Emt – patient relationships

EMT – Patient Relationships

Confidentiality

HIPAA

Defamation

Consent

Refusal of Service

Confidentiality

Confidentiality means that any medical or personal information about a patient – including medical history, assessment findings, and treatment – will not be released to a third party without the express permission of the patient or legal guardian. However, there are specific circumstances under

which a patient’s confidential information may be released:

Confidentiality

Patient consents to the release of his records. A Pt may request a copy of his medical records

for any reason. If the Pt is a child, consent for release of medical

records must be obtained from the child’s parent or other legal guardian.

Request should be in writing May be released to physician, insurance company,

attorney or other party if specified

Confidentiality

Other medical care providers have a need to know. On-line medical direction ER nurse/doctor

Permitted because it allows medical care appropriate for Pt to be continued

NOT acceptable to discuss confidential Pt info with medical providers who have no responsibility for the Pt’s care.

Confidentiality

EMS is required by law to release a patient’s medical records. Court Order Subpoena (a command to appear at a certain

time and place to give testimony) Consult with counsel

Confidentiality

There are third-party billing requirements

Confidentiality

Penalties for violation of Pt Confidentiality The law provides penalties for the breach of

confidentiality. The improper release of information may result in a lawsuit against the EMT for defamation (libel or slander), breach of confidentiality, or invasion of privacy. If found guilty, the paramedic may be responsible for paying money damages to the patient.

Confidentiality

Libel Is the act of injuring a person’s character, name,

or reputation by false statements made in writing or through the mass media with malicious intent or reckless disregard for the falsity of those statements.

Slander Is the act of injuring a person’s character, name,

or reputation by false or malicious statements spoken with malicious intent or reckless disregard for the falsity of those statements.

HIPAA

Health Insurance Portability and Accountability Act

It adds important new layers of privacy protection for EMS patients. EMS providers must develop administrative,

electronic, and physical barriers to unauthorized disclosure of Pt’s protected health information.

HIPAA

Disclosure of information – except for purposes of treatment, obtaining payment for services, health care operations, and disclosures mandated or permitted by law – must be in preauthorized in writing.

HIPAA provides both civil and serious criminal penalties for violations of privacy.

HIPAA

Patients are given the right to inspect and copy their health records, restrict use and disclosure of their individually identifiable health information, amend their health records, require a provider to communicate with them confidentially, and account for disclosures of their protected health information except for treatment, payment, health care operations, and legally required reporting purposes.

HIPAA

Invasion of privacy An EMT may be accused of invasion of privacy

for the release of confidential information, without legal justification, regarding a Pt’s private life, which might reasonably expose the Pt to ridicule, notoriety, or embarrassment. That includes, for example, the release of information regarding HIV status or other sensitive medical information. The fact that released information is true is not a defense to an action for invasion of privacy!

Consent

Consent The granting of permission to treat. More

accurately, it is the granting of permission to touch.

It is based on the concept that every adult human being of sound mind has the right to determine what should be done with his own body.

Touching a Pt without appropriate consent may subject you to charges of assault and battery.

Consent

Competent A Pt must be competent in order to give or

withhold consent. Lucid Understands your questions and recommendations Understands implications of his decisions

Although there is no absolute test for determining competency, keep the following factors in mind when making a determination: the Pt’s mental status, the Pt’s ability to respond to questions, statements regarding the Pt’s competency from family or friends, evidence of impairment from drugs or alcohol, or indications of shock.

Consent

Informed Consent Conscious, competent Pt’s have the right to

decide what medical care to accept. However, for consent to be legally valid, it must be informed consent. That is, a Pt must understand the nature, risks, and benefits of any procedures to be performed. Therefore, before providing medical care, you must explain the following to the Pt in a manner he can understand.

Consent

Nature of the illness or injury Nature of the recommended treatments Risks, dangers, and benefits of those

treatments Alternative treatment possibilities, if any, and

the related risks, dangers, and benefits of accepting each one

Dangers of refusing treatment and/or transport

Consent

Informed consent must be obtained from every competent adult before treatment may be initiated. Conscious, competent Pt’s may revoke consent at any time during care and transport.

Generally, a child’s parent or legal guardian must give informed consent before treatment of the child can begin.

Consent

Express consent Verbal, nonverbal, or written communication by a

Pt that he wishes to receive medical care. Implied consent

Consent for treatment that is presumed for a patient who is mentally, physically, or emotionally unable to grant consent.

