The document discusses essential aspects of EMT-patient relationships, focusing on confidentiality, consent, and legal implications. It outlines the importance of protecting patient information under HIPAA, the various types of consent required for treatment, and the legal ramifications of refusing service or improperly handling a patient's information. Additionally, it addresses scenarios EMTs may encounter regarding consent and decision-making for patients in various states of competency.

1. EMT – Patient Relationships Confidentiality HIPAA Defamation Consent Refusal of Service

2. Confidentiality Confidentiality means that any medical or personal information about a patient – including medical history, assessment findings, and treatment – will not be released to a third party without the express permission of the patient or legal guardian. However, there are specific circumstances under which a patient’s confidential information may be released:

3. Confidentiality Patient consents to the release of his records. A Pt may request a copy of his medical records for any reason. If the Pt is a child, consent for release of medical records must be obtained from the child’s parent or other legal guardian. Request should be in writing May be released to physician, insurance company, attorney or other party if specified

4. Confidentiality Other medical care providers have a need to know. On-line medical direction ER nurse/doctor Permitted because it allows medical care appropriate for Pt to be continued NOT acceptable to discuss confidential Pt info with medical providers who have no responsibility for the Pt’s care.

5. Confidentiality EMS is required by law to release a patient’s medical records. Court Order Subpoena (a command to appear at a certain time and place to give testimony) Consult with counsel

6. Confidentiality There are third-party billing requirements

7. Confidentiality Penalties for violation of Pt Confidentiality The law provides penalties for the breach of confidentiality. The improper release of information may result in a lawsuit against the EMT for defamation (libel or slander), breach of confidentiality, or invasion of privacy. If found guilty, the paramedic may be responsible for paying money damages to the patient.

8. Confidentiality Libel Is the act of injuring a person’s character, name, or reputation by false statements made in writing or through the mass media with malicious intent or reckless disregard for the falsity of those statements. Slander Is the act of injuring a person’s character, name, or reputation by false or malicious statements spoken with malicious intent or reckless disregard for the falsity of those statements.

9. HIPAA Health Insurance Portability and Accountability Act It adds important new layers of privacy protection for EMS patients. EMS providers must develop administrative, electronic, and physical barriers to unauthorized disclosure of Pt’s protected health information.

10. HIPAA Disclosure of information – except for purposes of treatment, obtaining payment for services, health care operations, and disclosures mandated or permitted by law – must be in preauthorized in writing. HIPAA provides both civil and serious criminal penalties for violations of privacy.

11. HIPAA Patients are given the right to inspect and copy their health records, restrict use and disclosure of their individually identifiable health information, amend their health records, require a provider to communicate with them confidentially, and account for disclosures of their protected health information except for treatment, payment, health care operations, and legally required reporting purposes.

12. HIPAA Invasion of privacy An EMT may be accused of invasion of privacy for the release of confidential information, without legal justification, regarding a Pt’s private life, which might reasonably expose the Pt to ridicule, notoriety, or embarrassment. That includes, for example, the release of information regarding HIV status or other sensitive medical information. The fact that released information is true is not a defense to an action for invasion of privacy!

13. Consent Consent The granting of permission to treat. More accurately, it is the granting of permission to touch. It is based on the concept that every adult human being of sound mind has the right to determine what should be done with his own body. Touching a Pt without appropriate consent may subject you to charges of assault and battery.

14. Consent Competent A Pt must be competent in order to give or withhold consent. Lucid Understands your questions and recommendations Understands implications of his decisions Although there is no absolute test for determining competency, keep the following factors in mind when making a determination: the Pt’s mental status, the Pt’s ability to respond to questions, statements regarding the Pt’s competency from family or friends, evidence of impairment from drugs or alcohol, or indications of shock.

15. Consent Informed Consent Conscious, competent Pt’s have the right to decide what medical care to accept. However, for consent to be legally valid, it must be informed consent. That is, a Pt must understand the nature, risks, and benefits of any procedures to be performed. Therefore, before providing medical care, you must explain the following to the Pt in a manner he can understand.

16. Consent Nature of the illness or injury Nature of the recommended treatments Risks, dangers, and benefits of those treatments Alternative treatment possibilities, if any, and the related risks, dangers, and benefits of accepting each one Dangers of refusing treatment and/or transport

17. Consent Informed consent must be obtained from every competent adult before treatment may be initiated. Conscious, competent Pt’s may revoke consent at any time during care and transport. Generally, a child’s parent or legal guardian must give informed consent before treatment of the child can begin.

