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Special Issues in Emergency Care and Resuscitation > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

Introduction

A
  • medical providers provide care under a set of laws affecting how patients must be treated
  • you must understand the laws and ethics related to emergency care
  • failure to perform your job can result in civil/criminal liability
  • ethics
  • laws
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2
Q

ethics

A
  • deals with the study of distinction between right and wrong
  • this presentation is only a framework
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3
Q

two types of ethics

A
  • personal
  • professional
  • in cases where they conflict you MUST put your personal ethics aside
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4
Q

medical ethics

A
  • medical ethics are related to the practice and delivery of medical care
  • Your understanding of medical ethics must be consistent with the codes of your profession
  • healthcare providers must be accountable for their actions at all times -> choose a mentor
  • professional ethics are also important
  • always be respectful of patients
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5
Q

the oath of geneva

A

– Drafted by the World Medical Association in 1948

– Taken by medical students after completion of their studies

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6
Q

apply 3 basic ethical concepts when making a decision

A
  • do no harm
  • act in good faith
  • act in the patients best interest
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7
Q

the most successful and fulfilled paramedics

A
  • are patient advocates
  • engage in training and professional development
  • put the good of the team first
  • you are responsible the the future of EMS
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8
Q

two types of law that govern health care providers in court

A
  • civil

- criminal

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9
Q

civil law

A
  • patients can sue for perceived injury
  • mental, structural, emotional, physical harm
  • nothing criminal happened
  • concerned with establishing liability
  • civil suit is a legal action of this sort
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10
Q

criminal law

A
  • state can prosecute for breaking a statute
  • from a government going against a organization, person, group
  • action taken by government against someone prosecutors believe violated a law
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11
Q

tort reform

A
  • limitation on how much you can sue

- civil cases mostly

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12
Q

types of law

A
  • most suits against provider involve negligence
  • you did something that led to harm or didn’t do something that led to harm
  • intentional tort claims may also be filed:
  • assault
  • battery
  • libel or slander
  • false imprisonment
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13
Q

arbitration

A
  • in civil law if two parties are suing each other and both want to settle out of court
  • dont want the details to be disclosed
  • mutual terms
  • amount of money is typically less than what was sued for
  • speeds up the process
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14
Q

comission

A

-you did something that you shouldnt have done

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15
Q

omission

A

-an action you should have done

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16
Q

defamation

A
  • communication of false information that damages reputation of a person
  • libel if written
  • slander if spoken
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17
Q

the legal process

A
  • begins when a complaint is filed
  • process may take several years
  • discovery period- everyone gathers all the facts (subpoenas, records, depositions)
  • motions- legal actions, deciding where everyone stands
  • settlement process or trial- arbitration or public trial
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18
Q

healthcare providers must answer to

A
  • medical directors- credentialing employers
  • licensing agency- state level
  • employer- rare employer is separate from medical director
  • despite overlap, distinctions are important
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19
Q

administrative regulations

A
  • set by bureaucracies at state and federal levels
  • affect and define rules for practice
  • policies statements- not laws, govern the way a certain law should be handled
  • administrative law- they review policy statements to make sure they are legal
  • administrative agency may take action against a paramedics license
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20
Q

certifcation

A
  • not the legal ability to do something (that is licensure)
  • certain level of credentials
  • certain level of education
  • criteria met for minimum competency
  • doesnt mean you can do/practice it
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21
Q

licensure

A

-privilege granted by government authority

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22
Q

credentialing

A

granted by employer

-may also be adopted

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23
Q

licensing action may be taken if an infraction occurs

A
  • providers have the right to due process
  • notice
  • opportunity to be heard
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24
Q

medical practice act

A
  • defines minimum qualifications of health service providers
  • defines skills practitioners can use
  • establishes means of licensure/certification
  • may also include relicensure requirements
  • you dont want to practice outside of scope -> civil or criminal law
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25
Q

scope of practice

A
  • care may perform according to the state under it license or certification
  • ex. medical director may not permit paramedic to perform all skills/give all medications
  • practicing outside scope of practice is negligence or a criminal offense
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26
Q

health insurance portability and accountability act

A
  • HIPAA
  • federal essence of healthcare privacy
  • stringent privacy requirements
  • provides for criminal sanctions and civil penalties
  • information can be disclosed:
  • for treatment
  • for payment
  • when authorized- consent
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27
Q

special reporting situations: HIPAA

A
  • mandated reporting- must report child abuse
  • authorized data collection/research- often consented, but if not it is deidentified
  • subpoenas
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28
Q

privacy officer required: HIPAA

A
  • ensures PHI is not released illegally
  • makes sure there isnt improper release of PHI
  • almost every organization has one
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29
Q

HIPAA cont.

