Chapter 4: Ready for Review
• Paramedics operate in a community that exposes them to professional liability and that
requires them to have a solid understanding of law and ethics. Failing to perform their job
as expected within the medical community, the legal community, and the regulations of the
jurisdiction in which they function will expose them to civil and/or criminal liability.
• When personal ethics conflict with professional ethics, the paramedic usually will be bound
by professional ethics and must temporarily set aside personal ethics.
• Three primary ethical principles for paramedics are to do no harm, act in good faith, and act
in the patient’s best interest.
• EMS research, while important, presents unique ethical dilemmas regarding informed
patient consent. Staying aware of the issues and the latest research is the best way to
promote the development of evidence-based practice for paramedics.
• The foundation of the legal system in the United States is the federal government. There are
three branches of government: executive, judicial, and legislative.
• There are two types of law: civil and criminal.
– Civil cases result in monetary damages.
– Criminal cases result in incarceration of a person.
• Paramedics are particularly susceptible to charges of assault and battery. Assault is when
you instill the fear of bodily harm in a person. Battery is when you (as a paramedic)
unlawfully touch another person without his or her consent.
• False imprisonment can occur when a paramedic restrains a patient against his or her will.
Protection against this charge can exist only if appropriate documentation and policy exist
regarding the specific call.
• Defamation, slander, and libel present risks to paramedics when they make statements,
either verbal or written, that injure a person’s good name.
• Lawsuits follow a general process that starts with a complaint or notice of complaint, a
response or answer by the defendant, discovery, settlement discussions, and trial process.
• Paramedics are subject to multiple legal jurisdictions, including state law, state regulations,
local medical protocol, and departmental policy.
• Medical directors have a supervisory relationship over paramedics, but each paramedic is
held personally responsible for his or her own actions.
• Your activities function as an extension of a series of medical directions from the medical
director that are either online or off-line. These directives are binding on paramedics unless
they believe that they will cause harm to the patient.
• State legislation enables paramedics to practice in every state. It is the responsibility of
paramedics to understand the statutes of the state in which they practice.
• State jurisdictions issue paramedics either licenses or certificates. Paramedics must
understand that the licensure or certification is a privilege extended by the governing
authority that allows paramedics to practice within the enacting legislation.
• Paramedics have a right to due process, a fair procedure that includes appropriate legal
notice of the action to be taken, and the opportunity to be heard before the
licensing/certifying agency.
• State laws define scope of practice for the paramedic, which specifies the limits of practice
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allowed under the Medical Practice Act.
HIPAA was enacted to protect patient information from unlawful and unnecessary
dissemination.
EMTALA is another federal law designed to prevent hospital emergency departments from
turning patients away for any reason, including the ability to pay for care.
Emergency vehicle operations must be performed in a manner that protects the public from
further injury. No call can justify driving in a manner that endangers the public.
Transportation to a certain medical facility should be determined by taking into account the
patient’s preference and the medical needs of the patient.
Crime scenes present the intersection between EMS and law enforcement. Paramedics have
an obligation to assist the law enforcement community in preservation of evidence and
documentation of scenes or actions that may later be introduced on behalf of a criminal
prosecution.
Paramedics can be held legally responsible when they fail to report cases such as suspected
abuse, domestic violence, gunshot/stab wounds, childbirth outside a medical facility, rape,
infectious diseases, or animal bites.
Suspected homicides, suicides, prison inmate deaths, and other violent or unexpected deaths
should immediately be reported to local law enforcement personnel in order to allow a
coroner or medical examiner to examine the body.
All patients of sound mind have the legal right under the US Constitution to privacy,
consent, and refusal. Paramedics cannot infringe on these inalienable rights unless they
believe that patients are not of sound mind and pose a detriment to themselves or others.
Patient refusals pose a large potential legal liability to paramedics. The only protection
against a civil suit over a refusal will be the documentation at the time of the incident.
– A refusal signature without narrative and evidence of a physical assessment is worthless.
You must obtain informed consent from patients prior to any medical process, including
examination.
You must get expressed consent—action demonstrating permission to provide care—from
patients before initiating treatment.
Implied consent is said to exist when patients are unable to answer for themselves and
paramedics deem that treatment is required.
Determining the decision-making capacity of a patient can be tricky, but tools such as pulse
oximetry and blood glucose measurements can provide factual documentation of patient
awareness and ability to make clear decisions regarding his or her medical care. In any
questionable circumstance, thorough documentation and consultation with medical control
will provide the best protection against lawsuits.
Minors pose challenges that local jurisdictions must address before a call occurs. In general,
if the patient is a minor, the minor has neither the right to consent to care nor the right to
refuse it, although exceptions for emancipated minors exist.
Violent patients may be restrained using physical or chemical means if they are a danger to
themselves or others. Always follow local medical and law enforcement protocols when
addressing the needs of violent or potentially violent patients.
Allocation of resources and triage challenges can present serious ethical dilemmas to
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paramedics. In such circumstances, well-established protocols and professional ethics
should take precedence over any personal feelings or ethics of the paramedic.
Negligence occurs only when the following four processes have occurred:
– Duty to act. The paramedic must have had a duty to act.
– Breach of duty. The paramedic did not fulfill that duty.
– Proximate cause. The paramedic’s breach of duty caused the plaintiff’s injury.
– Injury resulted. An injury occurred as a result of the above.
Negligence can be categorized as acts of commission (malfeasance and misfeasance) or acts
of omission (nonfeasance).
As the highest level of prehospital care providers, paramedics must ensure that they do not
abandon their patients. Abandonment can occur anytime paramedics turn over their patients
inappropriately or to a level of care lesser than themselves.
Documentation is the only methodology to prevent the appearance of abandonment.
Patients have the right to determine their own care. Paramedics must understand their legal
limitations based on any advance directives issued by the patient.
Do not resuscitate (DNR) orders are a specific form of advance directive that generally
define the care a patient wants when lifesaving procedures are required. A DNR order is not
a “do-not-care-for-the-patient” order.
Patients often decide on medical care and treatment issues prior to an emergency.
Paramedics need to be familiar with DNR orders, living wills, health care powers of
attorney, surrogate decisions, and organ donations.
Futile resuscitation efforts, which you may encounter, need to be addressed and considered
prior to an emergency event. Weighing various ethical issues prior to their occurrence
can help prevent and reduce suffering in your patient population.
You may provide care when off duty and in most jurisdictions be protected under the Good
Samaritan laws. Paramedics must remember that they are only protected if they perform
within their training and education and if they do not receive any compensation.
You can be protected under certain governmental immunity clauses. These protections may
not be valid if the paramedics have committed negligence or if the paramedics are deemed
to be personally liable.
Two common legal defenses are the statute of limitations (time in which to file a lawsuit)
and contributory negligence, when a plaintiff has contributed to the negative outcome by
committing an act or failing to disclose relevant information to medical practitioners.
Several federal and state laws affect the relationship between the paramedic and his or her
employer. These laws promote a healthier, safer workplace by addressing topics such as
discrimination, sexual harassment, family leave, and occupational safety regulations.