Transcript EMS and Legal Implications

EMS and Legal Implications
November 2012
Condell Medical Center
EMS System
Site Code: 107200E -1212
Prepared by: Sharon Hopkins, RN, BSN, EMT-P
Revised 12.12.12
1
Objectives
Upon successful completion of this module, the
EMS provider will be able to:
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1. Describe and differentiate between morals
and ethics
2. Define scope of practice vs standard of care
3. Describe the difference between certification
and licensure
4. Describe the impact of the Good Samaritan
Law and EMS
5. Review the impact of HIPAA
2
Objectives cont’d
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6. List the 4 elements of negligence and describe
them
7. List what to evaluate to determine competency
8. State the difference of a variety of consents
9. Describe when patients may refuse care
and/or transportation
10. Define abandonment, assault, and battery
11. List potential causes of behavioral changes
12. List medications used for behavioral
emergencies
13. Describe the difference between voluntary and
involuntary committal as they relate to EMS.
3
Objectives cont’d
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14. List documentation to include when using restraints
15. Describe the various forms of advanced directives
16. Describe the components of a valid State of
Illinois Advanced Directives.
17. Define abuse and neglect as it impacts
various age groups or populations.
18. Describe the process of reporting abuse,
neglect, and violence in various groups.
19. Describe EMS care for a patient who
experienced a sexual assault
4
Objectives cont’d
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20. Describe EMS action following the Illinois Safe
Haven Law
21. Discuss documentation for the various situations.
22.Given a variety of advanced directives, identify
a DNR, Durable of Power of Attorney for
Healthcare, and Living Will.
23. Participate in discussion in a variety of case
presentations
24. Successfully complete the post quiz with a score of
80% or better.
5
Ethical Considerations
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Ethics and morals closely related
Morals – usually considered to be social,
religious, or personal standards of right
and wrong
Ethics – also called moral philosophy;
addresses questions of morality

Usually refers to rules or standards that
govern a particular group or profession
6
Ethics and Morality
“How should one live?”
Question asked by Socrates
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The “Golden Rule”:
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Do unto others and you would have them do
unto you
Treat others as you wish to be treated
7
Ethics and the Profession
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To maintain the respect and trust by the
public, EMS must continue to display
ethical behavior
EMS was added to a Gallup poll list in
2001 (post 9/11) and scored highest in
public support
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Nursing consistently has scored highest since
included starting in 1999
Medical doctors, clergy and pharmacists also
have been named at the top
8
Definition - Scope of Practice
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Defined procedures, actions, processes
legally permitted by the licensed individual
Encompasses 3 categories
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Documented education and training for the
item in question
Governing body allows the item in question to
be performed for the licensed level
Resource hospital/SOP’s allows the item in
question to be performed
9
Definition – Standard of Care
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The degree of care, skill, judgment
expected under like or similar
circumstances by a similarly trained,
reasonable paramedic in the same
community
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“Did you do the right thing?”
“Did you do it properly?”
10
Definition - Certification
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The process by which an agency or
association grants recognition to an
individual who has met certain
qualifications
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Example: CPR for Healthcare Provider, ACLS,
PALS, ITLS, National Registry
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Definition - Licensure
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Process of occupational regulation
Governmental agency grants permission to
engage in a given trade or profession once the
degree of competency has been attained that
ensures the public’s protection
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Example: Paramedic, nurse, doctor, plumber, hair
stylist
Allowed to practice within a designated scope of
practice
Still need a State license to practice in Illinois
even if you have National Registry
12
EMS Profession
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EMS may only perform a skill or role for
which your are:
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Educated
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Trained to perform the skill or role
Certified
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Demonstrated competency in the skill or role
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Example: skills checked off during CE
Credentialed
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Permission by medical oversight (Medical Director)
to perform the skill or role
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Granted Authority to Practice
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This is a privilege and your personal
responsibility
License good for 4 years
Must satisfy 120 hours of CE hours
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No more than 25% (30 hours) in any one
category
Must complete and sign a child support
statement
14
What do you think?
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As a paramedic with the Condell EMS
System, you have been educated on the
use of the EZ IO. You were checked off in
competency during CE. Your license is in
good standing.
Can you perform this skill working in the
Condell EMS system?
Yes, but not a guarantee to perform if you
change systems
15
Legal Protection for EMS
Sec. 3.150. Immunity from civil liability.
