This document discusses several legal and ethical principles of emergency care, including: 1) Legal duties like scope of practice, standard of care, and ethics which value integrity, compassion, accountability, and respect. Emergency responders must provide appropriate medical care within their scope of practice and training. 2) The importance of obtaining consent from patients or their legal guardians before providing care, with exceptions for implied consent in emergencies or of minors. Patients have a right to refuse care if competent. 3) Other important topics like advance directives, negligence, abandonment, confidentiality, and mandatory reporting of certain events like abuse or violence. Emergency responders must balance legal, ethical, and patient care duties.

1. Legal and Ethical
Principles of Emergency
Care
2

2. LEGAL DUTIES

4. Legal Duties
• Scope of Practice
 What is legally permitted to be done by
individuals trained or licensed at a
particular level
 Does not define what must be done for
patient or in a particular situation
 Based on EMS education standards
continued on next slide

5. Legal Duties
• Standard of Care
 Varies from county to county, state to
state, region to region
 Based on level of training and
experience working under similar
conditions
 Expected to follow approved standing
orders/protocols for your EMS system

6. Figure 2.1 Different emergency personnel may be assisting during an emergency, including police, firefighters,
and EMTs. Each must practice the standard of care expected of his own level of training.
(Mark C. Ide/CMSP)

7. ETHICS

8. Legal Duties
• Ethics
 Study of principles that define behavior
as right, good, and proper
 EMS values
• Integrity
• Compassion
• Accountability
• Respect
• Empathy
continued on next slide

9. Legal Duties
• Ethical Responsibilities
 Patient's needs before responder's own,
so long as safe to do so
 Patient receives appropriate medical
care.
 Maintain an open mind.
continued on next slide

10. CONSENT

11. Consent
• Competence
 Being adequately or well qualified to
make decisions both physically and
intellectually

12. Consent
• Patient may not be competent to make
medical decisions.
 Being a minor
 Intoxication
 Drug ingestion
 Serious injury
 Mental illness

13. Consent
• Expressed Consent
 Advise patient of:
• Your level of training
• Why you think care may be necessary
• What care you plan to provide
• Any consequences related to refusing
care

14. Figure 2.2a Once the scene is safe, you must obtain consent to care for the patient.
continued on next slide

15. Figure 2.2b Always show respect when obtaining consent.

16. Figure 2.3 Implied consent is used when the patient is a minor.

18. Consent
• Emancipated Minor
 Legally allowed to make their own
decisions regarding medical care
• Married
• Pregnant
• Parent
• Member of armed forces
• Financially independent
• Living away from home

19. Consent
• Refusal of Care
 Alert and competent adults have the
right to refuse care.
 Restraining or threatening to restrain
patient against his/her wishes could
result in violation of criminal law.
 Parent/legal guardian can refuse to let
you care for a child.
continued on next slide

20. Consent
• Refusal of Care
 When care is refused
• Stay calm and professional.
• Inform patient of potential dangers of
refusal.
• Use aid of someone the patient trusts.
• Carefully document refusal of care.

21. Think About It
• What must the EMR receive from a
patient in order to provide care?
• How can the EMR determine
competence of a patient to refuse care?
• EMRs must not leave a patient refusing
care until someone with higher training
assumes care.

22. ADVANCE DIRECTIVES

23. Advance Directives
• Designation of agent to make decisions
on your behalf
• Do Not Resuscitate (DNR) order
• Living Will

24. Figure 2.4 A DNR order is one example of an advance directive. Other examples include POLSTs and living wills.

25. NEGLIGENCE

26. Negligence
• Failure to provide expected standard of
care
• Four elements to determine negligence
 Duty to act
 Breach of duty
 Damages
 Causation

27. ABANDONMENT

28. Abandonment
• To leave sick or injured patient before
equal or more highly trained personnel
can assume responsibility for care
• Could include failure to provide patient
information during transfer to more
highly trained personnel
 Facts gathered
 Assessment findings
 Care rendered

29. CONFIDENTIALITY

31. Confidentiality
• Authorization not required for you to
pass on patient information to other
health care providers
• Health Insurance Portability and
Accountability Act (HIPAA) gives
patients more control over their health
care information and limits ways that
information is stored and shared.

32. REPORTABLE EVENTS

33. Reportable Events
• May include:
 Crimes resulting in knife or gunshot
wounds
 Child and elder abuse
 Domestic violence
 Rape

34. SPECIAL SITUATIONS