Ch03 eec3

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Ch03 eec3

  1. 1. Medical/Legal and Ethical Issues Three Chapter
  2. 2. <ul><li>Scope of practice </li></ul><ul><li>Advanced directives </li></ul><ul><li>Patient consent and refusal </li></ul><ul><li>issues </li></ul><ul><li>Assessment and </li></ul><ul><li>care at crime scenes </li></ul>Three Chapter CORE CONCEPTS
  3. 3. A set of rules and duties that define your role as an EMT-Basic S COPE OF PRACTICE
  4. 4. <ul><li>Patient </li></ul><ul><li>Medical direction </li></ul><ul><li>State legislation </li></ul>EMT-B Is Responsible To:
  5. 5. <ul><li>Make patient’s needs a priority. </li></ul><ul><li>Maintain skills, knowledge. </li></ul><ul><li>Critically review performance </li></ul><ul><li>Prepare honest reports. </li></ul><ul><ul><ul><li>(seek ways to improve) . </li></ul></ul></ul>Ethical Responsibilities
  6. 6. A DVANCE DIRECTIVES
  7. 7. Advance Directives: Do-Not-Resuscitate Orders <ul><li>Patient has the right to </li></ul><ul><li>Usually requires written </li></ul>(Continued) refuse resuscitative efforts. physician order.
  8. 8. <ul><li>Become familiar with </li></ul><ul><li>When in doubt, resuscitate. </li></ul>protocols prior to need. Advance Directives: DNR Orders
  9. 9. DNR Order
  10. 10. P ATIENT CONSENT AND REFUSAL
  11. 11. <ul><li>Patient is of legal age and rational. </li></ul><ul><li>Patient must be informed. </li></ul><ul><li>Expressed consent must be obtained from conscious, competent adults </li></ul><ul><li>before treatment. </li></ul>Consent: Expressed
  12. 12. <ul><li>Consent is implied for </li></ul><ul><ul><li>unconscious patient. </li></ul></ul><ul><li>It is based on the assumption </li></ul>the patient would consent if conscious. Consent: Implied
  13. 13. <ul><li>Consent is required from </li></ul>Consent: Children and Incompetent Adults (Continued) parent or guardian.
  14. 14. Consent: Children and Incompetent Adults <ul><li>Consent is implied in </li></ul><ul><li>life-threatening emergency </li></ul><ul><li>in absence of parent/guardian. </li></ul><ul><li>Follow state regulations for </li></ul>age and emancipation.
  15. 15. <ul><li>Patients have the right to </li></ul>Patient Refusal <ul><li>Patients may revoke </li></ul>(Continued) refuse treatment. consent at any time.
  16. 16. <ul><li>Refusals must be made by </li></ul><ul><li>Patient must be fully informed </li></ul><ul><li>of risks and consequences. </li></ul>(Continued) competent adults. Patient Refusal
  17. 17. <ul><li>Patient must sign a </li></ul><ul><li>When in doubt, err in favor </li></ul>“ release form.” of providing care. Patient Refusal
  18. 18. <ul><li>Documentation is key to </li></ul><ul><li>Thoroughly note all assessment </li></ul>Patient Refusal: Documentation findings. liability prevention. (Continued)
  19. 19. Patient Refusal: Documentation <ul><li>Document attempts to </li></ul><ul><li>Document risks and consequences </li></ul>you outlined for patient. persuade patient to accept care.
  20. 20. Patient Refusal Checklist
  21. 21. Abandonment K EY TERM Termination of care of a patient without ensuring continuation of care at the same or higher level
  22. 22. Negligence Deviation from accepted standard of care, resulting in injury to a patient K EY TERM
  23. 23. <ul><li>Duty to act </li></ul><ul><li>Breach of the duty </li></ul><ul><li>Injury or damages inflicted </li></ul><ul><li>(physical or psychological) </li></ul><ul><li>Damages caused by actions or omissions by EMT-B </li></ul>Negligence: Components
