and patient later
dies or suffers, you are guilty of abandonment
Leaving a victim who refuses care, without waiting
for EMTs to arrive and assess victim, may also be
abandonment
19. ABANDONMENT: FAILURE TO
ATTEMPT RESUSCITATION
If you believe person is dead and do not
attempt resuscitation, you may be guilty
of abandonment
Conditions in which death can be assumed
include decapitation, rigor mortis, tissue
decomposition
If unsure what to do in any situation, call
medical control for advice
20. NEGLIGENCE
Failing to give care following the accepted
standard of care
Includes not giving care and giving
improper or poor-quality care
If the patient suffers further injury or
disability, you may be sued for
negligence
21. NEGLIGENCE CONTINUED
May be negligent if:
You have a duty to act
You breach that duty
Your actions (or inactions) cause injury or
damage
22. GOOD SAMARITAN LAWS
Protect you:
When acting in an emergency,
voluntarily and without
compensation
When acting as a reasonable, prudent
person with the same training
would act
When performing emergency care as
trained
23. CONFIDENTIALITY
When gathering patient’s history, you may
learn private information
Assessment findings and emergency care
provided are confidential
You have ethical responsibility to respect
patient’s right to privacy
Never share patient information with
others, including family members and
coworkers
24. HEALTH INSURANCE
PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)Confidentiality of all patient information legally protected
You must not disclose any patient information except to others providing
treatment, law enforcement personnel, or when subpoenaed by a court
Violations may lead to civil or criminal penalties
Follow the policies of your EMS system
When in doubt, consider everything you know about a patient to be
confidential
A written release form signed by patient is required to share information
26. MEDICAL IDENTIFICATION INSIGNIA
Include necklaces, bracelets, cards worn or carried
Used by patients with certain medical conditions such as allergies, diabetes,
epilepsy, and heart conditions
Not looking for such insignia during patient assessment may be negligence
27. CRIME SCENES
At potential crime scene, take precautions
to preserve evidence
Make sure scene is safe before entering
Ensure that law enforcement personnel are
responding
Do not disturb any item at scene unless
emergency care requires it
28. CRIME SCENES CONTINUED
Emergency care is top priority
Observe and document anything unusual
at scene
When removing clothing to expose injury,
do not cut through holes from gunshot
or stabbing wounds
Follow directions of law enforcement
personnel, and explain what is
necessary to provide essential patient
care
29. REPORTABLE EVENTS
First Responders are obligated to report:
Child, elder, and spouse abuse or domestic
violence
Crimes, such as gunshot and knife wounds,
suspicious burns, rape and sexual assault
Vehicle crashes
Certain infectious diseases
Exposure to a patient’s body fluids
30. DOCUMENTATION
Documenting patient assessment and care is very important
Helps other EMS professionals assess and treat patient.
Because patient’s condition often changes, report of early assessments provides
key information
Your record is a legal document that helps support what you saw, heard, and did at
scene
Complete the record as soon as possible after the emergency
State and local EMS requirements for documentation vary
Many EMS systems have printed forms used by First Responders