A
  • confidentiality is part of the code of ethics for emergency medical technicians
  • you must provide patients with a copy of your services privacy policy
  • HIPAA also regulates electronic information -> end to end encryption
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30
Q

some states have patient confidentiality laws

A

-this is on top of HIPAA
-stricter
-

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31
Q

BAA- business associate agreement

A
  • information is protected by law
  • company follow encryption standards
  • agreement between healthcare and information exchange companies
  • electronic
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32
Q

emergency medical treatment and active labor act (EMTALA)

A
  • establishes to combat “patient dumping”
  • never make decisions based on finances
  • know local transport selection protocols
  • guarantees medical screening exam and treatment
  • regulates patient transfers
  • unfunded mandate
  • cannot turn someone away or send them somewhere else to lesser care
33
Q

emergency vehicle laws

A

-most states have specific statutes
– Define emergency vehicle
– Dictate what traffic should do
• Emergency vehicles must be operated
safely.
– Most states have a higher standard for EMS.
– If a crash occurs, EMS is usually at fault.

34
Q

mandatory reporting

A
  • each state has its own requirements
  • virtually every state has laws for reporting child and elder abuse
  • many states have immunity provisions- if you report someone and you are wrong you cannot be sued for damaging that persons image
  • failure to report a crime - illegal
  • known reporting requirements in your state
35
Q

consent and refusal

A
  • you must obtain consent before providing care
  • to provide consent, a patient must
  • be of legal age
  • possess decision making capacity- can hear and understand the pros and cons of decisions
  • patients can refuse care
36
Q

informed consent

A

-must be obtained from every adult with decision making capacity

37
Q

to obtain informed consent

A
  • signing informed consent does not mean consent -> they must understand
  • describe the problem and proposed treatment
  • discuss risks and alternatives
  • advise the patient of consequences of refusal
38
Q

expressed consent

A
  • type of informed consent
  • used primarily for common procedures
  • gestures that show consent
  • no risk in it
  • ex. blood pressure
39
Q

implied consent

A

-consent that is assumed when an adult is unconscious or too ill/injured to verbally consent

40
Q

involuntary consent

A
  • do a real thing

- oxymoron

41
Q

decision making capacity

A
  • refusals must be informed
  • ability to change your mind
  • ability to choose no treatment even if it means death
  • may not want to admit there is a problem
  • maintain a courteous sympathetic attitude
  • documentation is critical **
  • ability of the patient to:
  • understand information
  • process information
  • make a choice
42
Q

back up refusal forms with action

A
  • do everything you can to inform the patient

- ultimately, respect his or her rights

43
Q

If a conscious patient with decision-making

capacity refuses treatment

A

– Cannot be treated without a court order

– Use your “people skills.

44
Q

emancipated minors

A
  • treated as legal adults because of qualitiying circumstances
  • military
  • pregnant
  • someone who has reason to be apart from parents -> legal orders
45
Q

obtaining consent is a difficult skill

A

-tour expertise will build over time

46
Q

Obtain consent from a legal guardian

A

– In loco parentis if guardian is unavailable

  • Notify law enforcement and medical control if a parent refuses necessary treatment.
  • State may assume custody
47
Q

violent patients and restraints

A
  • you can only use force in response to a patients force against you or themselves
  • do not enter an unsafe scene
  • only restrain medical patients who are a danger to themselves or others
48
Q

negligence and protection against negligence claims

A
  • no protection for gross negligence
  • behaving according to established standards and procedures is the best protection
  • consider insurance coverage
  • negligence occurs when:
  • there was a legal duty to the patient
  • there was a breach of duty- you did or didnt do something that you should have
  • the failure to act was the proximate cause of injury- cause
  • harm resulted
49
Q

foreseeability

A
  • if this same situation was given to these (other) people would they have foreseen the situation and avoided it
  • using your knowledge to see into the future and know the consequences of your actions -> if someone was hypoxic and goes into cardiac arrest…why didnt you intubate them when you had the chance
50
Q

negligence is typically divided into three categories

A
  • Malfeasance- did the wrong action
  • Misfeasance- right action, wrong circumstances
  • Nonfeasance- lack of action
51
Q

duty

A
  • prescribed by law
  • do not further harm to patient
  • obligated to respond to calls while working
  • typically not while off duty
  • make sure appropriate personnel respond
  • must perform within a standard of care when providing assistance
  • Cannot abandon the patient once care begins
  • Must maintain licensure or certification and skills
52
Q

breach of duty

A
  • standard of care
  • what a reasonable paramedic would do in a similar situation
  • some states distinguish between ordinary and gross negligence (he said not to worry about this part)
  • Re ipsa loquitur or negligence per se may apply
53
Q

proximate cause

A

-improper action or failure to act caused harm

54
Q

harm

A
  • usually physical injury

- may also include emotional distress, loss of income, loss of spousal consortium, etc.

55
Q

abandonment

A
  • termination of care without patients consent
  • implies continuing need for treatment
  • once you respond you cannot leave until a provider with equal or higher training takes responsibility.
56
Q

patient autonomy

A
  • resolve ethical conflicts through communication
  • if you disagree, discuss it
  • always act as a patient advocate
  • you may need to treat a patient against his or her wishes
  • if someone has capacity they can refuse
57
Q

advance directives

A
  • expresses medical care, if any, the patients wants if he or she can no longer articulate personal wishes
  • do not hospitalize
  • do not intubate
  • do not resuscitate
  • differs from state to state:
  • laws are often state to state
  • know and follow state laws
58
Q

types of advance directives

A

-related to end of life medical care
-sometimes called durable powers of attorney
=the living will.
-Durable power of attorney for health care/Medical power of attorney.
-POLST (Physician Orders for Life-Sustaining Treatment)
-Do not resuscitate (DNR) orders.
-Organ and tissue donation.

