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Emergency Medical Care

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Immediate care, or treatment, that is often provided by an EMT.

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Consent

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Permission given by the patient to render care. If a person is conscious, rational, and capable of making informed decisions, he or she has a legal right to refuse care, even though ill or injured. Can be expressed (actual) or implied and can also apply to the care of a minor or a mentally incompetent patient.

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Decision Making Capacity

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The foundation of consent. The ability of a patient to understand the information you are providing to him or her, coupled with the ability to process that information and make an informed choice regarding medical care that is appropriate for him or her.

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Patient Autonomy

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The right of a patient to make decisions concerning his or her health.

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Distinctions between "Competence" and "Decision Making Capacity"

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"Competence" is generally regarded as a legal term and determinations regarding competence are typically made by a court of law. "Decision Making Capacity" is the term more commonly used in health care to determine whether or not a person is capable of making health care decisions.

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Factors to consider when determining a patient's decision making capacity

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- Intellectual capacity impaired by mental limitations or dementia? - Of legal age? (18 years of age in most states) - Impaired by alcohol/drugs/serious injury/illness? - Appear to be experiencing significant pain? - Any apparent hearing or visual problems? - Language barrier present? Do you and your patient speak the same language? - Appear to understand what you are saying? Does he or she ask rational questions that demonstrate an understanding of the information you are trying to share?

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Types of consent

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- Expressed consent - Implied consent - Involuntary consent

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Expressed Consent

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The type of consent given when the patient verbally or otherwise acknowledges that he or she wants you to provide care or transport. Also known as actual consent. May be nonverbal.

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Informed Consent

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Permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained. Valid if given orally, but it may be difficult to prove at a later point in time. Rarely do EMS providers have patients sign a consent form, so it is alway advisable to document consent in your run report. A witness to the patient's consent may be helpful is the issue of consent is later challenged in court.

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Implied Consent

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Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. Applies only where a serious medical condition exists and should never be used unless there is a threat to life or limb.

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Emergency Doctrine

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The principle of law that permits a health care provider to treat a patient in an emergency situation when the patient is incapable of granting consent because of an altered level of consciousness, disability, the effects of drugs or alcohol, or the patient's age.

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Medicolegal

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Relates to medical jurisprudence (law) or forensic medicine.

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Emancipated Minors

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Individuals who, despite being under the legal age in a given state (in most cases the age is 18 years), can be legally treated as adults based on certain circumstances. Examples include if the minor is living away from and no longer relying on his or her parents for support, married, member of the armed services, or if he or she is a parent (who may also give consent for his or her own child).

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in loco parentis

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Refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent. You should still make an effort to obtain consent from a parent or legal guardian whenever possible; however, if a true emergency exists and the parent or legal guardian in not available, the consent to treat the minor is implied, just as with an adult.

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Forcible Restraint

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The act of physically preventing an individual from initiating any physical action. Sometimes necessary when you are confronted with a patient who is in need of medical treatment and transportation but is combative and present a significant risk of danger to himself, herself, or others.

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Breach of Confidentiality

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Disclosure of information without proper authorization. Communication between you and the patient is considered confidential and generally cannot be disclosed without permission from the patient or a court order.

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Confidential Information includes

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- Patient History - Assessment Findings - Treatment Provided

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Protected Health Information (PHI)

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Any information about health status, provisions of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.

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Do Not Resuscitate (DNR) Orders

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Written documentation by a physician giving permission to medical personnel to not attempt resuscitation in the event of cardiac arrest. Also known as a "do not attempt resuscitation" order).

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DNR orders must meet the following requirements:

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- Clear statement of the patient's medical problem(s). - Signature of the patient or legal guardian. - Signature of one or more physicians. - In some states, DNR orders contain an expiration date, whereas in others, no expiration date is included. DNR orders with expiration dates must be dated in the preceding 12 months to be valid.

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Competent

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Able to make rational decisions about personal well-being.

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Advanced Directive

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Written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions, also called a living will, or health care directive. Most commonly used when a patient becomes comatose.

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Comfort Care Order

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An advanced directive that specifies care a person should receive in the even that they become incompetent. May include nutrition and medication for pain.

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Durable Powers of Attorney for Health Care

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A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decisions making capacity. Also known as Health Care Proxies.

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"Brain Death" Provisions

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Refer to irreversible cessation of all functions of the brain and brain stem.

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General rule to an absence of DNR orders:

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If the body is still warm and intact, initiate emergency medical care. An exception is cold temperature (hypothermia) emergencies.

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Hypothermia

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A general cooling of the body in which the internal body temperature becomes abnormally low: below 95F (35C). It is considered a serious condition and is often fatal. At 86F (30C), the brain can survive without perfusion for about 10 minutes. When the core temperature drops to 82.4F (28C), the patient is in grave danger; however, individuals have survived hypothermic incidents with temperatures as low as 64F (18C). The patient should not be considered dead until he or she is warm and dead.

