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Medico Legal Aspects Of Prehospital Care
This document provides an overview of legal and ethical issues in prehospital emergency care. It discusses the differences between legal, ethical and moral responsibilities and reviews laws impacting EMS providers, such as scope of practice and vehicle operation laws. It also examines accountability and malpractice, including the standard of care and elements required to prove negligence. Specific issues related to patient consent, refusals, restraint and confidentiality are analyzed. The document concludes with discussions of operational concerns like equipment failure, documentation requirements and interactions with law enforcement.
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Medico Legal Aspects Of Prehospital Care
- 1. Medical/Legal Aspects ofPrehospital Care Dr. Ashendu Pandey
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- 15. Topics to DiscussLegal vs. Ethical vs. Moral Responsibilities Review of the Legal System Specific Laws Applicable to EMS Accountability & Malpractice Specific Paramedic-Patient Issues Operational Issues Documentation
- 16. Legal vs. Ethicalvs. Moral Responsibilities What are the differences? Legal Responsibilities Ethical Standards Morality
- 17. Legal vs. Ethicalvs. Moral Responsibilities Legal Responsibilities Established by the law-making bodies of government Ethical Standards Principles of conduct identified by members of a group or profession Morality Individual’s assessment of right and wrong
- 18. The Legal SystemSources of Law Constitutional Administrative Legislative and Administrative are often the focus of EMS Providers
- 19. The Legal SystemCentral Vs State law Categories of Law Criminal Law Civil Law Tort Law What are examples of how each of these may affect the paramedic?
- 20. The Legal SystemTerminology Plaintiff Defendant Discovery phase Deposition Interrogation Documentation Appeal
- 21. Laws Affecting EMSScope of Practice Paramedic Vs MBBS Vs Specialist Ability to Practice Certification or Licensure Authorization to Practice
- 22. Laws Affecting EMSMotor Vehicle Laws Infectious Disease Exposure Assault against Public Safety Officer Obstruction of Duty Good Samaritan Law
- 23. Laws Affecting EMSMandatory Reporting Criminal Acts MLC Animal Bites Communicable Diseases Out of hospital deaths Possession of Controlled Substances
- 24. Accountability & MalpracticeIssues Standard of Care Negligence Liability when off-duty
- 25. Accountability & MalpracticeStandard of Care The expected care, skill, & judgment under similar circumstances by a similarly trained, reasonable paramedic Negligence Deviation from accepted or expected standards of care expected to protect from unreasonable risk of harm What are the required components for proof of a negligence claim in EMS?
- 26. Accountability & MalpracticeElements Required to prove Negligence Duty to Act Breach of duty Actual damage or harm Proximate cause
- 27. Accountability & MalpracticeCivil Cases Proof of guilt required by a “preponderance of evidence” “res ipsa loquitur” Burden of proof shifts to the defendant Simple vs. Gross Negligence
- 28. Defenses Good SamaritanLaw Government Immunity Statue of Limitations Contributory Negligence
- 29. Specific Paramedic-Patient IssuesIssues Surrounding Consent Refusals Restraint Abandonment Transfer of Patient Care Out of Hospital Death Confidentiality & Privacy
- 30. Specific Paramedic-Patient IssuesIssues Surrounding Consent Patient has legal & mental capacity Patient understands consequences Types of Consent Informed Expressed Implied Involuntary
- 31. Specific Paramedic-Patient IssuesIssues Surrounding Consent Specific Consent Issues Minors Prisoners
- 32. Specific Paramedic-Patient IssuesRefusals Consent for Transport vs. Treatment Withdrawing Consent Refusal of Service Has legal & mental capacity Is informed of risks & benefits Offer alternatives All of the above are well documented & witnessed
- 33. Specific Paramedic-Patient IssuesRefusals Incompetent Persons Unable to understand the nature & consequences of his/her injury/illness Unable to make rational decisions regarding medical care due to physical or mental conditions Do not assume incompetence unless obvious
- 34. Specific Paramedic-Patient IssuesRestraint In Custody of Law Enforcement or Corrections Patient is not competent to refuse & requires care Patient is a danger to self or others (involve law enforcement) Does not provide authorization to harm!
