LEGAL ASPECTS OF
PRE-HOSPITAL CARE
Temple College
EMS Professions
ECA
Topics
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Morals
Ethics
Law
Scope of Practice
Standard of Care
Negligence
Abandonment
Consent
Morals
• Definition per Webster:
• The rules or habits of conduct
• Concerned with the discernment of what is
right and wrong
• Individual
Ethics
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Definition per Webster:
A body of principles of good conduct
Any set of moral principles or values
Set by a Group
Ethical Responsibility
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Make patient’s needs a priority
Maintain skills and knowledge
Critically review performance
Be Honest
EMT Code of Ethics
• Our statement to the Public
• Written by: Charles Gillespie, M.D.
Adopted by: The National Association of
Emergency Medical Technicians, 1978
Law
• Types
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Constitutional
Legislative
Executive
Judicial
Administrative
• Only defines what is illegal
Texas Laws of Interest
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Health and Safety Code
Traffic Code
Detention of mentally ill individuals
DSHS Administrative Rules
– Certification
– Recertification
– Disciplinary Action
Scope of Practice
• Care providers are allowed to provide to the
patient
• Determines different Levels of Providers
• Most States have very specific lists
– In TEXAS - There is no “defined” scope of
practice
Texas Scope of Practice
• Established by Medical Director (In
Texas)
– Texas Medical Practice Act
• Allows Physicians to delegate procedures to
EMS personnel
– Protocol
– Standing Order
– On-Line
Standard of Care
– “- - - how a reasonably prudent person with
similar training & experience would act under
similar circumstances, with similar equipment,
and in the same place.”
Standard of Care
• Local Custom
– Similar Training & Experience
– Protocol
– Other factors
• Location
• Hazards
• Crowds
Standard of Care
• Professional Standards
– American Heart Association (AHA)
– American Ambulance Association (AAA)
– National Association of Emergency Medical
Technicians (NAEMT)
– Texas Department of State Health Services
(DSHA)
– Department of Transpiration
Standard of Care
• Institutional Standards
– Service
– Regional Systems
Negligence
• Simple (Ordinary) Negligence
• Gross Negligence
• Proving Negligence
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Duty to Act
Breach of Duty
Damages
Causation
Abandonment
• Failure to Continue Treatment:
– Termination of care without Pt’s consent
– Termination of care without provision for
continued care
Abandonment Examples
• Failure to transport
• Handing over care to lesser trained
personnel
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EMT > EMT
EMT > EMT-P
EMT > ECA
EMT > Physician
EMT > Nurse
Consent
• Permission to treat the patient
• Obtained from conscious patients before
assessment, treatment, and transport
• Types
– Expressed
– Implied
– Involuntary
Expressed Consent
• Spoken or communicated consent
• Must be informed
– Injury/Illness
– Risks
• Not receiving treatment
• Adverse consequences of treatment
– Benefits
– Alternatives
Expressed Consent
• Able to give expressed consent if:
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Patient of legal age (18) and rational
Married
Pregnant (and consent is for care of fetus)
Armed Services
Emancipated
Implied Consent
• Pt. is unconscious or unable to
communicate and is suffering from what
appears to be a life-threatening injury or
illness
• Assumes patient would want to be treated
Involuntary Consent
• An adult may be treated against his will
only if:
– Treatment is ordered by a magistrate
– Treatment is ordered by a peace officer or
corrections officer who has the patient under
arrest or in custody
• Consent of the Mentally Ill
Patient Refusal
• Patients have the right to refusal
treatment/transport!
– Legally able to do so
– Informed of injury/illness, risks, benefits,
treatments, & alternatives
– Obtain signature & witness
Options for Patient Refusal
• Get help from other family members
• Law enforcement
• Medical Control
When in doubt, err in favor of the patient!