18. Consent Express consent Verbal, nonverbal, or written communication by a Pt that he wishes to receive medical care. Implied consent Consent for treatment that is presumed for a patient who is mentally, physically, or emotionally unable to grant consent. Involuntary consent Consent to treatment granted by the authority of a court order.

19. Consent A competent adult in police custody does not necessarily lose the right to make medical decisions for himself . In fact, many prisoners have successfully sued health care providers for rendering treatment without consent. Generally, forced treatment is limited to emergency treatment necessary to save life or limb or treatment ordered by the court.

20. Consent Minor Under 18 Consent should be obtained from a parent or, legal guardian, or court-appointed custodian. The same is true for a mentally incompetent adult If a responsible person can not be located, and if the child or mentally incompetent adult is suffering from a apparent life-threatening injury or illness, treatment may be rendered – implied consent

21. Consent Emancipated Minor An emancipated minor is considered an adult. This is a person under 18 who is married, pregnant, a member of the armed forces, or financially independent and living away from home. As an adult, an emancipated minor may legally give informed consent. Anyone else under the age of 18 may not grant informed consent.

22. Consent Withdrawal of consent A competent adult may withdraw consent for any treatment at any time. However, refusal must be informed. A common example of a Pt withdrawing consent occurs after a hypoglycemic Pt regains full consciousness with the administration of dextrose. The Pt should be encourage - but may not be forced - to go to the ER

23. Consent Withdrawal of consent Sometimes Pt’s choose to accept one recommended treatment but refuse others. For example, a Pt involved in an MVA may refuse to be fully immobilized but ask to be transported to the hospital. Explain importance of treatments and possible repercussions. Fully document circumstances of refusal Get signature on AMA form

24. Refusal of Service Not every EMS run results in the transportation of a Pt to a hospital. Emergency care should always be offered to a Pt, no matter how minor the injury or illness may be. However, often, the Pt will refuse. If this occurs, you must:

25. Refusal of Service Be sure the Pt is legally permitted to refuse care; that is, the Pt must be a competent adult. Make multiple and sincere attempts to convince the Pt to accept care. Enlist the help of others, such as the Pt’s family or friends, to convince the Pt to accept care.

26. Refusal of Service Make certain that the Pt is fully informed about the implications of his decision and the potential risks of refusing care. Consult with on-line medical direction Have the Pt and a disinterested witness, such as a police officer, sign a release-from-liability form (AMA). Advise the Pt that he may call you again for help if necessary.

27. Refusal of Service Attempt to get the Pt’s family or friends to stay with the Pt. Document the entire situation thoroughly and accurately on your PCR.

28. Legal Complications Abandonment Abandonment is the termination of the EMT – Pt relationship without providing for the appropriate continuation of care while it is still needed and desired by the Pt. You can not initiate Pt care and then discontinue it without sufficient reason. You can not turn the care over of a Pt over to personnel who have less training than you without creating potential liability for an abandonment action.

29. Legal Complications Assault Assault is defined as unlawfully placing a person in apprehension of immediate bodily harm without his consent. For example, your Pt states that he is scared of oxygen masks and refuses to allow you to place a mask on his face. If you hook up a mask and bring it to his face, you may be liable for assault.

30. Legal Complications Battery Battery is the unlawful touching of another individual without his consent. It would be battery to place the oxygen mask on your Pt or otherwise touch your Pt without consent. An EMT can be sued for assault and battery in both criminal and civil contexts.

31. Legal Complications False Imprisonment False Imprisonment may be charged by a patient who is transported without consent or who is restrained without proper justification or authority. It is defined as intentional and unjustifiable detention of a person without his consent or other legal authority, and may result in civil or criminal liability.

32. Legal Complications False Imprisonment This is a particular problem with psychiatric Pt’s. In most cases, you can avoid allegations of false imprisonment by having a law enforcement officer apprehend the Pt and accompany you to the hospital. If no officer is available (DUH) you should attempt to consult with medical direction and carefully judge the risks of false imprisonment against the benefits of detaining and treating the Pt.

33. Legal Complications False Imprisonment You should determine whether medical treatment is immediately necessary and whether the Pt poses a threat to himself or to the public when you are making your decision to treat or transport.

34. Legal Complications Reasonable force If it is safe to do so, you may use a reasonable amount of force to control an unruly or violent Pt. The definition of reasonable force depends on the amount of force necessary to ensure that the Pt does not cause injury to himself, you, or others. Excessive force can result in liability for the EMT. The use of restraints may be indicated for a combative Pt. Restraints must conform to your local protocols.

