Medical, legal, ethical issues

EMTs minimize litigation risk by providing competent care that meets established medical and ethical standards. Ensuring that treatment follows protocols and best practices reduces the likelihood of legal action. While using universal precautions and proper lifting techniques is important, competent medical care is the foundation for avoiding malpractice claims. Proper documentation and communication with medical control also help prevent legal issues.

Patients have the right to accept or refuse medical treatment as long as they are mentally competent. They may agree to transportation but refuse treatment, and EMTs must respect this decision. However, patients under the influence of drugs or alcohol may not be considered competent and can be treated under implied consent laws. Expressed consent does not require written approval from a family member.

Expressed consent is when a competent patient directly requests or agrees to treatment or transport. It can be verbal, written, or through gestures, such as nodding. Implied consent applies to unconscious or incapacitated patients who are presumed to want help. Informed consent occurs when the patient is fully educated about the risks and benefits of treatment before agreeing.

When dealing with a minor, a parent or legal guardian must provide consent for medical care. If a parent refuses, EMTs should explain the risks and attempt to persuade them that treatment is necessary. If refusal persists, document the refusal properly and have the parent sign a refusal form. Threatening the parent with child abuse accusations is not appropriate, as legal intervention should be left to law enforcement or child protection services.

Patient information is protected under HIPAA and can only be released with the patient's consent or in specific legal situations. If the patient is competent and provides written authorization, their information may be shared. Requests from law enforcement, family members, or media representatives do not automatically permit disclosure without proper authorization. Medical records must always remain confidential unless legally required to be disclosed.

Thorough documentation is the best legal protection in cases where a competent patient refuses treatment or transport. It should include the patient’s mental status, vital signs, explanation of risks given, and any statements made by the patient. While advising medical control is helpful, clear documentation serves as the primary defense against legal action. Patients have the right to refuse care, and EMTs must ensure they record the refusal properly.

Dependent lividity is the pooling of blood in the lowest parts of the body, indicating that circulation has ceased for an extended period. This is a definitive sign of death and distinguishes it from reversible conditions like cardiac arrest. While absence of a pulse and breath sounds suggest clinical death, they are not definitive, as resuscitation might still be possible. Profound cyanosis indicates lack of oxygen but is also not a definitive sign of death.

Putrefaction refers to the decomposition of body tissues after death, resulting in discoloration, gas formation, and breakdown of organic matter. It typically occurs several hours to days after death, depending on environmental conditions. Blood settling (dependent lividity) and cyanosis occur earlier in the post-mortem process but do not indicate complete decomposition. Separation of the torso is considered severe trauma rather than putrefaction.

An EMT's scope of practice is primarily defined by the medical director, who establishes protocols and standing orders for care. While state EMS offices set broad regulations, local medical directors oversee specific procedures and treatments EMTs are allowed to perform. The EMS supervisor and local health district do not define an EMT’s medical scope but may oversee operational or public health policies. EMTs must work within their authorized protocols to avoid legal liability.

Assault is the act of making someone fear immediate physical harm, even if no physical contact occurs. Battery is the actual unlawful physical contact, such as treating a patient without consent. Libel refers to written false statements that damage someone’s reputation. Negligence occurs when an EMT fails to provide the expected standard of care, leading to patient harm.

Good Samaritan laws protect EMTs from liability when acting in good faith, but they do not cover cases of gross negligence. If an EMT acts recklessly or deviates from accepted medical standards, they can still be held legally responsible. While these laws offer some protection, they do not provide absolute immunity from lawsuits. Proper documentation and adherence to protocols remain the best legal safeguards.