EMT: Brady Emergency Care 11th Edition - Chapter 3 - Medical/Legal and Ethical Issues Flashcards

Terms Definitions
Define "scope of practice."
Scope of practice is a set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT's job
Define consent.
Consent is permission from the patient for care or other action by the EMT.
On what calls must you obtain consent to render emergency care?
You must gain some sort of consent on every call.
What are the three types of consent?
1) Expressed
2) Implied
3) Consent to treat minors or incompetent patients
Define "expressed consent."
Expressed consent is given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being.
Define "implied consent."
Implied consent is the consent that we would presume that the patient or patient's parent or guardian would give if they could. This is applicable to unconscious patients, and patients whose parents cannot be contacted when care is needed.
What conditions must be fulfilled in order for a patient to refuse care or transport?
1) Patient must be legally able to consent (i.e. of legal age or an emancipated minor)

2) Patient must be mentally competent and oriented. An altered mental status, unstable vital signs, and other diseases or injuries can affect competence.

3) Patient must be fully informed. He must understand the risks of refusal.

4) Patient must sign a release form that releases the ambulance squad from any liability arising form patient's refusal.
What actions should be taken in order to persuade a patient to consent to care in the case of refusal?
1) Spend time speaking with the patient.

2) Inform the patient of consequences of not going to the hospital.

3) Consult medical direction.

4) Contact family members to help convince the patient.

5) Call law enforcement if necessary.

6) ABOVE ALL, try to determine why the patient is refusing care, and address the concern
Define "Do Not Resuscitate Order" (DNR)
A DNR is a signed legal document stating that the patient has a terminal illness and refuses resuscitation.
What's another term that describes a do not resuscitate order?
Advance directive
Define "Negligence."
Negligence has three components:

1) The EMT had a duty to act
2) The EMT did not provide the standard of care, including failure to act.
3) By not providing the standard of care, harm was done to the patient
Define "duty to act."
Duty to act is an obligation to provide care to a patient.
Define "abandonment."
Abandonment is leaving a patient after care has been initiated and before the patient has been transferred to somebody with equal or greater medical training.
What are good Samaritan laws?
Good Samaritan laws are state laws designed to limit liability to citizens and personnel providing emergency care.
Define "confidentiality."
Confidentiality is the obligation not to reveal information obtained about a patient EXCEPT to other health care professionals involved in care, or under court subpoena, or once patient has signed a release, or in cases that require mandatory reporting.
What's HIPAA?
HIPAA is the Health Insurance Portability and Accountability Act, a law protecting the privacy of patient-specific information and granting the patient control over the information.
What's an organ donor.
An organ donor is a person that has completed a legal document that allows for donation of organs and tissues upon death.
Define "crime scene."
A crime scene is the location where a crime has been committed or where evidence may be found.
When entering a crime scene, what components of evidence must an EMT be careful not to disturb unless absolutely necessary?
1) Condition of the scene
2) The patient
3) Fingerprints and footprints
4) Microscopic evidence
What three actions will make you more useful to police after you've entered a crime scene?
1) Remember what you touch
2) Minimize impact on the scene
3) Work with police
What conditions could make somebody an "emancipated minor," thus giving them the authority to refuse treatment as an adult?
1) Minor is married
2) Minor is pregnant
3) Minor is independent
4) Minor is in armed forces
When in doubt...
Err on the side of patient care!
What is the leading cause of lawsuits against EMTs?
Poor documentation of refusals.
In what two situations might an EMT be charged with criminal battery?
1) EMT unlawfully touches a patient without consent.

2) EMT provides care without consent.
What are the three major types of "advance directives?"
1) Do Not Resuscitate order (DNR)

2) Living will

3) Healthcare proxy
What exactly is a DNR?
A DNR (Do Not Resuscitate order) is a legal document signed by the patient and their physician. If no DNR is presented, or if it's validity is in question, resuscitate! DNR will specify what treatments are and aren't acceptable.
What are the four major ethical responsibilities of an EMT?
1) Make patient needs a priority
2) Maintain skills and knowledge
3) Quality improvement
4) Prepare honest reports
Define "negligence."
Deviation from accepted standards of care recognized by law -- something either not done (nonfeasance) or done incorrectly (malfeasance, misfeasance)
What four conditions must be fulfilled in order to charge an EMT with negligence?
1) There was a duty to act
2) That duty was breached
3) Actual damages occurred as a result
4) The EMT's breach of duty was an action or inaction that immediately worsened the situation (proximate cause).
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