59
Q

various types of powers of attorney

A

-not all authorize health care

-

60
Q

surrogate decision maker

A
  • has no authority until patient becomes incapable
  • defer to patient whenever possible
  • when unsure, begin care
61
Q

DNR order

A
  • do not resuscitate
  • describes which life sustaining procedures, if any, should be performed
  • laws differ between states
  • may include a physician order or medical jewelry
  • you must still provide supportive measures if a patient is not in cardiac arrest
  • you still must treat just do not resuscitate
  • DNRS must generally:
  • clearly state medical problem
  • have patient/guardian signature
  • have signature of one or more physician
62
Q

durable power of attorney

A
  • only certain specific certain circumstances

- ex. only if they are intubated

63
Q

end of life decisions

A
  • you will often deal with patients at the very end of their lives
  • treat with respect and empathy
  • never question why help was called
  • providing information and support is part of your job
  • avoid imposing your own moral code
  • respect patients wishes even if you disagree
  • you may encounter confusing scenarios
  • resuscitate until paperwork is confirmed
  • avoid hostile encounters with family members who disagree with patients wishes
64
Q

Medical orders for life-sustaining treatment (MOLST)

A
  • Similar to DNR, but more expansive
  • May apply with impending pulmonary failure
  • Guide use of CPR, intubation, feeding tubes antibiotics, palliative care
  • not an advance directive
65
Q

medical examiner cases

A
  • involvement depends on nature/scene of death
  • examiner notified in cases of:
  • dead on arrival (DOA)/dead on scene (DOS)
  • death without previous medical care
  • suicide
  • violent death
66
Q

defenses to litigation

A
  • your first defense is an open, informative, trust based relationship with patients
  • when this is not possible, several defenses may be used including:
  • statute of limitations
  • contributory negligence
67
Q

good samaritan legislation

A
  • provides immunity from liability- passed to encourage public to help
  • apply when youre not working and in public
  • doe snot apply while on duty -> legal duty applies
  • must do all you can, within your knowledge
68
Q

american with disabilitys act (ADA)

A
  • protects qualified persons with disabilities from employment discrimination
  • all aspects of employment (hiring, salary, etc.)
  • for ADA protection, a person must:
  • Have a disability that limits life activities
  • Possess the basic qualifications and be able to perform the essential job functions
  • Employers cannot inquire about disabilities or require a medical exam until after the job offer is made.
  • Reasonable accommodations must be provided.
  • Employers are not required to give preference to disabled employees.
69
Q

Title VII of the Civil Rights Act

A

-Prohibits discrimination based on race, color,
religion, gender, national origin
-Also prohibits sexual harassment
-Applies to all aspects of employment
-Generally, a pattern over time, not single incident

70
Q

sexual harassment

A
  • Sexual comments
  • Display of offensive material
  • Unwelcome advances, touching
  • Inappropriate personal inquiries
  • Employers are obligated to prevent harassment.
  • Must investigate all claims promptly
  • Must provide training
  • Employees must promptly report any harassment
71
Q

Additional Federal Laws Dealing With Discrimination

A
  • Pregnancy Discrimination Act- cannot discriminate
  • Equal Pay Act of 1963- gender gap, race gap
  • Men and women who perform equal work in the same workplace must receive equal pay.
  • Age Discrimination in Employment Act of 1967
72
Q

Family Medical Leave Act (FMLA)

A
  • Up to 12 weeks unpaid leave per year
  • For eligible employees
  • Under certain circumstances
  • Some states have their own versions.
  • May provide more rights
73
Q

Occupational Safety and Health Administration (OSHA)

A
  • Regulates safety in the workplace
  • States may enforce regulations tighter.
  • Covers all employers
  • Additional responsibilities in health care
  • standards are often changing
  • Do all you can to avoid injuries.
74
Q

Ryan white act

A
  • Provides safeguards and protections for health care workers exposed or potentially exposed to certain designated diseases
  • Notify your infection control officer if you believe you may have been exposed
  • assess to medical records even without consent
75
Q

National Labor Relations Act (Wagner Act)

A
  • Establishes:
  • Rights of unions and union workers
  • Regulates unfair labor practices by employers
  • Become familiar with your rights and the union laws in your state
76
Q

assault

A
  • Unlawfully placing person in fear of immediate bodily harm

- Example: restraint

77
Q

battery

A

-Unlawfully touching a person

– Example: providing care without consent

78
Q

kidnapping

A
  • Seizing, confining, abducting, or carrying away by force
  • Example: transport against will
  • A false imprisonment charge is more likely (defined as unauthorized confinement of a person).
79
Q

documentation = protection

A
  • Complete promptly after patient contact.
  • Be thorough.
  • Be objective.
  • Be accurate.
  • Maintain patient confidentiality.
  • Never alter a patient care record

Special Issues in Emergency Care and Resuscitation (15 decks)

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