Involuntary consent Consent to treatment granted by the authority of a

court order.

Consent

A competent adult in police custody does not necessarily lose the right to make medical decisions for himself. In fact, many prisoners have successfully sued

health care providers for rendering treatment without consent. Generally, forced treatment is limited to emergency treatment necessary to save life or limb or treatment ordered by the court.

Consent

Minor Under 18 Consent should be obtained from a parent or,

legal guardian, or court-appointed custodian. The same is true for a mentally incompetent adult If a responsible person can not be located, and if

the child or mentally incompetent adult is suffering from a apparent life-threatening injury or illness, treatment may be rendered – implied consent

Consent

Emancipated Minor An emancipated minor is considered an adult. This is a person under 18 who is married,

pregnant, a member of the armed forces, or financially independent and living away from home.

As an adult, an emancipated minor may legally give informed consent. Anyone else under the age of 18 may not grant informed consent.

Consent

Withdrawal of consent A competent adult may withdraw consent for any

treatment at any time. However, refusal must be informed.

A common example of a Pt withdrawing consent occurs after a hypoglycemic Pt regains full consciousness with the administration of dextrose. The Pt should be encourage - but may not be forced - to go to the ER

Consent

Withdrawal of consent Sometimes Pt’s choose to accept one

recommended treatment but refuse others. For example, a Pt involved in an MVA may refuse to be fully immobilized but ask to be transported to the hospital. Explain importance of treatments and possible

repercussions. Fully document circumstances of refusal Get signature on AMA form

Refusal of Service

Not every EMS run results in the transportation of a Pt to a hospital. Emergency care should always be offered to a Pt, no matter how minor the injury or illness may be. However, often, the Pt will refuse. If this occurs, you must:

Refusal of Service

Be sure the Pt is legally permitted to refuse care; that is, the Pt must be a competent adult.

Make multiple and sincere attempts to convince the Pt to accept care.

Enlist the help of others, such as the Pt’s family or friends, to convince the Pt to accept care.

Refusal of Service

Make certain that the Pt is fully informed about the implications of his decision and the potential risks of refusing care.

Consult with on-line medical direction Have the Pt and a disinterested witness, such

as a police officer, sign a release-from-liability form (AMA).

Advise the Pt that he may call you again for help if necessary.

Refusal of Service

Attempt to get the Pt’s family or friends to stay with the Pt.

Document the entire situation thoroughly and accurately on your PCR.

Legal Complications

Abandonment Abandonment is the termination of the EMT – Pt

relationship without providing for the appropriate continuation of care while it is still needed and desired by the Pt. You can not initiate Pt care and then discontinue it

without sufficient reason. You can not turn the care over of a Pt over to

personnel who have less training than you without creating potential liability for an abandonment action.

Legal Complications

Assault Assault is defined as unlawfully placing a person

in apprehension of immediate bodily harm without his consent.

For example, your Pt states that he is scared of oxygen masks and refuses to allow you to place a mask on his face. If you hook up a mask and bring it to his face, you may be liable for assault.

Legal Complications

Battery Battery is the unlawful touching of another

individual without his consent. It would be battery to place the oxygen mask on

your Pt or otherwise touch your Pt without consent.

An EMT can be sued for assault and battery in both criminal and civil contexts.

Legal Complications

False Imprisonment False Imprisonment may be charged by a patient

who is transported without consent or who is restrained without proper justification or authority.

It is defined as intentional and unjustifiable detention of a person without his consent or other legal authority, and may result in civil or criminal liability.

Legal Complications

False Imprisonment This is a particular problem with psychiatric Pt’s.

In most cases, you can avoid allegations of false imprisonment by having a law enforcement officer apprehend the Pt and accompany you to the hospital. If no officer is available (DUH) you should attempt to consult with medical direction and carefully judge the risks of false imprisonment against the benefits of detaining and treating the Pt.

Legal Complications

False Imprisonment You should determine whether medical treatment

is immediately necessary and whether the Pt poses a threat to himself or to the public when you are making your decision to treat or transport.

Legal Complications

Reasonable force If it is safe to do so, you may use a reasonable

amount of force to control an unruly or violent Pt. The definition of reasonable force depends on the amount of force necessary to ensure that the Pt does not cause injury to himself, you, or others.

