Medical, Legal and
Ethical Issues
Medical Responsibilities
Scope of Practice
The range of duties and skills that
emergency medical technicians are
allowed and expected to perform.
Scope of Practice
 Defined by state law
 Outlines care you can provide
 Further defined in protocols and
standing orders
 Authorized through online and offline medical direction
Standard of Care
The degree of skill and judgment
expected of an individual when
caring for a patient and is defined
by training, protocols, and the
expected actions of the care
providers with similar training
and experience, working under
similar conditions
Standard of Care
 Standard imposed by local custom
 Often based on locally accepted
protocols
 Standard imposed by the law
 May be imposed by statutes,
ordinances, administrative
guidelines, or case law
Standard of Care
 Professional or institutional
standards
 Recommendations published by
organizations and societies
 Specific rules and procedures of
your service or organization
WA State Standards
 Authorized care under RCW 246.976.182
 Medical Practices Act
 Exempts EMT-Bs from licensure requirements
 Certification
 Process of evaluating and recognizing that EMT-B
has met certain predetermined standards
Legal Issues and
Liability
Legal Protection
 EMS Immunity Act
 Governmental (Sovereign) Immunity
 “Good Samaritan” Laws
 Do 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
Negligence
Failure to provide the same care
that a person with similar training
would provide
Negligence
 Duty
 Responsibility to act reasonably based on standard of
care
 Breech of duty
 Failure to act within the expected and reasonable
standard of care
 Damages
 Physical or mental harm created in a noticeable way
 Cause
 Existence of reasonable cause and effect
Duty to Act
 Individual’s responsibility to
provide patient care.
 Responsibility to provide care
comes from either statute or
function.
 Legal duty to act begins once an
ambulance responds to a call or
treatment is initiated.
Confidentiality
 Information received from or about a
patient is considered confidential.
 Disclosing information without
permission is considered a breach of
confidentiality.
 Generally, information can only be
disclosed if the patient signs a written
release.
HIPAA
 Health Insurance Portability and
Accountability Act of 1996
 Amends IRC of 1986 to improve portability
and continuity of health insurance
coverage in group and individual markets
 Federal law mandates privacy and
confidentiality in all issues regarding
patient care
Adult Consent
 Adult - Any person over 18 years of age
who is not under a court-ordered disability
 Actual Consent (Informed, Expressed)
 Implied Consent
 Pt. is unconscious or unable to communicate
and is suffering from what appears to be a
life-threatening injury or illness
Adult Consent
 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
Adult Consent
 Right of Refusal of Treatment/Transport
 Mentally competent adults have the right to
refuse care
 The person must be informed of risks,
benefits, treatments, & alternatives
 Remember to document and obtain
signatures of patient & witness
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)
 Parents
 Guardian
 Others Closely Related of Majority Age
Minor Consent
 Emancipated Minors
 Under 18, married, pregnant, a parent,
member of the armed forces, financially
independent and living away form home
 Implied Consent
 Life or Limb Threatening
 No Parental Refusal
Minor Consent
 Right of Refusal of Treatment/Transport
 Mentally competent adults (Parent/Guardian)
have the right to refuse care for their children
 The person (Parent/Guardian) must be
informed of risks, benefits, treatments, &
alternatives
 Remember to document and obtain
signatures of Parent/Guardian & witness
Refusal of Treatment
 Mentally competent adults have the
right to refuse care.
 Patients must be informed of risks,
benefits, treatments, and
alternatives.
 EMT-B should obtain a signature and
have a witness present, if possible.
Abandonment
 Termination of care without
patient’s consent
 Termination of care without
provisions for continued care
 Care cannot stop unless
someone of equal or higher
training takes over
Assault & Battery
 Assault
 Unlawfully placing a person in fear of
immediate bodily harm without consent
 Battery
 Unlawfully toughing a person
Libel and Slander
 Libel
 The act of injuring a person’s character,
name, or reputation by false or malicious
written statements
 Slander
 The act of injuring a person’s character,
name, or reputation by false or malicious
spoken statements
Advance Directives
 Specifies medical treatments desired if
patient is unable to make decisions
 Do not resuscitate (DNR) orders
 Patients have the right to refuse resuscitative
efforts.
 Require a written order from one or more
physicians
 When in doubt, begin resuscitation.
Advance Directives
 POLST Orders
 WA State DNR Form
 Living Wills or Advance Directives
 Must be Presented upon Patient Contact
 Specifics of care?
 Determine validity
 May not be witnessed by anyone who would
benefit from the death of the patient
Special Situations
 Organ donors
 Medical
identification
insignia
EMT Ethics
Ethical Responsibilities
 Make the physical/emotional needs of
the patient a priority.
 Practice/maintain skills to the point of
mastery.
 Critically review performances.
 Attend continuing education/refresher
programs.
 Be honest in reporting.