- 35. Specific Paramedic-Patient IssuesRestraint Involve Law Enforcement Early Have a plan of action Ensure safety of all Reasonable force Physical restraints Chemical restraints Document well
- 36. Specific Paramedic-Patient IssuesPatient Abandonment Unilateral termination of the patient-provider relationship Still needed and desired Exceptions MCI Risks to well-being
- 37. Specific Paramedic-Patient IssuesTransfer of Patient Care Transfer of Care to other Providers Transfer of Care at the ED
- 38. Specific Paramedic-Patient IssuesOut of Hospital Death Can EMT declare a patient dead?? SOP for out f hospital death
- 39. Specific Paramedic-Patient IssuesPatient Confidentiality & Privacy “Medical information about a patient will not be shared with a third party without consent, statute, or court order”
- 40. Specific Paramedic-Patient IssuesPatient Confidentiality & Privacy Colleague & Station Talk Must not identify the patient Maintains confidentiality of specific medical info Scene or Patient Photographs EMS Radio Dispatch & Discussions “Need to Know” Basis
- 41. Operational Issues Equipmentfailure Interaction with Law Enforcement Crime Scenes Preservation of Evidence Vehicle Operation Medical Control Instructor Liability Hospital Selection Dispatch Interfacility Transfers
- 42. Operational Issues EquipmentFailure Product Liability Design flaw in ventilator Failure on part of owner/operator No backup battery for defibrillator
- 43. Operational Issues Interactionwith Law Enforcement Crime Scenes Request law enforcement Await law enforcement arrival if possible Minimize areas of travel and contact with scene Document any alterations to the scene created by EMS personnel Minimize personnel within scene if possible Document pertinent observations
- 44. Operational Issues Interactionwith Law Enforcement Evidence Preservation Avoid cutting through penetrations in the clothing Save everything – clothing of assault victim, items found on person, etc Prevent sexual assault victim from washing Follow sound chain of evidence procedures
- 45. Operational Issues VehicleOperation It is 3:00 am. While responding to a MVC, a driver fails to yield the right of way at an intersection. The driver’s traffic signal is green. You attempt to stop but are unable to do so. Witnesses state your emergency lights were on but do not recall hearing your siren. The driver is injured. (cont’d)
- 46. Operational Issues VehicleOperation What issues might the driver’s attorney consider? Were all of your emergency lights really operational? Are daily inspections performed? Why was the siren not working? Were poorly maintained brakes responsible for your inability to stop? What type of PM is performed on your ambulance? Did you exercise due regard for the safety of others?
- 47. Operational Issues MedicalControl Issues Failure to follow med contr direction Following obviously harmful direction Implementing therapies without prior authorization Following direction of an unauthorized person Med Contr directs EMS to an inappropriate hospital The paramedic exceeds the scope of his training or medical authorization
- 48. Operational Issues InstructorLiability Student discrimination Sexual harassment Student injury during laboratory Patient claim re. Failure to properly train graduate or supervise student Instructors – Follow curriculum, document student attendance & competency
- 49. Operational Issues HospitalSelection Paramedic & Medical Control decision Closest & Appropriate Facility Written policies or guidelines What is the closest & most appropriate facility? What does this mean?
- 50. Operational Issues DispatchIssues Untimely dispatch Failure to provide responding units with adequate directions (incorrect address) Dispatch of inadequate level of care Failure to provide pre-arrival instructions Inadequate recordkeeping
- 51. Operational Issues InterfacilityTransfer Issues Do you have the necessary equipment & training? Should any specialized providers accompany you? Do you have a patient report including history? Is the patient “stable”? What are the potential complications? Are there any specific physician orders? Has the patient been accepted? Who are the transferring & accepting physicians?
- 52. Documentation Patient ConfidentialitySecuring/Sharing/Requests for Information Quality & Effectiveness
- 53. Documentation Patient ConfidentialityWritten report only intended for those with a need to know Personal identifiers may be removed for QA/QI uses Patient radio reports should not contain personal identifiers
- 54. Documentation Securing/Sharing/Requests forInformation Where are completed patient reports stored? Who received the report at the ED? Requests for copies should be routed through an accepted policy or an attorney Does the requestor have a need to know?
- 55. Documentation Quality &Effectiveness Complete soon after the patient contact Be thorough and accurate Be honest, objective and factual Caution with abbreviations Maintain confidentiality Do not alter
- 56. Documentation Quality &Effectiveness Does your report relay to future healthcare providers the information you obtained regarding this patient? Is the information clear and concise? Will the report help you recall this incident if necessary 3 years from now? Are you willing to sit in court with only this document?
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