Minor Consent
• Minor - any person under 18 years of age who
has never been married and who has not had
his/her minority status changed by the court
• Actual Consent (Informed, Expressed)
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Parents
Guardian
Grandparents
Adult Brother/Sister
Adult Aunts/Uncles
Minor Consent
• Implied Consent
– Life or Limb Threatening
– No Parental Refusal
Refusal for minors
• Parents/Guardians have the right to refuse
treatment and or transport
– Mentally competent adults (Parent/Guardian)
– Parent/Guardian must be informed of
injury/illness, risks, benefits, treatments, &
alternatives
– Obtain signature of Parent/Guardian & witness
Assault & Battery
• Assault
– Unlawfully placing a person in fear of
immediate bodily harm without consent
• Battery
– Unlawfully toughing a person
In Texas – Assault is used to describe both fear of harm and actual
unwanted physical contact
Immunity
• Governmental (Sovereign) Immunity
• “Good Samaritan” laws
– Generally does not apply if on duty
– Does not prevent lawsuits
– Offer a defense for those who act in “Good
Faith” and meet the Standard of Care”
– Do not protect against Gross Negligence
Living Wills/Advance Directives
• Patients have a right to determine what
happens to them
• “Living Will”/ “Advance Directives” must
be Presented upon Patient Contact
• Determine validity
• Hospital vs Field documents
Advanced Directives
• DNR
• Power of Attorney for Healthcare
Do Not Resuscitate
• Refusal to Honor
– The patient is pregnant
– There are unnatural or suspicious circumstances
surrounding the death
– The form is not signed twice by all who need to
sign it or is filled out incorrectly
• Consider Family Reaction
• If in Doubt – Treat!
Texas OOH DNR
• Bracelet/Necklace
• Vinyl Band
• Form
Organ Retrieval
• Provide Care
• Identify Possible Candidates
– Donor Card or Driver’s License Sticker
– Nature of Injury
• Notify Proper Officials
Records & Reports
• Complete & Accurate
• Legible & Neat
– An untidy or incomplete report is evidence of
incomplete or inexpert care.
• Legal Document
– If it wasn’t written down, it didn’t happen!
Patient Confidentiality
• Privacy Practices
• HIPPA
– Federal law
– Protects patient
• What information is protected
– Protected health information (PHI)
– Oral, written, and electronic information
Patient Confidentiality
• Patient Confidentiality must be Kept:
– To Ensure the Patient’s Right to Privacy
– To Maintain the EMT’s Reputation of
Professionalism
– To Maintain the Service’s Reputation of
Professionalism
– It is No One else’s Business!
Patient Confidentiality
• Patient Information May Only be Released:
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It is necessary to ensure continuity of care
It is requested by Law Enforcement (Judge)
It is required for billing purposes
It is Subpoenaed
When the Patient Signs an Information Release
Form
Special Reporting
Requirements
• Childbirth
• Child Abuse
– Report to:
• Law Enforcement
• Physician - Emergency Department
• Child Protective Services (CPS)
– Don’t Accuse - Report Observations Only
– Immunity - Good Faith
Special Reporting
Requirements
• Elder Abuse
• Injury During the Commission of a Felony
• Drug Related Injuries
Special Reporting
Requirements
• Crime Scene
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Scene Survey
Document
Preserve
Report to Law Enforcement
Special Reporting
Requirements
• Sexual Assault
– Report to Law Enforcement (with Patient’s
Permission)
– Retain Evidence
Special Reporting
Requirements
• Dead on Scene
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Document Absence of Vital sign
Contact Coroner
Contact Law Enforcement
Do Not Disturb or Move Body
As ECAs
• We are given a great deal of power, and
responsibility
• People freely invite us into their homes
• They trust of with their possessions
• They trust us with their lives and that of
their loved ones
As ECAs
• We have a “duty to act” when call on for
help.
• We have an ethical responsibility to
understand what is right or wrong for our
patient, even if it goes against what we
personally believe.
• We have a responsibility to act to our
standard of care.