(a) Any person, agency or governmental body
certified, licensed or authorized pursuant to this Act or
rules thereunder, who in good faith provides emergency
or non-emergency medical services during a Department
approved training course, in the normal course of
conducting their duties, or in an emergency, shall not be
civilly liable as a result of their acts or omissions in
providing such services unless such acts or omissions,
including the bypassing of nearby hospitals or medical
facilities in accordance with the protocols developed
pursuant to this Act, constitute willful and wanton
misconduct.
16
Illinois Vehicle Code
(625 ILCS 5/11-205)
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The driver of an authorized emergency
vehicle when responding to an emergency
call may:
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Park or stand irrespective of signs or markings
Proceed past a red or stop signal or stop sign,
but only after slowing down as required and
necessary for safe operation
Exceed maximum speed limits so long as not
to endanger life or property
Disregard one way streets or turning
restrictions
17
Illinois Vehicle Code
(625 ILCS 5/11-205)
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The exceptions granted to an emergency vehicle
shall apply only when the emergency vehicle is
using an audible signal when in motion or visual
signals
The driver of an authorized emergency vehicle is
not relieved from the duty of driving with due
regard for the safety of all persons, nor do such
provisions protect the driver from the
consequences of his reckless disregard for the
safety of others.
18
Good Samaritan Law
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First enacted in 1959 in California
Specifically designed to protect people
especially in the medical field who stopped
at the scene of an emergency to render
aid
Intended to protect those not being paid
for delivering acts performed in good faith
unless there was gross negligence
Laws vary State to State
19
Illinois Good Samaritan Law
(745 ILCS 49/)
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…who in good faith provides emergency
care without fee or compensation to any
person shall not, as a result of his or her
acts or omissions, except willful and
wanton misconduct on the part of the
person, in providing the care, be liable to
a person to whom such care is provided
for civil damages.
20
Confidentiality - HIPAA
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Health Insurance Portability and Accountability
Act
Came into being in 1996
Adds layers of protection/privacy for patients
EMS must develop administrative, electronic and
physical barriers to unauthorized disclosure of
patient's protected health information
Disclosures must be authorized in writing
And…keep it off of face book!!!
21
What would you do?
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You are at the scene of a call. The pastor
arrives and asks if he can be of help. You
inform him that the patient is being
transported and direct him to the spouse
How do you respond when the pastor asks
what is wrong with the patient?
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Being apologetic, the correct response would
be to indicate that due to HIPAA, you are
unable to discuss the medical condition. Direct
the pastor to the spouse
22
Libel
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The act of injuring a person’s character,
name, or reputation by false statements
made in writing
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Think libel / library as written like a library
book
23
Slander
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The act of injuring a person’s character,
name, or reputation by false or malicious
statement spoken with malicious intent or
reckless disregard for the falsity of the
statement
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Think slander is spoken
24
Negligence
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Occurs due to deviation from accepted
standards of care
Synonymous with malpractice in health
care professions
In claim against a paramedic, plaintiff
must establish and prove 4 elements
25
Elements of Negligence
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Duty to act
Breach of duty
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Based on standard of care
Determined if performance was a wrongful or
unlawful act (i.e.: assaulting the patient);
performance in a harmful or injurious manner
(i.e.: intubating the esophagus); or failure to
perform (i.e.: not immobilize a patient with
neck pain and numbness and tingling)
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Elements of Negligence cont’d
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Actual damages
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Person actually harmed in a way that can be
compensated by award of damages (i.e.: lost
wages, medical bills, conscious pain and
suffering)
Proximate cause
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Proof that the action or inaction immediately
caused or worsened damage suffered (i.e.:
damage had to be foreseeable by EMS); often
involves use of expert witnesses
27
Consent
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By law, you must receive the patient’s
consent before you can provide medical
care or transport
Consent grants permission to touch and to
treat
Based on concept that adults of sound
mind have the right to determine what
should be done with their body
28
Competency to Consent
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Considered to be the adult who is:
Lucid
 Able to make informed decisions about
medical care
 Understands your questions and
recommendations
 Understands the implications of his decisions
for medical care
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Can be difficult to absolutely determine
competency at times
29
Determining Competency
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Evaluate:
Mental status
 Ability to respond to questions
 Statements of competency from family or
friends
 Evidence of impairment from drugs or alcohol
 Indications of shock or hypoxia
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Note: Being alert and oriented does not
always imply you can make rational
decisions
30
Decisional Capacities
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You are called to the scene for a 34 year old
patient walking around a shopping plaza in a
robe
The patient is alert, oriented, and cooperative
They deny complaints; they state “this type of
thing happens all the time” (EMS and police
being called)
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They state they have been persecuted for over 2000
years; they are use to it
If this person is deemed to be a patient, can
they sign a release???
