Legal and Ethical issues
SIDS, DNR, LEGAL
Know Your Reporting
Responsibilities!
this applies to you!
SIDS, DNR, LEGAL
Special Reporting Requirements (1 of 2)
 Abuse
of children, elderly, and spouse
 Injury
during the commission of a
felony
 Drug-related
 Childbirth
SIDS, DNR, LEGAL
injury
Special Reporting Requirements (2 of 2)
Infectious
Crime
scene
Deceased
SIDS, DNR, LEGAL
disease exposure
Reporting
 It
is a misdemeanor to fail to report
abuse.
 report
suspicion of child abuse, you do
not need proof to report an incident.
SIDS, DNR, LEGAL
What, When & Who
What
When
 verbal report
- immediately
 written report
- within 36 hours
Who
 law enforcement
 protective services
SIDS, DNR, LEGAL
Elder Abuse
 Any
person who takes advantage of
person, property or emotional state
 Victims are often hesitant or unable to
report
 Signs of abuse are often overlooked
 Pt. often has multiple medical
conditions and are dependent on others
SIDS, DNR, LEGAL
Assessment of Elder Abuse
(1 of 2)
 Repeated
visits to the emergency
room
 A history of being “accident-prone”
 Soft-tissue injuries
 Vague explanation of injuries
 Psychosomatic complaints
SIDS, DNR, LEGAL
Assessment of Elder Abuse
(2 of 2)
 Chronic
pain
 Self-destructive behavior
 Eating and sleeping disorders
 Depression or a lack of energy
 Substance and/or sexual abuse
SIDS, DNR, LEGAL
Signs of Physical Abuse
 may
be obvious or subtle.
 Obvious signs include bruises, bites,
and burns.
 Look for injuries to the ears.
 Consider injuries to the genitals or
rectum as evidence of abuse.
SIDS, DNR, LEGAL
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.
SIDS, DNR, LEGAL
Do Not Resuscitate
- DNR or “no code”
 supportive measures only - No CPR
 family member can request
resuscitation
 AKA
SIDS, DNR, LEGAL
Medical facility Vs. Home or
Street
There are different requirements
SIDS, DNR, LEGAL
DNR- Nursing facilities
 written
order in patient's chart
– no CPR
– no code
– DNR
VERBAL ORDER FROM MD NOT
VALID unless put in writing
SIDS, DNR, LEGAL
SIDS, DNR, LEGAL
DNR - home/street
 L.A.
County “Prehospital DNR” Form
 California “Prehospital DNR” Form**
 MEDIC ALERT TAG bracelet or necklace
 No
other type of DNR may be honored in
Los Angeles County
SIDS, DNR, LEGAL
SIDS, DNR, LEGAL
SIDS, DNR, LEGAL
Legal issues
 Authority
for patient care - most qualified at
rendering emergency care
 Physicians
at the scene must show
identification and agree to assume
responsibility in order to direct care
SIDS, DNR, LEGAL
Consent – three types
 Expressed
consent
 Implied
consent
 Minors
and mentally incompetent
adults
– “In loco parentis”
– ALOC
SIDS, DNR, LEGAL
Legal age of consent
 Minor
is under 18 years-old
 Emancipated
minor
 Female - pregnancy related
SIDS, DNR, LEGAL
Adults - Competence
 Must
be competent to refuse treatment or
transport
 hypotensive
 hypoglycemic
 under
the influence
 suicidal ideations or actions
SIDS, DNR, LEGAL
Adults - Competence
 Any
EMT-B or EMT-P can deem a
patient incompetent
 This
SIDS, DNR, LEGAL
is NOT a 5150
Refusal of Treatment
Against Medical Advice
 when
 do
a patient refuses care or transport
not need if you believe patient is OK
without treatment.
SIDS, DNR, LEGAL
Valid AMA
 Patient
Alert and Oriented X3
 Competent
 EMT-B
should obtain a witnessed
signature
MUST advise pt :
 Of need for treatment
 Of consequences of refusal
 That they may re-contact 911
SIDS, DNR, LEGAL
5150 (72 hour hold)
Patients may be placed on a hold if...
– danger to self
– danger to others
– gravely disabled due to mental
disorder
SIDS, DNR, LEGAL
5150 (72 hour hold)
who may place hold
– Law Enforcement
– PET or PMRT member
– County “designated” doctors
SIDS, DNR, LEGAL
Limited Legal Authority
 As
an EMT-B, you have limited legal
authority to require or force a patient to
undergo care.
 Police
may put a patient in protective
custody to allow you to provide care.
 Know
SIDS, DNR, LEGAL
your local laws and protocols.
Assault and Battery
 Know
when to force TX
 Assault
– Unlawfully placing a person in
fear of immediate bodily harm
without consent
 Battery
– Unlawfully touching a person
SIDS, DNR, LEGAL
Duty to Act
 Individual’s
responsibility to provide
patient care
 Begins
once an ambulance responds
to a call or treatment is initiated
SIDS, DNR, LEGAL
Standard of Care
 The
minimum level of care that a
person can expect
 Imposed
by local protocol
 Imposed
by the law
 Professional
SIDS, DNR, LEGAL
or institutional standards
Negligence
 Failure
to apply the standard of care
Failure
to provide the same care
that a person with similar training
would provide
 Act
or omission of an act
 Good Samaritan Act does not apply to
on-duty personnel
SIDS, DNR, LEGAL
Negligence Determination
Duty
Breech
of duty
Damages
Cause
SIDS, DNR, LEGAL
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
SIDS, DNR, LEGAL
Ethical Responsibilities
 Make
physical/emotional needs a priority
 Practice/maintain skills
 Critically review performances
 Attend continuing education/refresher
programs
 Be honest in reporting
SIDS, DNR, LEGAL
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.
SIDS, DNR, LEGAL
Records and Reports
 Complete
documentation is a
safeguard against legal complications
 If
an action or procedure is not
recorded, it was not performed
 An
incomplete or untidy report is
evidence of incompetence
SIDS, DNR, LEGAL
Standards Imposed by States
– Medical Practices Act
Exempts
EMT-Bs from licensure
requirements
– Certification
Process
of evaluating and recognizing that
EMT-B has met certain predetermined
standards
SIDS, DNR, LEGAL
Regulation updates
 EMT-1
 Titles
or EMT-B designation only
that no longer exist
– EMT-1(AA)
– EMT-1 (D)
SIDS, DNR, LEGAL
Certification Application
Requirements
Be 18 years old or older.
Have valid Course Completion
Certificate.
Apply within 2 years of course
completion.
SIDS, DNR, LEGAL
Certification requirements
Submit application and fees.
Pass a written certification
examination.
And ..
SIDS, DNR, LEGAL
Background Check
Disqualifying convictions
Violent crimes
Sex related crimes
Drug related crimes (including DUI)
SIDS, DNR, LEGAL
Re-certification Requirements
 Every
two years
– Complete refresher course
Or
– Obtain 24 hours of approved continuing
education
 Submit
SIDS, DNR, LEGAL
application and fees
Approved Continuing Education
 BLS
level
 many methods to obtain CE
 MANDATORY CPR & airway
management course at least once every 2
years
 YOU must find a CE Provider
SIDS, DNR, LEGAL
End
questions??
SIDS, DNR, LEGAL