EMT Lecture - EMT Role, BSI/PPE, & Medical/Legal/Ethical Issues

Introduction to Emergency Medical Services (EMS)

Overview of EMS

• The term "EMS" refers to Emergency Medical Services, which includes volunteer ambulances and other emergency medical responders.

• Historically, communities relied on local knowledge for emergencies before the establishment of formal EMS systems.

Evolution of EMS

• The development of highways led to increased mobility but also resulted in higher injury rates due to accidents occurring far from immediate help.

• Military practices have significantly influenced modern EMS protocols, as they were historically focused on battlefield medicine.

The Role of Transportation in EMS Development

Transition from Transportation to Health Services

• Initially, the Department of Transportation was responsible for managing road safety and injuries; however, this evolved into a focus on public health.

• As states gained autonomy, they began developing their own health regulations and systems for addressing medical emergencies.

Current Structure of EMS in New York State

• The New York State Department of Health now oversees EMS operations, reflecting a shift towards prioritizing healthcare over transportation concerns.

• Despite this shift, the Department of Transportation still plays a role in regulating ambulance services and vehicle compliance.

Understanding EMT Regulations and Operations

EMT Requirements and Regional Differences

• Each ambulance service must adhere to specific regulations outlined in Part 800 of the New York State Health Code regarding equipment and operational standards.

• New York State is divided into regions with varying requirements for EMT operations; understanding these differences is crucial for effective service delivery.

Key Roles within Ambulance Services

• Every ambulance company must have a medical director who oversees operations and ensures compliance with medical protocols.

Understanding Medical Control in Emergency Services

What is Medical Control?

• Medical control, also known as treatment protocols or standing orders, allows EMTs and paramedics to perform certain medical procedures without prior permission from a physician.

• It is established by the medical director, who provides guidelines on what actions can be taken in emergency situations.

• EMTs primarily use this system to call for assistance or special orders from a designated physician available 24/7.

The Role of Online Medical Control

• An example scenario involves an EMT needing guidance when a patient refuses transport to the hospital; they must communicate vital signs and observations to the doctor.

• If the attending physician convinces the patient to go to the hospital, responsibility shifts from the EMT to the doctor regarding patient care decisions.

• This process emphasizes that online medical control (OLMC) connects EMTs directly with physicians for real-time decision-making.

Understanding Scope of Practice

• Scope of practice defines what actions are permissible for EMTs and paramedics based on their training and state regulations.

• Each state recognizes only one medical director per agency, which may differ from local directors accepted by other neighborhoods or regions.

Development of Scope of Practice

• New York State's scope of practice outlines specific tasks that EMTs can perform, such as administering Narcan for opioid overdoses.

• The approval process involves three levels: state regulations, regional assessments, and agency policies. Each level must agree before new practices are implemented.

Standard of Care

• Standard of care refers to how procedures should be performed consistently across all practitioners within a region.

Negligence in EMT Practice

Understanding Negligence

• Negligence is a complex legal term that refers to doing something wrong that affects others, particularly in the context of Emergency Medical Technicians (EMTs).

Key Components of Negligence

• To establish negligence, three elements must be present:

• Duty: The obligation to provide care once an EMT clocks in for their shift.

• An EMT cannot refuse to assist a patient if they receive a call; they are required to fulfill their duty during their working hours.

Types of Malpractice

• There are specific terms related to negligence:

• Malfeasance: Intentionally doing something harmful (e.g., physically harming a patient).

• Misfeasance: Performing a task correctly but missing critical steps (e.g., failing to administer oxygen properly).

• Nonfeasance: Failing to act when action is required, which can lead to harm or worsening conditions for the patient.

Consequences of Actions

• Harm must result from the actions taken by the EMT. For example, making a patient walk with an injury could exacerbate their condition and lead to liability.

• A good attorney can prove negligence if it can be shown that duty was breached and harm resulted from that breach.

Legal Protections for EMTs

• If EMTs perform their duties correctly and within the scope of practice, they are less likely to face lawsuits.

• Abandonment occurs when an EMT transfers care improperly; they cannot hand off patients to someone less qualified than themselves.