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Decisional Capacities cont’d
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Discussion
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Is the patient alert and oriented?
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Does this patient demonstrate the ability to
make a decision for signing a refusal?
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Yes to time, person, and place
No, they are not demonstrating decisional
capabilities comparable with other people in like
situations
What would you do?
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Contact Medical Control if questions, request police
support if needed
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Informed Consent
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Consent given based on full disclosure of
information
Patient understands nature, risks, and
benefits of any procedures to be
performed
Can include alternative possibilities and
dangers of refusing treatment or transport
Revoking consent
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Can be done at any time from every
competent adult before, during, after care
and transport
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Expressed Consent
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Most common type
Person directly grants permission to treat
verbally, nonverbally, or in writing
Consent for one aspect of care does not
necessarily fall over to all aspects of care
Examples expressed consent
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The act of calling 911 for an ambulance
Allowing care to be rendered without
opposition to care
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Implied Consent
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Consent assumed in that the patient
would want life saving treatment if they
were able to give informed consent
Usually considered implied in the
unconscious patient
In place while the patient is unconscious
or no longer requires emergency care
35
Involuntary Consent
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Usually court ordered
Usually for patients held for mental health
evaluations or for those under arrest
Forced treatment limited to emergency
treatment necessary to save life or limb or
treatment ordered by court
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Just because a patient is a prisoner does not
mean the police can force a patient to receive
care
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Refusal of Services
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Competent adults may withdraw or refuse
any or all parts of care &/or transport
Patient must understand risks of not
continuing treatment or transport
Documentation must support that patient
appears mentally capable to refuse
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Documentation must include a description of
orientation
Patient may refuse some or all of
treatment including transport
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Refusal of Service
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Any questionable, confusing, and /or complex
“refusal of Service” calls should be called in and
documented with Medical Control while on the
scene
Refusal of service is signed when patient is
considered a patient
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Make every attempt to convince patient to allow
assessment, be treated and accept transport
Have patient sign a release/refusal form
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Make sure all information is completed on form
Includes dates and signatures – patient, witness,
person filling out form
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The “Lift Assist” Call
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BE CAREFUL!!!
You’ve been to the house how many times???
It’s Mr. ___; Mrs.____; whoever who just fell
again!!!
The patient may not want to be a bother;
It may be the umpteenth time you’ve
responded;
These patients still deserve head to toe full
assessments – one time they may be injured
and just don’t know it
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It’s “them” again…
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How do you prove what you did on the
call?
Documentation is your record
Any time you are on a patient call you
should complete a patient care run report
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Injuries may take time to develop
The patient’s story may change over time
Your protection is your documentation of what
you found, what you did, what you tried to do
for the patient
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Completion of Refusal
41
Refusal of Services/Transport
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Of all times to complete documentation, it
is for these calls
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If the patient were transported at least the
hospital would be doing another evaluation
Best to document the assessment at time
of first contact comparatively to last
contact
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If at all possible, complete 2 sets of vital signs
and fill in the 2nd assessment boxes
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Documents condition of patient when you left
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Transport to Farther Hospital
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EMS transports patients to the closest
appropriate facility (Routine Medical Care
SOP)
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This is with consideration of the patient’s
choice within the department’s transport area
whenever possible or the nearest hospital in
cases of life threatening emergencies
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Transporting Following Patient’s
Request
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What if the patient requests transport to a
farther hospital?
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Are you comfortable transporting?
Do you feel the patient's condition is
imminently changing?
Have you contacted Medical Control for
guidance/support?
Have patient sign the release for transport
to the farther hospital
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Alternate Hospital Destination
45
What would you do?
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EMS is called to the scene for a 75 yearold male who fell
The patient immediately denied need for
transport
Allowed assessment to be completed
Release was obtained
46
Is this enough documentation?
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Comments: Called to scene for elderly male
who fell. Upon arrival pt A & O sitting in a
chair. Stated he accidently tripped and
stumbled backwards then fell on left side.
