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You Are the Emergency Medical Responder

Lesson 4: Medical, Legal and Ethical Issues. You Are the Emergency Medical Responder.

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You Are the Emergency Medical Responder

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  1. Lesson 4: Medical, Legal and Ethical Issues You Are the Emergency Medical Responder A20-year-old cyclist on a mountain bike team was temporarily unconscious after falling off his bike during practice. As the athletic trainer for the team, you respond to the incident. The injured cyclist is awake but complaining of dizziness and nausea. After assessing and taking a history and baseline vital signs, you tell him to go home and rest.

  2. Obtaining Consent As an EMR, you must— • Identify yourself to the patient. • State your level of training. • Ask if you may help. • Explain observations. • Explain what is planned.

  3. Types of Consent • Directly expressed • Verbal • Gesture • Implied • Patient is unconscious, confused, mentally impaired, seriously injured or seriously ill • Assumption that the patient would give consent if able to do so

  4. Refusal of Care • Must be honored • Not an all-or-nothing issue • Specific steps to follow if patient refuses care

  5. Advance Directives • DNR (DNAR) • Living will • Durable power of attorney • Health care proxy, attorney-in-fact, agent, patient advocate • Next of kin

  6. Activity You are called to the home of a patient with cancer. The patient’s daughter called because her father was experiencing severe nausea and vomiting over the past few days after receiving chemotherapy. The daughter tells you that her father has not been able to keep anything down, including liquids. The patient is lying on the couch, moaning quietly. He tells you, “Just let me die.”

  7. Other Legal Issues • Assault • Battery • Abandonment • Negligence

  8. Requirements for Negligence • The EMR had a duty to act. • The EMR breached that duty. • The patient was injured due to the EMR’s breach of duty (proximate cause). • Harm or injury occurred.

  9. Confidentiality and Privacy • HIPAA • Privacy protection for protected health information (PHI) • Written consent necessary for release of information

  10. Permitted Disclosure Without Consent • Payment of services • Mandatory reporting situations (public health issues and law enforcement issues) • Research • Abuse, neglect or domestic violence • Organ-procurement agencies • Health oversight agency • Workmen’s compensation programs

  11. Special Situations • Medical ID tags • Obvious death • Organ donation • Evidence preservation

  12. Mandatory Reporting • Abuse or neglect • Injuries from a crime • Suspected sexual assault (in some states) • Some infectious diseases (differs by state, updated annually) • Tuberculosis (TB) • Hepatitis B • HIV • AIDS

  13. You Are the Emergency Medical Responder At home, the cyclist loses consciousness and his roommate calls for an ambulance. Later, at the hospital, he is diagnosed as having a severe head injury that could have been minimized if medical care had been provided earlier.

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