emr ch2
TRANSCRIPT
Legal and Ethical Principles of Emergency Care
2
LEGAL DUTIES
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
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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
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)
ETHICS
Legal Duties
• Ethics Study of principles that define behavior
as right, good, and proper EMS values• Integrity• Compassion• Accountability• Respect• Empathy
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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.
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CONSENT
Consent
• Competence Being adequately or well qualified to
make decisions both physically and intellectually
Consent
• Patient may not be competent to make medical decisions. Being a minor Intoxication Drug ingestion Serious injury Mental illness
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
Figure 2.2a Once the scene is safe, you must obtain consent to care for the patient.
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Figure 2.2b Always show respect when obtaining consent.
Figure 2.3 Implied consent is used when the patient is a minor.
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
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.
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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.
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.
ADVANCE DIRECTIVES
Advance Directives
• Designation of agent to make decisions on your behalf
• Do Not Resuscitate (DNR) order• Living Will
Figure 2.4 A DNR order is one example of an advance directive. Other examples include POLSTs and living wills.
NEGLIGENCE
Negligence
• Failure to provide expected standard of care
• Four elements to determine negligence Duty to act Breach of duty Damages Causation
ABANDONMENT
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
CONFIDENTIALITY
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.
REPORTABLE EVENTS
Reportable Events
• May include: Crimes resulting in knife or gunshot
wounds Child and elder abuse Domestic violence Rape
SPECIAL SITUATIONS