Patient Refusal: any conscious, alert pt with decision making capacity can refuse emergency care at any time. There are times when you disagree with a refusal in such situation, the pt needs to a sign a refusal form acknowledging they are aware of all risks that may occur in doing so. You may have already packaged the pt and may be on the way to the ED and they refuse continuing care, at such moment you can let them leave your ambulance in a safe location of course and they will be responsible for their health at that point, again have them sign the refusal form. There may be various reasons why someone would refuse care, fear of doctors, they may be scared of reprisal from an abusive partner who caused injuries, etc. The most important things to remember is to document everything and snag a witness if you can, and always know that as long as they are able they can refuse what they want. Do express to the pt and/or family member to follow up with doctor or ED if pain/symptoms persist.
Confidentiality: shall not be breached by anyone without permission from patient or court order. Again, make sure you are not violating HIPAA laws, which can cause legal action to be taken upon you if you do.
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Advance Directive/DNR: document that specifies treatment is pt is unable to do so, commonly used in geriatric pts or terminally ill.
With laws differing in each state, the standard requirement for a DNR is: statement of medical problem, signature of pt or guardian, one or more health providers, and an expiration date (in some states). Being presented with a DNR can prove difficult and put you a sticky situation when family members may want you to do the opposite. In a case when someone has a DNR and you are presented with it, you should exhaust all efforts to resuscitate. The order still means you can provide oxygen, comfort if needed. You may also be in a situation when just providing emotional support can help.
Death: we are technically not allowed to declare someone dead, but if all efforts are exhausted to resuscitate then consulting with med control should be done to declare (in some cases).
Physical signs of death include: pulseless/apneic pt, cyanosis, no BP, low body temp, rigor mortis (stiff body muscles, first developed in face and jaw), obvious mortal damage (decap), dependent lividity (blood settled in body), putrefaction (body decomp)
Scope of practice : the care you are legally authorized to provide. For example, EMTs and paramedics have different scopes of practice, we can assist a pt in med admin and medics can actually administer meds, and have access to multiple. Staying without your scope of practice can prevent legal action being taken against you in something you arent trained in.
Negligence is failure to provide the same care a person with similar training will provide in a situation. You can be charged with negligence based on these 4 factors: 1. duty: obligation to provide care 2. breach of duty: doesnt act to provide reasonable care 3. pt is physically/psychologically harmed 4. causation: the cause of those such injuries that could happen.
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Abandonment: ceasing care of pt or not transferring care to an equal or higher lever provider, TURNOVER is very important, you can hand of a pt to check in clerk at the front desk of ED, transfer to someone who will assume proper responsibility.
Assault: "words"
Battery: "action"
if you verbally threaten someone that is assault and if unlawfully touch someone that is battery.
Kidnapping/False imprisonment: failure to let a pt out of an ambulance after refusal of care can be classified as false imprisonment and you can be tried.
Defamation: you always hear the term defamation of character, which is false information spread to ruin a reputation. Defamation in writing is libel and that is spoken in slander.