Certification Levels in New York State

• In New York City, there are three recognized levels of medical personnel:

• Certified First Responders (CFR), Emergency Medical Technicians (EMT), and Paramedics.

• Intermediate certifications exist outside NYC but are not recognized within city limits.

Good Samaritan Laws

• Most states have Good Samaritan laws protecting individuals who help others in emergencies as long as they act within their training and scope of practice.

Mandatory Reporting and Consent in Child Abuse Cases

Understanding Mandatory Reporting

• Certain professionals, such as teachers, police officers, firefighters, and EMTs, are mandated reporters of child abuse. If they suspect abuse while on duty, they must report it to the state.

• It is crucial to report any suspicion of child abuse immediately. If someone witnesses a violent act against a child, they should call the police without hesitation.

• Mandatory reporters cannot choose not to report suspected abuse; failing to do so can lead to significant legal consequences.

The Importance of Consent

Types of Consent

• In the U.S., consent is required before providing any medical assistance. This includes explicit permission from patients for treatment.

Expressed Consent

• Expressed consent occurs when a patient verbally agrees to a procedure after being informed about it (e.g., "Can I take your blood pressure?").

Informed Consent

• Informed consent involves explaining the procedure and obtaining agreement from the patient. It's essential that patients understand what will happen during treatment.

Implied Consent

• Implied consent applies in emergencies where a patient cannot communicate (e.g., an unconscious person). Medical professionals assume that a reasonable person would want necessary care.

Who Can Give Consent?

• To give valid consent, individuals must be mentally competent. Children under 18 typically cannot provide consent themselves but may have parents or guardians make decisions on their behalf.

Confidentiality in Healthcare

Importance of Patient Confidentiality

• Maintaining confidentiality is critical for healthcare workers. They must not disclose any information about patients or cases they encounter during their work.

Handling Sensitive Information

Understanding HIPAA and Its Implications

Overview of HIPAA Regulations

• HIPAA is a federal law that ensures medical professionals, including doctors and dentists, cannot share patient information without consent.

• The discussion highlights that organizations not receiving federal funding are not bound by HIPAA regulations, particularly when they do not accept Medicare payments.

Operational Challenges Under HIPAA

• Medical professionals must communicate effectively about patient cases while adhering to HIPAA guidelines; sharing information without proper authorization is prohibited.

• If a healthcare provider receives a subpoena (a court order), they are legally obligated to disclose all relevant patient information despite HIPAA restrictions.

Handling Minors in Medical Situations

• The speaker discusses the complexities of dealing with minors under 18 years old who may face medical emergencies at school without parental guidance.

• Schools should have medical forms on file for students to inform staff of any significant health issues or allergies, which is crucial during emergencies.

Responsibilities During Emergencies

• In emergency situations involving children, it’s essential for school staff to accompany the child until parents arrive, ensuring the child's safety and well-being.

• There are legal considerations regarding who can make decisions for minors in emergencies; schools often need permission from parents or guardians.

Emancipated Minors and Their Rights

• The concept of emancipated minors is introduced; these individuals can make their own medical decisions if they live independently or serve in the military.

Importance of Documentation in Healthcare

• Proper documentation is critical in healthcare settings. Every call requires detailed reporting through electronic systems like eCR (electronic Call Report).

• Accurate documentation serves as protection for healthcare providers against potential legal claims many years later by providing a clear record of actions taken during care.

Conclusion on Documentation Practices

Understanding the Role of EMTs in Death and Dying

The Importance of Self-Care for EMTs

• The speaker emphasizes that before EMTs can care for others, they must prioritize their own well-being.

• Unlike many jobs, EMTs genuinely care about the health and safety of their colleagues, which is crucial for effective performance.

Coping with Stress Related to Death

• The discussion begins with the unique challenges EMTs face regarding death and dying, noting that most people do not regularly encounter these situations.

• Initial experiences with death can be overwhelming; however, over time, EMTs may become desensitized as it becomes a part of their routine.

Understanding Medical Definitions of Death

• It’s essential for EMTs to have a clear medical definition of death since they may be first responders on the scene.

• Key indicators include checking for breathing and heart activity to determine if CPR should be initiated.

