Chapter 4, Medical, Legal, and Ethical Issues
EMT & PARAMEDIC Preparation・55 minutes read
Understanding laws, ethics, and the legal system is vital in pre-hospital emergency care, with codes and concepts guiding healthcare professionals. Medical ethics, the legal system in the United States, and patient rights are all essential components of providing effective care while navigating complex legal and ethical dilemmas.
Insights
- Understanding laws and ethics in pre-hospital emergency care involves various regulations like motor vehicle laws, EMS legislation, and confidentiality laws such as HIPAA, guiding healthcare professionals in making decisions and prioritizing patient welfare.
- The legal system in the United States, encompassing civil and criminal laws, governs paramedics, with factors like defamation, consent, and patient refusal shaping practices, highlighting the importance of accurate communication, adherence to standards, and patient advocacy in EMS.
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Recent questions
What are the fundamental ethical concepts in pre-hospital care?
"Do no harm," "act in good faith," and "act in the patient's best interest" are fundamental ethical concepts in pre-hospital care. These principles guide healthcare professionals in making decisions and prioritizing patient welfare, ensuring that patient safety and well-being are the top priorities in emergency medical situations.
How does the legal system in the United States govern paramedics?
The legal system in the United States governs paramedics through civil and criminal laws, which include liability, negligence, assault, battery, false imprisonment, and kidnapping. Civil law allows patients to sue for perceived injuries, while criminal law permits prosecution for breaking legal statutes. Intent to harm is crucial in criminal cases, while consent plays a vital role in civil cases, highlighting the importance of adhering to legal standards in pre-hospital care.
What is the role of physician orders in paramedic activities?
Physician orders are crucial for many paramedic activities, which are typically given via radio, cell phone, or online medical control. Paramedics must follow these orders unless patient harm is at risk, and any conflicts should be resolved through online medical control. This ensures that paramedics provide appropriate care based on medical guidance and supervision.
How do paramedics handle patient refusals of medical care?
Paramedics handle patient refusals of medical care by documenting the refusal to prevent claims of abandonment. Thorough assessment and mental status documentation are essential in these situations to ensure that patients are making informed decisions. In cases where patients are deemed incompetent to make decisions, treatment may be necessary despite their refusal, emphasizing the importance of proper documentation and patient assessment.
What are the key considerations in end-of-life decisions in pre-hospital care?
End-of-life decisions in pre-hospital care require respect and empathy for patients and their families, especially when DNR orders are unavailable. Deciding when to stop CPR or resuscitation efforts involves common sense and judgment, with guidelines from the National Association of EMS Physicians for termination of resuscitation. Different laws in each state define paramedics' roles in end-of-life care, emphasizing the need for compassionate and thoughtful decision-making in these challenging situations.
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Summary
00:00
Laws, Ethics, and Legal System in Pre-Hospital Care
- Completion of Chapter 4 involves understanding laws and ethics in pre-hospital emergency care, distinguishing personal, professional, and medical ethics, and comprehending the legal system in the United States.
- Laws and ethics are crucial in pre-hospital care, with various regulations such as motor vehicle laws, EMS legislation, medical licensing statutes, and confidentiality laws like HIPAA.
- Medical ethics encompass personal and professional ethics, with codes like the Declaration of Geneva and the Code of Ethics for EMS Practitioners guiding healthcare professionals.
- Ethical concepts like "do no harm," "act in good faith," and "act in the patient's best interest" are fundamental in making decisions and prioritizing patient welfare.
- The legal system in the United States involves the legislative, judicial, and executive branches, with civil and criminal laws governing paramedics, including liability and negligence.
- Civil law allows patients to sue for perceived injuries, while criminal law permits prosecution for breaking legal statutes, with malpractice suits typically tried under civil law.
- Criminal laws applicable to pre-hospital care include assault, battery, false imprisonment, and kidnapping, with intent to harm crucial in criminal cases and consent vital in civil cases.
- Defamation, involving false statements that harm a person's reputation, can lead to lawsuits, emphasizing the importance of accurate and respectful communication in patient reports.
