EMT-Basic/Preparatory/Medical Legal

Lesson 1.3: Medical/Legal and Ethical Issues

Objectives
By the end of this lesson, the EMT-Basic should be able to:
 * 1) Define the EMT-Basic scope of practice.
 * 2) Discuss the importance of Do Not Resuscitate (DNR) orders and other advance directives and local or state provisions regarding EMS application of such directives.
 * 3) Define consent and discuss the methods of obtaining consent.
 * 4) Differentiate between expressed and implied consent.
 * 5) Explain the role of consent of minors in providing care.
 * 6) Discuss the implications for the EMT-Basic in patient refusal of transport.
 * 7) Discuss the issues of abandonment, negligence, and battery and their implications to the EMT-Basic.
 * 8) State the conditions necessary for the EMT-Basic to have a duty to act.
 * 9) Explain the importance, necessity, and legality of patient confidentiality.
 * 10) Discuss the considerations of the EMT-Basic in in issues of organ retrieval.
 * 11) Differentiate the actions that an EMT-Basic should take to assist in the preservation of a crime scene.
 * 12) State the conditions that require an EMT-Basic to notify local law enforcement officials.
 * 13) Explain the role of EMS and the EMT-Basic regarding patients with DNR orders.
 * 14) Explain the rationale for the needs, benefits, and usage of advance directives.
 * 15) Explain the rationale for the concept of varying degrees of DNR.

Introduction
Through acting in good faith and following a standard of care, you can easily avoid legal ramifications within your duties as an EMT. Failure to follow an appropriate standard of care, or even sometimes if a good standard of care is provided, may still lead to you being sued by a patient whether for monetary compensation or a perceived injustice. Understanding the medico-legal statutes which you operate under can help prevent future problems during your work.

Consent
To become a patient, a person must first give Consent for treatment. Refusal to consent denies permission to any future acts you may take to treat the patient. Consent arises from everybody's capacity to make decisions. Provided that a person understands the situation, and is able to process it into a decision to accept or refuse treatment, he or she has the right to do so.

Expressed Consent
Expressed consent is when a patient verbally expresses or indicates that he is a willing participant in his treatment. In order to give expressed consent the patient must meet four criteria:
 * Conscious - The patient must be conscious and alert to give consent
 * Competent - The patient must be aware of the consequences of their decision
 * Informed - the patient must be told what treatment they are going to receive
 * Adult - The patient must be at least 18 years of age (or whatever the local age of majority is), or be emancipated.

Implied Consent
Implied consent is consent which is not expressly granted by a person, but rather implicitly granted by a person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's silence or inaction). ex: you are dispatched to a MVA and the person is unconscious. It is implied by their condition that they need medical attention.

Confidentiality
Hipaa

Signs of Death
Definitive signs of death are - Mortal damage - Rigor mortis - Putrefaction and lividity