Grieving Process Awareness

• The speaker introduces the grieving process and its psychological impact on those who lose loved ones.

• Five stages of grief are outlined: denial, anger, bargaining, depression, and acceptance. Anger often manifests towards EMT personnel present at the scene.

Supporting Families During Crisis

• EMT responsibilities extend beyond medical care; they also involve supporting grieving families by helping them navigate immediate needs after a loss.

• Respectful handling of deceased individuals is emphasized along with maintaining professionalism during sensitive moments.

Understanding Critical Incidents in EMS

Physiological Responses to Stress

• The body reacts to stress with increased heart rate, faster breathing, and cool, moist skin. These responses are normal during critical incidents.

Defining Mass Casualty Incidents (MCI)

• An MCI is characterized by a situation where the number of patients exceeds available resources. For example, a school bus accident involving 60 children may only have two EMTs responding.

• Historical examples include the plane landing in the Hudson River; while no injuries occurred, it was still classified as an MCI due to potential casualties.

Frequency of MCIs in Urban Settings

• In New York City, any house fire triggers an MCI declaration because responders cannot predict how many victims there will be or what resources will be needed.

Emotional Impact of Traumatic Calls

• Responding to traumatic incidents involving children can lead to long-lasting emotional distress for EMS personnel. Such calls are among the most challenging for first responders.

Managing Stress After Critical Incidents

• EMS systems utilize Critical Incident Stress Management (CISM), which includes debriefings that allow personnel to discuss their experiences and feelings after traumatic events.

• Professional mental health support is often provided shortly after a distressing incident to help staff process their emotions privately.

Scene Safety and Personal Protection

Importance of Scene Safety

• Understanding what went wrong during past emergencies emphasizes the need for strict safety protocols when responding to incidents.

Body Substance Isolation (BSI)

• BSI is now referred to as Personal Protective Equipment (PPE). Both terms emphasize protecting oneself from bodily fluids and infectious diseases during medical response situations.

Guidelines for Handling Bodily Fluids

• A key guideline states: "If it's warm, wet, and not yours—don't touch it." This highlights the importance of using gloves and other protective gear when dealing with potentially hazardous materials.

Types of Protective Equipment

• Various forms of PPE exist beyond gloves; face shields and masks are also crucial for protection against infectious diseases encountered on duty.

Specific Masks Used in EMS

Understanding Infectious Diseases and Safety Protocols

The Nature of Infectious Diseases

• Discusses the complexity of handling bodily fluids, emphasizing that it requires effort and awareness due to their potential infectious nature.

• Highlights the transmission of diseases through droplets, which are microscopic particles that can spread infections even without direct contact, such as sneezing or breathing.

• Lists common diseases like measles and influenza that have vaccinations available, reducing their threat level significantly.

High-Risk Diseases Without Vaccinations

• Identifies meningitis as a particularly concerning disease due to the lack of immunization options available for prevention.

• Mentions other diseases like tuberculosis, which pose significant health risks and are difficult to treat effectively.

Importance of Cleanliness in Medical Settings

• Stresses the necessity of maintaining cleanliness in medical environments to prevent infections from spreading.

• Emphasizes personal safety protocols for emergency medical services (EMS), advising against entering unsafe scenes.

Scene Safety Protocols

• Underlines the importance of assessing scene safety before providing assistance; personal safety must take precedence over patient care.

• Advises EMS personnel to be vigilant about changing conditions at a scene that could compromise their safety.

Patient Interaction and Consent

• Explains the concept of "refusal of medical assistance" (RNA), where patients who are mentally competent can decline treatment.

Ethics and Responsibilities in Medical Situations

Understanding Ethics in Medical Contexts

• The discussion emphasizes the importance of ethics, defining it as the distinction between right and wrong actions. It contrasts ethics with personal morals, suggesting that individual moral beliefs can vary significantly.

• The conversation highlights that ethical considerations can differ based on various factors such as agency policies or neighborhood standards, indicating a lack of uniformity in medical practices.

Decision-Making in Emergency Situations

• A scenario is presented where a person on an airplane is asked if there are any medical professionals onboard. The speaker reflects on the pressure to respond but asserts that helping is ultimately a personal choice.