Posted by Unit 122

http://www.wgrz.com/news/local/story.aspx?storyid=79101&catid=37

Very interesting, I had someone this week who was .17, and the cop vehemently disallowed an on scene assessment in favor of rushing the patient to the station to do the breathalyzer so he could nail him on the DWI.

The call was an MVA with a significant MOI involved, and the officer was clearly wrong from a medical standpoint – the front end of the car was obliterated, and a full C-spine was called for. This law makes sense beyond the obvious legal ramifications since it gives medics leverage over any other responding entity who has interests other than patient care in mind. A simple blood draw can ensure that the law-enforcement side of things are covered, and we can then focus on patient care having taken care of the BAC issue.

However, I believe that this would need to be approved by the agency Medical Director, since REMAC protocols only currently indicate blood drawing on standing orders by Cyanide/Smoke Inhalation before Hydroxocobalamin (yes, that was a test question). The GOP states that any other blood drawing would be a discretionary decision made by the agency Medical Director.

Posted with WordPress for BlackBerry.

11/9/2008

Ethics, the philosophy of right and wrong

Morality, defined by society, religion, personal conscience

Oath of Geneva, 1948

Code of ethics for EMTs – 1978

Always, what is best for my pt

Patient Autonomy

• Right to direct own care
• Decide end of life issues
• Decide when care should be stopped

Advanced Directives

• Living wills
  
• Healthcare proxy
  
• DNR
  
  • Vary from state to state
    • NY – once started, do not terminate care
      
  • Some states require bracelet

http://www.health.state.ny.us/nysdoh/ems/policy/99-10.htm

What procedures are and are not preformed if the patient presents a DNR?

• Do not resuscitate (DNR) means, for the patient in cardiac or respiratory arrest, NO chest compressions, ventilation, defibrillation, endotracheal intubation, or medications.
• If the patient is NOT in cardiac or respiratory arrest, full treatment for all injuries, pain, difficult or insufficient breathing, hemorrhage and/or other medical conditions must be provided.
• Relief of choking caused by a foreign body is usually appropriate, although if breathing has stopped, ventilation should not be assisted.
• CPR must be initiated if no Out of Hospital or facility DNR is presented. If a DNR order is presented after CPR has been started, stop CPR.
• For unusual situations or questions on individual patient circumstances, contact medical control.

Medics always accountable to;

• Patients
• Medical Director
• EMS system

Meet expectations of the community

11/2/08
Medical Ethics

Civil law – tort – jury of 6 – 5/6
Criminal law – 12/12 jury –grand jury 16//-23 , probable cause
Legislative law
Administrative law (OSHA)
 
Common law/case law
 
 
Stare decisis – past judgments for future cases
Statutory law – law on books
 
Tort law, laws f negligence
Omission
Commission
 
Negligence
Ordinary – oops
Gross –
 
Malfeasance – improper act
Misfeasance – appropriate act but doing it wrong
Nonfeasance – not doing
Comparative negligence – fault of victim and provider
Notice –
 
Reasonable and prudent man concept
Prima facia
 
Malpractice
Duty to act
Reasonably trained
Proximate cause – directly caused the injury/illness
 
Assault – threat
Battery – actual contact
 
Defamation – untrue statements about character
· Libel – written or mass media (malicious intent)
· Slander – spoken (malicious intent)
 
Ethical responsibilities
· Respond to pt needs w respect
· Maint of skills
· Cmes
· Report honestly/confidentially
· Respect for peers
 
Best protection; appropriate assessment and documentation
 
Scope of practice
· Range of duties and skills
· Usually set by state law

Medical direction
 
Medical practice act
 
Mandatory reporting
· Child/elder abuse
· Sexual assault
· Animal bites
· Gunshot/stab
· Communicable diseases
 
Good Samaritan law
· Layperson/bystander
 
Negligence
· Duty to act (may be undertaken voluntarily)
· Breach of duty – not doing what similarly trained would do
Malfeasance – improper act
Misfeasance – appropriate act but doing it wrong
Nonfeasance – not doing
Res ipsa loquiter – injury could have only happened through negligence
· Injury
· Proximate cause
 
 
Borrowed servant – bls supervised by als – depends on degree of supervision and control

Protection against negligence
· Appropriate education
· Appropriate med direction
· Accurate documentation
· Professional attitude

Release of information
· HIPAA

Consent
· Informed consent –legal age – properly informed
· Expressed consent
· Implied consent
· Involuntary