Outlines the care that you are able to provide for the patient

Medical director Provides legal authorization

Via

Online - Radio or telephone communication

Off-line - Develops Protocols and Standing Orders

• How a reasonably prudent person with similar training and experience would act under similar circumstances, with similar equipment, and in the same place
• Established by
  • local custom
  • statutes
  • ordinances
  • administrative regulations
  • case law

• A Serious situation, such as injury or illness that 
  • arises suddenly
  • threatens life or welfare of a person, or group of people
  • requires immediate attention

• A minimum standard of care
• It is expected that anyone who offers assistance will exercise reasonable care and act prudently

• 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
• Once certified, you are:
  • obliged to conform to the standards that are recognized nationally 
  • Stay current with certificate and skills

• An individual's responsibility to provide patient care
• Comes from statute or function
• Once your ambulance responds to a call or treatment has begun, you have a legal duty to act

• The failure to provide the same care that a person with similar training would provide
• Determination of negligence is based on 4 factors (all must be present for Negligence)
  • Duty to Act
  • Breach of Duty
  • Damages
  • Cause

There must be a reasonable cause and effect

(eg. dropping a patient)

• Unilateral termination of care by the EMT-B without the patient's concent and without making provisions for continuing care by a medical professional with skills at the same or higher level
• Once care is started, you have assumed a duty that must not be stopped until an equally competent person assumes responsibility
• Legally and ethically serious
  • civil
  • criminal

• Required of all conscious, mentally competent adults
• If this person refuses consent, you may not care for the patient

Expressed Consent

(actual Consent)

• The patient speaks or acknowledges that he/she wants you to provide care or transport
• It must be Informed Consent

• The patient has been told of the potential risks, benefits, and alternatives to treatment and has given consent to treatment
• Patient must be of legal age
• able to make a rational decision
• Valid, only if given orally
  • Witness and signed consent helpful

• Limited to Life-Threatening situations
• Patient is
  • unconscious
  • delusional
  • unresponsive
  • physically unable to give expressed consent

• In most instances, the law allows the
  • Spouse
  • close relative
  • next of kin
• to give consent for an injured person who is unable to give consent

• EG. a patient pulling an arm out of the splint
• DOCUMENT!

• Law requires that a parent or legal guardian give consent for treatment or transport
• In a true medical emergency:
  • consent is implied
  • never withhold lifesaving support

• Unable to give informed consent
• Obtain consent from a guardian or conservator
• In a life-threatening situation - assume implied consent

• The act of physically preventing an individual from any physical action
• Must consult medical control 
• law enforcement
• Eposes me to civil and criminal penalties
• Used only in circumstances of risk to myself or others

• Unlawfully placing a person in fear of immediate bodily harm
• Threatening to restrain a patient who does not want to be transported could be considered assault

• Unlawful touching a person
• Includes emergency care without consent
• Considered if I apply a splint or Epi-Pen without consent
  • Obtain Express consent
  • Consult Medical Director

• Mentally competent adults have the right to refuse treatment or withdraw from treatment at any time
• If a patient refuses treatment or transport you must make sure they understand, or is informed about
  • Potential Risks
  • Benefits
  • Treatments
  • Alternatives to treatment
• Fully inform patient about the consequences of refusing treatment and encourage patient to ask questions
• Document Refusal
• Obtain a witness signature

• You must assess whether the patient's mental condition is impaired
• If impaired:
  • You cannot assume that the refusal is an informed refusal

• EMT-Bs should summon Law enforcement officials to further document for treatment and transport of the elderly
• parents's refusal for their child
  • Obtain a signature
  • Refusal to sign:
  • Document
  • Inform Medical Control

• When you reasonably help another person, you should not be liable for errors or omissions that are made in giving good faith emergency care
• Do not protect me from liability or failure to provide proper care
• Do not pertain to acts outside the scope of care
• Do not protect anyone from wanton, gross, or willful negligence

Advance Directive

(Living Will)

• A Written document that specifies medical care that a person would like to have administered should he/she becomes unable to make medical decisions
• Not all advance directives are directions to withhold care

• Clearly state the patient's medical problem(s)
• Be signed by the patient or legal guardian
• Be signed by 1 or more physicians
• May have an expiration date
• Still obligated to provide supportive measures when not in cardiac arrest
  • Oxygen 
  • Pain relief
  • Comfort

• Patients have the right to refuse treatment
• A Written order for a physician is required
• I should review state and local protocols and law
• When in doubt - I have a responsibility to resuscitate
• CT has an orange or metal bracelet, which must be intact

• Related to action, conduct, motive, or character
• Associated with what the profession of EMS providers deem as fitting
• NAEMT website for list

• Communications between you and the patient are considered confidential
• Cannot be disclosed without permission from the patient or court order
• Includes
  • Patient history
  • assessment findings
  • Treatment provided
  • Diagnosis
  • Mental or Physical conditions

Confidentiallity and

Automatic Release

• Does not require a written form
• Allows you to:
  • Share information with other health care providers so that they may continue care
  • Inform of Rape
  • Inform of Abuse
  • 3rd party billing

HIPPA

(Health Insurance and Accountability Act - 1996)

• Provides guidance on what types of information is protected
• The Resposibilty of health care providers regarding that protection
• Penalties for breaching that protection

• Compile a complete and accurate record of all incidents in which you come in contact with sick or injured patients
• Legal safeguard
• If an action or procedure is not recorded on the written report, it was not performed
• An incomplete or untidy report is evidence of incomplete or inexpert emergency medical care

Abuse of child or elderly

Spouse

• Unresponsive to painful stimuli
• Lack of carotid pulse or heartbeat
• Absence of breath sounds
• No dep tendon or coneal reflexes
• Absence of eye movements
• No systolic blood pressure
• Profound cynosis
• Lowered or decreased body temperature
• In the case of hypothermia -dead only if warm and dead

• Obvious mortal damage (decapitation)
• Dependent Lividity - blood settling to the lowest point of the body, causing discoloration to the skin
• Rigor Mortis - stiffening of the body muscles between 2 & 12 hours after death)
• Putrefaction - decomposition of body tissues

• The person is DOA
• Death without previous medical care or when the physician is unable to state the cause of death
• Suicide
• Violent Death
• Poisoning, known or suspected
• Death resulting from accidents
• Suspicion of a criminal act

On CT Liscence

Provide the same level of care, as if they were not donors