35. EMT – Patient Relationships 1. The termination of the EMT – Pt relationship by the EMT without assurance that an equal or greater level of care will continue is known as: a) assault b) abandonment c) misfeasance d) battery

36. EMT – Patient Relationships 2. The principal of law that prohibits the release of medical or other personal information about a patient without the patient’s permission is known as: a) privacy b) privilege c) primum non nocere d) confidentiality

37. EMT – Patient Relationships 3. Pt is a 16 y/o male reported to have ingested 8-10 beers over 2 hours. He fell while jumping on a trampoline, striking his head on the paved driveway. No LOC but Pt has a laceration to the occipital area of the head. Pt is CA&Ox4 but shows not concern for seriousness of his injury and has slurred speech. The parents are not available. Which is the best course of action?

38. EMT – Patient Relationships a) Treat the Pt under the doctrine of implied consent of the parents b) Have the Pt arrested for underage drinking and obtain the consent of law enforcement to treat the Pt c) Treat the Pt as an emancipated minor and allow him to decide whether he wants treatment and transport d) Use the doctrine of res ipsa loquitur to support your decision to either treat and release or treat and transport

39. EMT – Patient Relationships 4. The type of consent that must be obtained from a conscious, competent, adult Pt before an EMT can begin treatment is called __________ consent. a) informed b) implied c) ex officio d) voluntary

40. EMT – Patient Relationships 5. Your Pt is a 45 year old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The Pt’s wife called EMS because he has refused to take his lithium and is “driving her crazy with his hyperactive attitude.” She insists that you transport him to the hospital. The Pt admits to voluntary noncompliance with his lithium, stating he has not felt “this good for a long time.”

41. EMT – Patient Relationships He is curious about your job and wants to know how he could get into an EMT class. He states that he’s also thinking about going to law school but wants to finish his PhD first. The physical examination is unremarkable, and HR=82, BP=122/80, RR=10, SaO2=99%. He says, “See, I told you I’m fine. I don’t need to go to the hospital.” Which one of the following is the best course of action?

42. EMT – Patient Relationships Restrain the Pt if necessary and transport. Request police backup, restrain the Pt, and transport to the ER for evaluation. Explain to the wife that you cannot force the Pt to go to the hospital and that if he refuses you must have him sign an AMA form and leave. Explain to the Pt that he has no choice. If he is unwilling to take his medication, you must take him to the hospital for evaluation.

43. EMT – Patient Relationships 6. Under the confidentiality doctrine, as an EMT, you may release otherwise confidential Pt information, without consent, to: a) the Pt’s employer if Pt has a transmittable disease. b) other medical care providers who have a need to know. c) the Pt’s school if Pt has a transmittable disease. d) All of the above.

44. EMT – Patient Relationships 7. Your Pt is a 59 y/o female, who has consumed an unknown amount of alcohol, is found inside her crashed car. There are no other passengers and bystanders do not know her. She is conscious and able to give you her name. However, she does not know where she is, how she got here or what year it is. She complains of abdominal pain. Vitals show HR=120, RR=35, BP=80/45, SaO2=85%. Pt states she is fine and does not wish to be treated or transported. You should:

45. EMT – Patient Relationships a) Attempt to have Pt sign an AMA and call a tow truck for her car. b) Go through Pt’s purse and cell phone and attempt to contact family. c) Treat and transport under implied consent doctrine. d) Call Law Enforcement for at 51-50 hold and orders to treat and transport.

46. EMT – Patient Relationships 8. Pt is a 20 y/o male who is severely injured and has facial injuries. This vitals are WNL and ABCs are good. You attempt to communicate with the Pt to obtain consent but Pt is unable to speak. When you ask Pt if you can help he is only able to nod his head. You should:

47. EMT – Patient Relationships Begin treatment immediately Not treat the Pt because he is unable to give you verbal consent. Find a pen and paper to obtain written consent before treatment. Withhold treatment until Pt is able to consent or loses consciousness and rely on implied consent.

48. EMT – Patient Relationships 9. An emancipated minor is a minor who is all but which of the following: a) pregnant b) a runaway c) married d) a member of the armed forces e) financially independent

49. EMT – Patient Relationships 10. Battery is? a) the same as assault. b) always permissible if the Pt needs treatment. c) unlawful touching of another individual. d) 12 volt in most vehicles.

50. EMT – Patient Relationships Scenario You are dispatched to a single vehicle MVA, vehicle into a tree. Unknown number of Pts and Unknown injuries. Location is at the rear of CCVFD There is no report of fire or entrapment. Unit 306 and 309 are dispatched.