Online Medical Direction
-Direct contact between physician and EMT via phone or radio.
Medical Director
-Physician oversight of patient care and quality improvement.
Offline Medical Direction
-Written guidelines and protocols.
-Continuous Quality Improvement
-Continuous audit and review of all aspects of the EMS system to identify areas of improvement.
EMTs first priority is….
-Always scene safety, after personal safety then partner, patient, and then bystanders.
Occupational Safety and Health Administration (OSHA)
-Oversees regulations concerning workplace safety, including infectious diseases precautions.
Scope of Practice
-Outlines the actions a provider is legally allowed to perform based on his or her license or certification level.
Standard of Care
-Is the degree of care a reasonable person with similar training would provide in a similar situation.
Informed Consent
-Is required from all patients who are alert and competent.
Expressed Consent
-Requires that the patient be alert and competent to give expressed consent. Expressed consent can be given verbally or nonverbally.
Implied Consent
- Allows assumption of consent for emergency care from an unresponsive or incompetent patient.
- Implied consent can be used to treat a patient who initially refused care but later loses consciousness or becomes otherwise incapacitated.
Minor Consent
- Minors are not competent to accept or refuse care.
- Consent is required from a parent or legal guardian. Implied consent can be used when unable to reach a parent or guardian and treatment is needed.
- Minor consent is not required for emancipated minors. Criteria for emancipation varies but usually includes minors who are married or pregnant, already a parent, a member of the armed forces, financially independent, or emancipated by the courts.
Involuntary Consent
-Used for mentally incompetent adults or those in custody of law enforcement. Consent must be obtained from the entity with the appropriate legal authority.
Advanced Directives
-Written instructions, signed by the patient, specifying the patient’s wishes regarding treatment and resuscitative efforts. There are several types of advanced directives.
Do Not Resuscitate (DNR)
-DNRs are specific to resuscitation efforts and do not affect treatment prior to the patient entering cardiac arrest.
Living Will
-Living wills are broader than DNRs. They address health-care wishes prior to entering cardiac arrest. This may include use of advanced airways, ventilators, feeding tubes, etc.
Samaritan Law
-Designed to protect someone who renders care as long as he or she is not being compensated and gross negligence is not committed.
Duty to Act
-The EMT had an obligation to respond and provide care.
Breech of Duty
-The EMT failed to assess, treat, or transport patient according to the standard of care.
Damage
-The plaintiff experienced damage or injury recognized by the legal system as worthy of compensation.
Causation
-(also called “proximate cause”). The injury to the plaintiff was, at least in part, directly due to the EMT’s breech of duty.
Gross Negligence
- Gross negligence exceeds simple negligence. Gross negligence involves an indifference to, and violation of, a legal responsibility.
- Reckless patient care that is clearly dangerous to the patient is grossly negligent.
Abandonment
-Once care is initiated, EMS providers cannot terminate care without the patient’s consent. Some patient encounters may also require direct contact with medical direction prior to terminating care. Most EMS agencies have written protocols for terminating care without transporting the patient to a higher level of care.
False Imprisonment
-You may be guilty of false imprisonment if you transport a competent patient without consent.
