- Organ Donation: Only consider the patient for organ donation if there is signed, legal documentation. Treat organ donors the same way that you would treat all other patients. Communicate the possibility of organ donation with medical direction.
- Medical Identification Tag: Look for these during patient assessment as they provide information on any medical conditions the patient may have, including allergies, asthma, diabetes, or epilepsy.
- Death: When in doubt, always assume the patient is alive and begin resuscitation efforts. Signs of death include
- Absence of breathing and pulse.
- Completely unresponsive to any stimuli.
- Rigor mortis.
- Dependent lividity (skin discoloration due to the effect of gravity on blood causing the underside to be dark red to purple).
- Obvious signs such as decapitation, decomposition, and suicide.
- An EMT is unlikely to be sued successfully if there is documentation proving that he or she meets the duty to act, practice within the scope of practice, at a level the same as or above the standard of care.
Terms to Understand and Rules to Abide By
- Duty to Act: While on-duty, EMTs are required by law to care for a patient who requires and consents to it. Different states have different policies for off-duty EMTs, but most will not require an off-duty EMT to help a patient. However, if the EMT does stop to help, then he or she is required by law to continue helping the patient until care is transferred to someone with the appropriate expertise, such as a paramedic or a doctor.
- Scope of Practice: Defines what an EMT with the appropriate licensure can and cannot do by law. It is illegal to perform operations outside your scope of practice.
- Standard of Care: Defined as the level of care at which the average, prudent provider in a given community would practice.
- Medical Direction: EMTs must follow medical direction at all times. This includes off-line directions such as protocols approved by medical direction and on-line directions directly communicated by the doctor. When in doubt, always ask for medical direction.
- Patient Consent: The conscious, mentally competent adult has the right to accept or refuse emergency medical care. Thus, always make sure that the patient consents before beginning emergency care. There are three types of consents: expressed, implied, and that which deals with a minor. Expressed consent is made by conscious, mentally competent adults. Implied consent is automatically assumed if a patient is unresponsive or unable to make a rational decision (e.g. altered mental status). To treat a minor, an EMT must obtain the consent of the parent or guardian. If the parent or guardian is unreachable, then implied consent is assumed.
- Patient Refusal or Withdrawal of Treatment: Always ask the patient to fill out sign a refusal form, including documentation of what was told to the patient and his or her response. However, before this, the EMT should have persuaded the patient to receive care and then made certain that the patient is indeed mentally competent and capable of making rational decisions. When in doubt, ask for medical direction.
- Advanced Directives: these are instructions given in advance such as a DNR (Do Not Resuscitate) order. These directions should be honored if clear, unambiguous documentation exists.
- Confidentiality: laws exist that protect a patient's privacy. The HIPAA (Health Insurance Portability and Accountability Act) of 1996 is a federal law that protects the confidentiality of patient health care information. HIPAA training is required for all EMTs. As a general rule, do not disclose information obtained during emergency care to family, friends, or anyone else.
- COBRA and EMTALA: The Consolidated Omnibus Budget Reconciliation Act and the Emergency Medical Treatment and Active Labor Act prevents hospital discrimination of emergency patients based on the ability or inability to pay. All patients should be transported to the nearest medical facility regardless of their ability to pay. Always obtain the proper documentation when transferring patients between facilities.
- Crime Scenes: when treating patients in a crime scene, always take steps to preserve evidence. These include communicating with police officers, document unusual discoveries, avoid cutting through evidence such as knife or bullet holes in clothing, and ask the patient to avoid washing or going to the bathroom if the crime is rape.
- Reporting: If patient assessment suggests child abuse or crime, report to the appropriate authorities.
- Tort: a wrongful act, injury, or damage. Negligence is an example of a tort.
- Intentional Tort: a tort that is committed knowingly. Examples include abandonment, assault, battery, false imprisonment, and defamation.
- Negligence: occurs when all four of the following conditions are met
- The EMT had a duty to act.
- The EMT breached that duty.
- Harm or damages were caused to the patient.
- The harm or damages were caused by the breach of duty.
- Abandonment: When an EMT begins treating a patient, but stops without transferring the care to someone with appropriate expertise.
- Assault: can occur as an act or a threat to inflict harm on a patient.
- Battery: the act of touching a patient without consent.
- False Imprisonment: keeping and transporting the patient without consent.
- Defamation: Release of damaging information about a patient to the public. Verbal defamation is called slander, and the written form is called libel. The best way to avoid defamation is to maintain patient confidentiality at all times.
- Treat all patients with dignity and respect without respect to factors such as race, gender or creed.
- Treat all coworkers and health care workers with dignity and respect.
- Maintain knowledge and skill competencies as an EMT.
- Exercise honesty and integrity when documenting.
- Advocate for the patient's best interest at all times, even off-duty.
- Good Samaritan Laws exist to protect an off-duty EMT from liability when he or she provides care to patients out of ethical responsibility.