Excessive force can result in liability for the EMT. The use of restraints may be indicated for a

combative Pt. Restraints must conform to your local protocols.


1. The termination of the EMT – Pt relationship by the EMT without assurance that an equal or greater level of care will continue is known as:

a) assault

b) abandonment

c) misfeasance

d) battery


2. The principal of law that prohibits the release of medical or other personal information about a patient without the patient’s permission is known as:

a) privacy

b) privilege

c) primum non nocere

d) confidentiality


3. Pt is a 16 y/o male reported to have ingested 8-10 beers over 2 hours. He fell while jumping on a trampoline, striking his head on the paved driveway. No LOC but Pt has a laceration to the occipital area of the head. Pt is CA&Ox4 but shows not concern for seriousness of his injury and has slurred speech. The parents are not available. Which is the best course of action?


a) Treat the Pt under the doctrine of implied consent of the parents

b) Have the Pt arrested for underage drinking and obtain the consent of law enforcement to treat the Pt

c) Treat the Pt as an emancipated minor and allow him to decide whether he wants treatment and transport

d) Use the doctrine of res ipsa loquitur to support your decision to either treat and release or treat and transport


4. The type of consent that must be obtained from a conscious, competent, adult Pt before an EMT can begin treatment is called __________ consent.

a) informed

b) implied

c) ex officio

d) voluntary


5. Your Pt is a 45 year old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The Pt’s wife called EMS because he has refused to take his lithium and is “driving her crazy with his hyperactive attitude.” She insists that you transport him to the hospital. The Pt admits to voluntary noncompliance with his lithium, stating he has not felt “this good for a long time.”


He is curious about your job and wants to know how he could get into an EMT class. He states that he’s also thinking about going to law school but wants to finish his PhD first. The physical examination is unremarkable, and HR=82, BP=122/80, RR=10, SaO2=99%. He says, “See, I told you I’m fine. I don’t need to go to the hospital.” Which one of the following is the best course of action?


a) Restrain the Pt if necessary and transport.b) Request police backup, restrain the Pt, and

transport to the ER for evaluation.c) Explain to the wife that you cannot force the

Pt to go to the hospital and that if he refuses you must have him sign an AMA form and leave.

d) Explain to the Pt that he has no choice. If he is unwilling to take his medication, you must take him to the hospital for evaluation.


6. Under the confidentiality doctrine, as an EMT, you may release otherwise confidential Pt information, without consent, to:a) the Pt’s employer if Pt has a transmittable disease.b) other medical care providers who have a need to know.c) the Pt’s school if Pt has a transmittable disease.d) All of the above.


7. Your Pt is a 59 y/o female, who has consumed an unknown amount of alcohol, is found inside her crashed car. There are no other passengers and bystanders do not know her. She is conscious and able to give you her name. However, she does not know where she is, how she got here or what year it is. She complains of abdominal pain. Vitals show HR=120, RR=35, BP=80/45, SaO2=85%. Pt states she is fine and does not wish to be treated or transported. You should:


a) Attempt to have Pt sign an AMA and call a tow truck for her car.

b) Go through Pt’s purse and cell phone and attempt to contact family.

c) Treat and transport under implied consent doctrine.

d) Call Law Enforcement for at 51-50 hold and orders to treat and transport.


8. Pt is a 20 y/o male who is severely injured and has facial injuries. This vitals are WNL and ABCs are good. You attempt to communicate with the Pt to obtain consent but Pt is unable to speak. When you ask Pt if you can help he is only able to nod his head. You should:


a) Begin treatment immediately

b) Not treat the Pt because he is unable to give you verbal consent.

c) Find a pen and paper to obtain written consent before treatment.

d) Withhold treatment until Pt is able to consent or loses consciousness and rely on implied consent.


9. An emancipated minor is a minor who is all but which of the following:

a) pregnant

b) a runaway

c) married

d) a member of the armed forces

e) financially independent


10. Battery is?

a) the same as assault.

b) always permissible if the Pt needs treatment.

c) unlawful touching of another individual.

d) 12 volt in most vehicles.


Scenario You are dispatched to a single vehicle MVA,

vehicle into a tree. Unknown number of Pts and Unknown injuries.

Location is at the rear of CCVFD There is no report of fire or entrapment. Unit 306 and 309 are dispatched.

Emt – patient relationships

Health & Medicine

Transcript of Emt – patient relationships