  24. 24. <ul><li>Unlawfully touching patient </li></ul><ul><li>without consent can be </li></ul><ul><li>Providing care without </li></ul>consent can also be battery. battery. Assault / Battery
  25. 25. <ul><li>Legal or contractual </li></ul><ul><li>requirement to provide care </li></ul><ul><li>Formal duty: </li></ul><ul><li>Implied duty: </li></ul><ul><li>Call to 911, beginning care for patient </li></ul><ul><li>Contractual obligation between agency </li></ul><ul><li>and municipality </li></ul>Duty to Act
  26. 26. <ul><li>Off duty </li></ul><ul><li>Out of your EMS system, but </li></ul><ul><li>in an ambulance </li></ul>Duty to Act: Ethical/Moral
  27. 27. <ul><li>Patient history </li></ul><ul><li>Assessment findings </li></ul><ul><li>Treatment rendered </li></ul><ul><li>Written release required to </li></ul><ul><li>release information </li></ul>Confidential Information (Continued)
  28. 28. <ul><li>Exceptions to written release: </li></ul><ul><ul><li>Subpoena </li></ul></ul><ul><ul><li>Other health care personnel </li></ul></ul><ul><ul><li>treating patient </li></ul></ul><ul><ul><li>Mandatory reporting (rape, abuse) </li></ul></ul><ul><ul><li>Insurance </li></ul></ul>Confidential Information
  29. 29. Ambulance collisions are a significant source of liability for EMTs. They also have potential to produce serious injury. The “rush” of driving an emergency vehicle for a new EMT can be overwhelming. Be sure to remind new drivers of the need for caution, the danger of high speeds, and the potential for liability. Don’t forget to be a good example when you drive! P RECEPTOR P EARL
  30. 30. <ul><li>Requires signed donor form. </li></ul><ul><li>Driver’s license shows </li></ul>Organ Donation intent.
  31. 31. EMT-B Role in Organ Donation <ul><li>Organ donor patients are treated </li></ul><ul><li>the same as other patients. </li></ul><ul><li>Identify potential donors. </li></ul><ul><li>Notify medical direction. </li></ul><ul><li>Provide care to maintain vital </li></ul><ul><li>organs. </li></ul>
  32. 32. Medical Identification Devices <ul><li>Heart </li></ul><ul><li>Diabetes </li></ul><ul><li>Allergies </li></ul><ul><li>Epilepsy </li></ul><ul><li>Others </li></ul>Alert EMT-B to medical conditions Conditions
  33. 33. E MS AT CRIME SCENES
  34. 34. <ul><li>Patient care is the priority. </li></ul><ul><li>Do not enter the crime scene </li></ul><ul><li>Remain alert for evidence and </li></ul>Crime Scenes (Continued) until it is safe. signs of repeated violence.
  35. 35. <ul><li>Be observant. </li></ul><ul><li>Minimize your impact </li></ul><ul><li>on the scene. </li></ul><ul><li>Remember what you touch. </li></ul><ul><li>Plan and communicate with </li></ul>the police. Crime Scenes
  36. 36. Crime Scenes: Documentation <ul><li>Avoid opinions. </li></ul><ul><li>Use objective statements. </li></ul><ul><li>Place words of others in </li></ul>quotes.
  37. 37. <ul><li>Abuse (child, spouse, elderly) </li></ul><ul><li>Sexual assault </li></ul><ul><li>Gunshot wound </li></ul><ul><li>Infectious disease </li></ul>(Continued) exposure Special Reporting Situations
  38. 38. <ul><li>Restraint </li></ul><ul><li>MCI </li></ul><ul><li>Other unusual situations </li></ul><ul><li>Mandatory reporting laws </li></ul>from state to state vary Special Reporting Situations
  39. 39. 1. Define scope of practice. 2. Explain the purpose of the DNR order. 3. Discuss forms of patient consent and when patients can refuse your care. 4. Explain how assessment and care may differ at a crime scene. R EVIEW QUESTIONS

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