This document discusses medical/legal and ethical issues that EMTs may encounter, including scope of practice, advance directives like DNR orders, patient consent and refusal, and assessment and care at crime scenes. It defines an EMT's scope of practice and responsibilities. It explains that advance directives require written physician orders and that patients have the right to refuse resuscitation efforts or treatment, which EMTs must document thoroughly. It also notes that crime scenes require protecting evidence while providing medical care and being observant without interfering.
TEMS - Tactical Emergency Medical ServicesscanFOAM
A talk by Peter Anthony Berlac at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
TEMS - Tactical Emergency Medical ServicesscanFOAM
A talk by Peter Anthony Berlac at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
In this presentation it has been tried to give a glimpse of different type of consent, how it should be taken, how the patient to be explained, when consent is must and conditions where consent is not required, so as to guide you in your every day practice.
Chapter 11: Risk Management in
Selected High-Risk Hospital Depts
High Risk Depts. in Hospitals
All clinical depts. in hospitals have potential for risk, but some are greater than others:
Emergency Room
Obstetrics and Neonatology
Surgery and Anesthesia
Diagnostic Imaging
Treat highly vulnerable patients in often chaotic settings where the results of errors can be catastrophic and costly
Emergency Medicine
Which Definition?
AMA – any condition clinically determined to require immediate medical care
Federal Legislation – condition manifested by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to an individual’s health, serious impairment to bodily functions or serious dysfunction of any body organ or part
Clinicians –view emergencies as life-threatening situations
The mere existence of an ER implies a duty to treat any patient who arrives
Emergency Medicine Issues
Emergency Medical Treatment and Active Labor Act (EMTALA)
Pre-hospital services
Dept Capabilities and Staffing
Triage Process
Emergency Medicine Issues
Medical Records Documentation and Consent
Support Services
Departures, Discharges and Transfers
Risk Management
Obstetrics and Neonatology
Lawsuits in this category are usually the most expensive
Advanced technology has improved survival rates for infants but led to increased risks for facilities
Ethical Dilemmas
Standards and Guidelines
Levels of Care
Level 1 – least intensive and designed to treat low-risk mothers and babies
Level 2 – must be able to manage high-risk mothers, high-risk fetuses and small, sick neonates
Level 3 – must be able to monitor and maintain critical functions of mothers and neonates the nurse to patient ratio is more intensive as well
Obstetrics and Neonatology
Obstetrics and Neonatology
Prenatal and Perinatal Care
Intrapartum Period
Delivery
Neonatal Resuscitation and Management
Maternal Exam Post Delivery
Family Attendance Issues
Obstetrics and Neonatology
Medical Record Documentation
Neonatal Services
Infant Transport
Infant Abduction
Surgery and Anesthesia
Surgery and Anesthesia claims are usually co-dependent
Increased number of surgeries performed in outpatient or ambulatory settings with decrease in number of claims
Paid malpractice claims are higher in the outpatient setting
Handout Case Study
10
Surgery and Anesthesia
Negligence and Malpractice
Surgical Services Staff
Preoperative Assessment and Treatment
Intraoperative Risks
Postoperative Recovery
Documentation
Handout Case Study
11
Surgery and Anesthesia
Intraoperative Risks
Sedation and Anesthesia
Wrong Site, Wrong Procedure, Wrong Person
Implants
Retained Foreign Bodies
Patient Burns and Pressure Injuries
Surgical Fires
Handout Case Study
12
Diagnostic Imaging
Creating images of the human body utilizing various methods:
X-rays
Computed tomography (CT)
Interventional radiography
Ultrasound
Magnetic resonance imagine (MR ...
Chapter 18
Legal Reporting Requirements
Learning Objectives
Describe various forms of child abuse, how to recognize it, and reporting requirements.
Describe various forms of elder abuse, how to recognize it, and reporting requirements.
Explain why it is important to report communicable diseases, adverse drug reactions, & infectious diseases.
Learning Objectives (cont’d)
Discuss the importance of reporting births and deaths.
Explain how & why physician incompetency is reported.
Understand the importance of incident reporting, sentinel events, & the purpose of root cause analyses.
Abuse
Abuse in the healthcare setting often occurs to those who are most vulnerable and dependent on others for care.
Abuse can take many forms, such as physical, psychological, medical, and financial.
Abuse is not always easy to identify because injuries can often be attributed to other causes.
Child Abuse
Intentional serious mental, emotional, sexual, &/or physical injury inflicted by family or other person responsible for care.
Child Abuse Prevention & Treatment Act (CAPTA)
Minimum standards states must incorporate in their statutory definitions of child abuse and neglect.
Child Abuse
Who Should Report
Healthcare setting
Administrators, physicians, interns, registered nurses, chiropractors, social service workers, psychologists, dentists, osteopaths, optometrists, podiatrists, mental health professionals, & volunteers in residential facilities
Penalties for failure to report
States vary on penalties
Child Abuse
How to Detect
Indicators of abuse and maltreatment that appear to be part of a pattern
Physical indicators
Bruises
Sprains
Fractures
Cigarette burns
Child Abuse
How to Detect (cont’d)
Behavioral indicators
Diminished psychological or intellectual functioning
Failure to thrive
No control of aggression
Self-destructive impulses
Decreased ability to think and reason
Acting out and misbehavior, or habitual truancy
Child Abuse (cont’d)
Good faith reporting
Psychologist Immune to Liability
Failure to report child abuse
Psychologist’s Failure to Report Abuse
Nurse’s Failure to Document and Report
Physician Entitled to Immunity
Child Abuse Can Be Elusive
Senior Abuse
Mistreatment: Results in Harm or Loss
It can involve
Physical & Sexual Abuse
Domestic & Psychological Abuse
Financial abuse
Neglect
Failure to provide needed care
Senate Select Committee on Aging
Less Likely to be Reported than Child Abuse
Most Instances of Senior Abuse
Repeated Events
Not One-Time Occurrences
Senate Select Committee on Aging (cont’d)
Victims are often 75 years of age or older, & women more likely to be abused than men.
Seniors often ashamed to admit their loved ones abuse them.
may fear reprisals if they complain.
Family members are resentful of a frail & dependent senior parent.
Majority of abusers are relatives.
Signs of Senior Abuse
Unexplained or Unexpected Death
Development of “Pressure S ...
The objective of this presentation is to make you aware of issues which are generally confronted during medical practice.
SOURCES OF LAWS:
PRIMARY SOURCES
Laws passed by the Parliament or the State Legislative
Ordinances passed by the President and the Governor
Subordinate legislation: Rules and regulations made by the executive through the power delegated to them by the Acts.
SECONDARY SOURCES:
Judgments of the Supreme Court, High Court and Tribunals (The ratio decedendi is a binding precedent)
Judicial legislation
Judgment of Foreign Courts
International Treaty
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
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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