- The legal process for civil lawsuits begins with a dissatisfied patient contacting an attorney, leading to a complaint, discovery period, and potential settlement or trial, with the paramedic's relationship with the medical director being crucial in ensuring adherence to standards and supervision.
19:53
Paramedics' Responsibilities and Regulations in Healthcare
- Paramedics may restrict, supervise, or provide remedial training if they believe standards are not met.
- Orders from a physician are crucial for many paramedic activities, given via radio, cell phone, or online medical control.
- Paramedics must follow physician orders unless patient harm is a risk; conflicts should be resolved through online medical control.
- EMS enabling legislation structures EMS, designates responsibilities, and defines medical director roles and scope of practice.
- Administrative regulations set precise skills, medications, and licensing requirements for paramedics at state or federal levels.
- Licensing and certification differ; certification is based on training hours, while licensure grants practice authority.
- Due process ensures fair procedures for license actions against paramedics, including notice and opportunity to be heard.
- The Medical Practice Act defines qualifications, skills, and responsibilities for healthcare practitioners, varying by state.
- Scope of practice dictates care paramedics can provide under their license or certification, distinct from standard of care.
- HIPAA ensures patient privacy, with strict rules on information disclosure, enforced by the Department of Health and Human Services.
39:26
Challenges in Patient Refusal and EMS Care
- Patients may refuse medical care due to fear, emotional distress, or cost, posing challenges in addressing their concerns.
- Factors like head injuries, altered mental status, or unstable vital signs may prevent informed refusal, requiring medical control guidance.
- Psychiatric emergencies may involve police restraining and transporting patients against their will, with EMS following police requests.
- Establishing clear protocols for mentally disturbed patients who refuse transport involves defining roles of involved agencies beforehand.
- In cases where a patient is deemed incompetent to make decisions, treatment may be necessary despite refusal.
- Documenting patient refusals is crucial to prevent claims of abandonment, ensuring thorough assessment and mental status documentation.
- Minors lack legal status to consent or refuse medical care, requiring consent from parents or legal guardians, with state laws prohibiting denial of treatment.
- Use of force by paramedics is limited to situations where patients pose a danger, with restraints only for medical reasons.
- Negligence in EMS involves legal duty, breach of duty, approximate cause, and harm, with protection against liability through adherence to standards.
- Abandonment, a form of neglect, involves terminating care without patient consent, necessitating transfer of responsibility to another competent healthcare professional.
58:27
EMS and DNR Orders: Legal and Ethical Considerations
- DNR orders, or Do Not Resuscitate orders, describe life-saving procedures for patients in case of sudden deterioration, recognized in pre-hospital settings for the last 20 years.
- EMS recognizes patients' rights both inside and outside hospitals, with many states having specific DNR forms for EMS.
- DNR orders may expire in some states and require renewal, while others do not expire, but must be executed by a state-licensed physician.
- Deciding when to stop CPR or resuscitation efforts requires common sense and judgment, with guidelines from the National Association of EMS Physicians for termination of resuscitation.
- Resuscitation efforts may be futile, considering the time for care and likelihood of survival, with different laws in each state defining paramedics' roles.
- End-of-life decisions require respect and empathy for patients and their families, especially in cases where DNR paperwork is unavailable.
- End-of-life documents, more extensive than DNRs, apply to patients in cardiac arrest or with impending pulmonary failure, with provisions for CPR, feeding tubes, and antibiotics.
- Organ donation is crucial, with programs in some states allowing patients to agree to donation, emphasizing the role of EMS in securing transplants.
- Defenses to litigation include the statute of limitations and contributory negligence, with an open, informative relationship with patients as the first defense.
- Good Samaritan legislation provides immunity for those assisting in emergencies, with limitations on protection for off-duty EMS personnel and requirements for emergency care provision.
01:17:22
"Union Laws and Upcoming Lecture Series"
- Some states have right-to-work laws preventing employers or unions from mandating union membership for employment.
- Certain states may necessitate union membership within a specific timeframe post-hiring.
- The lecture on medical, legal, and ethical issues in chapter four is concluded, with upcoming chapters to be released soon.