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Presumptive Signs of Death

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- Unresponsiveness to painful stimuli - Lack of a carotid pulse or heartbeat - Absence of breath sounds - No deep tendon or corneal reflexes - Absence of eye movement - No systolic blood pressure - Profound cyanosis (blue or purple coloration of the skin or mucous membranes) - Lowered or decreased body temperature

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Definitive Signs of Death

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- Obvious mortal damage, such as a body in parts (decapitation) - Dependent Lividity - Rigor Mortis (Occurs sometime between 2 and 12 hours after death) - Putrefaction (occurs sometime between 40 and 96 hours after death)

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Dependent Lividity

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Blood settling to the lowest point of the body, causing discoloration of the skin.

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Rigor Mortis

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The stiffening of body muscles caused by chemical changes within muscle tissue. It develops first in the face and jaw, gradually extending downward until the body is in full rigor. The rate of onset is affected by the body's ability to lose heat to its surroundings.

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Putrefaction

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Decomposition of body tissues.

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Possible Medical Examiner (or Coroner in some states) cases

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- Person is dead on arrival (DOA) (or dead on scene [DOS]) - Death without previous medical care or when the physician is unable to state the cause of death - Suicide (self-destruction) - Violent death - Poisoning, known or suspected - Death resulting from accidents - Suspicion of a criminal act

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Organ Donor

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An individual who has expressed a wish to donate organs.

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Scope of Practice

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Most commonly defined by state law, outlines the care you are able to provide for the patient. Further defined by your medical director by developing protocols and standing orders. Not to be confused with the standard of care.

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Standard of Care

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Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.

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Emergency

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A serious situation, such as an injury or an illness that arises suddenly, threatens the life or welfare of a person or group of people, and requires immediate intervention.

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Certification

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The process by which an individual, institution, or program is evaluated and recognized as meeting certain predetermined standards to ensure safe and ethical patient care.

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Licensure

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The process by which a competent authority, usually the state, grants permission to practice a job, trade, or profession.

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Duty to Act

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An individual's responsibility to provide patient care.

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Negligence

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The failure to provide the same care that a person with similar training would provide in the same or similar situation. It is deviation from the accepted standard of care that may result in further injury to the patient.

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Determination of Negligence is based on four factors:

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- Duty - Breach of Duty - Damages - Causation

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Duty

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The EMT has an obligation to provide care and to do so in a manner that is consistent with the standard of care established by training and local protocols.

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Breach of Duty

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There is a breach of duty when the EMT does not act within an expected and reasonable standard of care.

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Damages

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There are damages when a patient is physically or psychologically harmed in some noticeable way.

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Causation

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There must be a reasonable cause-and-effect relationship between the breach of duty and the damages suffered by the patient.

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Proximate Causation

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When a person who has a duty abuses it, and causes harm to another individual, the EMT, the agency, and/or the medical director may be sued for negligence.

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res ipsa loquitor

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When the EMT or an EMS service is held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred.

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negligence per se

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A theory that may be used when the conduct of the person being sued to alleged to have occurred in clear violation of a statute.

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Torts

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A wrongful acts that gives rise to a civil suit.

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Abandonment

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The unilateral termination of care by the EMT without the patient's consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient. Once care has started, you have assumed a duty that must not stop until an equally competent EMS provider assumes responsibility.

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Assault

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Unlawfully placing a person in fear of immediate bodily harm.

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Battery

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Unlawfully touching a person; this includes providing emergency care without consent.

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Kidnapping

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The seizing, confining, abducting, or carrying away of a person by force.

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False Imprisonment

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The unauthorized confinement of a person that lasts for an appreciable period of time.

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Defamation

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The communication of false information that damages the reputation of a person.

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Libel

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Defamation in writing.

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Slander

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Defamation that is spoken.

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Good Samaritan Laws

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Statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care, unless there is wanton, gross, or willful negligence.

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Gross Negligence

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Conduct that constitutes a willful or reckless disregard for a duty or standard of care.

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Ethics

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The philosophy of right and wrong, of moral duties, and of the ideal professional behavior.

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Morality

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A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

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Bioethics

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The study of ethics related to issues that arise in health care.

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Applied Ethics

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The manner in which principles of ethics are incorporated into professional conduct.

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Precedence

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Basing current action on lessons, rules, or guidelines derived from previous similar experiences.

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Statute of Limitations

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The time within which a case must be commenced.

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Governmental Immunity

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If your service is covered by immunity, it may mean that you cannot be sued or it may limit the amount of the monetary judgement that the plaintiff may recover; generally applies only to EMS services that are operated by municipalities or other governmental entities.

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Contributory Negligence

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A legal defense that may be raised when the defendant feels that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff.

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Discovery

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The phase of a civil suit where the plaintiff and defense obtain information from each other that will enable the attorneys to have a better understanding of the case and which will assist in negotiating a possible settlement or in preparing for trial. Includes depositions, interrogatories, and demands for production of records.

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Interrogatories

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Written questions that the defense and plaintiff send to the other.

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Depositions

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Oral questions asked of parties and witnesses under oath.

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Compensatory Damages

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Damages awarded in a civil suit that are intended to restore the plaintiff to the same condition that he or she was in prior to the incident complained about in the lawsuit.

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Punitive Damages

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Damages that are sometimes awarded in a civil suit when the conduct of the defendant was intentional or constituted a reckless disregard for the safety of the public.

EMT 1114 – Ch 3: Medical, Legal, and Ethical Issues – Flashcards

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