NREMT EMT 1: Scene Size-Up and Safety - Legal and Ethical Duties, Consent, Implied Consent, Refusal of Care, Advance Directives

What This Is: Legal and Ethical Duties in Emergency Care

When someone is injured or ill, we need to know what to do to help them. This includes getting their permission to treat them, respecting their wishes if they don't want care, and following rules to keep everyone safe. Think of it like a recipe: we need the right ingredients (permission, consent, and safety), the right steps (assessment, treatment, and communication), and the right attitude (respect, empathy, and professionalism).

Key Steps / Core Facts:

• Informed Consent: Getting permission from the patient to treat them, explaining what we're doing and why. (e.g., "I'm going to give you oxygen to help you breathe.")
  • Why it matters: We need to respect their autonomy and decision-making.
  • Example: A patient with a Do Not Resuscitate (DNR) order.
• Implied Consent: Assuming permission to treat someone in an emergency, like a car accident. (e.g., "I'm going to check your airway, breathing, and circulation.")
  • Why it matters: We need to act quickly to save lives.
  • Example: A person is unconscious and can't give consent.
• Refusal of Care: When a patient doesn't want treatment, like a patient with a DNR order.
  • Why it matters: We need to respect their wishes and not force treatment.
  • Example: A patient with a DNR order refuses CPR.
• Advance Directives: Documents that outline a patient's wishes for care, like a living will or power of attorney.
  • Why it matters: We need to respect their wishes and follow their instructions.
  • Example: A patient has a living will that says they don't want life-sustaining treatment.
• Patient Autonomy: Respecting the patient's right to make decisions about their care.
  • Why it matters: We need to prioritize their needs and wishes.
  • Example: A patient refuses a medication.
• Confidentiality: Keeping a patient's medical information private.
  • Why it matters: We need to protect their trust and maintain confidentiality.
  • Example: A patient's medical record is accessed without permission.
• Cultural Competence: Providing care that respects a patient's cultural and linguistic background.
  • Why it matters: We need to be sensitive to their needs and provide care that's tailored to them.
  • Example: A patient speaks a language we don't understand.
• Communication: Clearly explaining what we're doing and why to the patient and their family.
  • Why it matters: We need to keep them informed and involved in their care.
  • Example: A patient's family member asks about their condition.
• Safety: Ensuring the patient and others are safe during treatment.
  • Why it matters: We need to prevent harm and injury.
  • Example: A patient is at risk of falling.
• Documentation: Accurately recording a patient's medical information.
  • Why it matters: We need to maintain accurate records and communicate with other healthcare providers.
  • Example: A patient's medical record is incomplete.

What Laypeople Can Do:

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder.
• If someone is injured, call 911 and provide basic first aid (like applying pressure to a wound).
• If someone is having a medical emergency, try to stay calm and provide information to the 911 operator.
• If someone is refusing treatment, respect their wishes and don't force care.
• If someone has an advance directive, respect their wishes and follow their instructions.

Common Mistakes:

• Mistake: Assuming implied consent is the same as informed consent.
  • Fix: Informed consent requires explicit permission from the patient.
• Mistake: Not respecting a patient's refusal of care.
  • Fix: We need to respect their autonomy and decision-making.
• Mistake: Not documenting patient information accurately.
  • Fix: We need to maintain accurate records and communicate with other healthcare providers.
• Mistake: Not communicating clearly with patients and their families.
  • Fix: We need to keep them informed and involved in their care.
• Mistake: Not prioritizing patient safety.
  • Fix: We need to prevent harm and injury.

Quick Practice Scenarios:

1. A patient with a DNR order is having a heart attack. What should you do first?

Answer: Respect their wishes and don't start CPR. Reason: We need to prioritize their autonomy and decision-making.

1. A patient is refusing treatment for a broken arm. What should you do first?

Answer: Respect their wishes and don't force care. Reason: We need to respect their autonomy and decision-making.

1. A patient is having a medical emergency and can't speak. What should you do first?

Answer: Call 911 and provide basic first aid. Reason: We need to act quickly to save lives.

Last-Minute Exam Cram:

• Agonal breathing is NOT normal breathing – start CPR.
• Normal vital signs: heart rate 60-100, blood pressure 90-120, respiratory rate 12-20.
• CPR compression depth: at least 2 inches – like pushing down a soda can.
• SAMPLE: Situation, Allergies, Medications, Past medical history, Last oral intake.
• OPQRSTI: Onset, Provocation, Quality, Region, Severity, Timing, Insurance.
• A patient with a DNR order is NOT the same as a patient who is refusing treatment.
• Advance directives: living will, power of attorney, healthcare proxy.
• Cultural competence: respect patient's cultural and linguistic background.
• Confidentiality: keep patient's medical information private.
• Documentation: accurately record patient's medical information.