Landed on left flank and ribs. Denied head,
neck, back pain. No LOC. Minor soreness to
left flank. No deformity or bruising present.
Lungs clear. VS: 118/60; 72; 18; 97% RA.
Pain scale “0”. Risks and benefits explained.
Refusal signed. No other complaints noted
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Enough documentation? Cont’d
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Is competency documented?
Was the assessment adequate?
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Note: 1 set of VS obtained; first set of boxes
checked off for assessment
Is nature of mechanism of injury
explained?
Were risks and benefits explained?
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Continued Case Discussion
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Patient called EMS back 15 hours later for
trouble breathing; remains alert and
oriented
VS: 170/86; 100; 20; 86% RA; lungs
clear; sinus tach; pain “0”
Puffy swelling noted to face including over
1 eye; denies eating anything unusual.
Swelling to face increased and started
complaining of tightening to throat
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Case Discussion cont’d
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Crew treated for allergic reaction
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IV
Benadryl 50 mg IM
Epinephrine 1:1000 – 0.3 mg SQ
Post VS: 94/64; 112; 20; 96% RA; clear lung
sounds with labored breathing; sinus tach
50
Case Discussion Questions
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1. Was 1st report detailed enough?
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Documentation of why patient fell?
Full assessment documented?
Stable at time EMS left patient?
2. Crew felt patient having an allergic
reaction on 2nd call
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Documentation supports allergic reaction?
Documented treatment appropriate?
51
Case Follow-up
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Patient had 5 left rib fractures
Had developed extensive subcutaneous
emphysema; 3 chest tubes eventually placed
Required intubation at time of arrival to ED
Admitted to ICCU
Expired 5 days later
Unknown more detail on how patient was
injured; initial call patient’s chest palpated with
no complaints of pain
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What would you do?
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EMS was called to the scene by the wife
The spouse was having chest pain 8/10, was
pale, diaphoretic and rubbing their chest
The patient refused assessment and transport
What would you do?
Being honest and sincere, explain your general
impression and what you want to do
Involve Medical Control – sometimes patients
will consent when they hear the doctor wants
them to consent
Can this patient refuse? If competent, they can
53
Minor Patients
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In Illinois, a minor is someone under the age of 21
 With respect to the ability to consent to medical
care, someone 18 and over can consent for
medical care
 Someone under the age of 18 cannot consent to
medical care
Emancipated minors are between 16-18 years of
age and have obtained court orders
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They have proven they are on their own and can support
themselves
Emancipation of Minor’s Act 750 ILCS30/1, et. Seq.
54
Consent to Treat From Minor
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Emancipated, pregnant or married minors
can give consent for medical treatment
Minors who are parents (male or female)
may consent for their own treatment and
for their child’s
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If the minor is no longer acting as the parent,
they are no longer able to give medical consent
A pregnant minor is not the same as an
“emancipated” minor (but they can be if court
order has been obtained) but we often use that
terminology
55
Abandonment
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EMS providers assume the responsibility of
providing care to an ill or injured person until
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The person gives consent to terminate care
Care is transferred to equal or greater level of care
Abandonment is termination of the relationship
without providing appropriate continuation of
care while still needed and desired by patient
56
What would you do?
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You arrive in the ED with a BLS transport
The only one available is a medic working
as an ED tech
Can you give report to this person and
leave?
No, the ED paramedic is functioning as an
ED tech and this would be turning care
over to a lesser level of care
57
Assault and Battery
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Assault – unlawfully placing a person in
apprehension of immediate bodily harm
without consent
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Battery – unlawful touching of another
person without their consent
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This is the threat of harm
Think of a bat as a device that strikes
something
Assault and battery could include criminal
and civil suits
58
Incompetent Patient
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Extremely difficult cases to decipher
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If behavior &/or medical condition suggest
mental incompetence to refuse medical
treatment or transport, efforts should be
made to explain the seriousness of the
condition and potential consequences of
refusing
If uncooperative, may need to restrain patient
if they are a threat to self or others
59
Incompetent Patient cont’d
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Will not be allowed to make health care
decisions
Transport to closest appropriate hospital
Initiate dialogue with Medical Control for
guidance
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Many of these calls are not so clear cut
The patient has had some drinks, does this make
them incompetent for decision making?
 The patient’s friends make statements the patient
denies; who do you believe?
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60
Behavioral Emergencies
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Establish scene and personal safety
Call law enforcement as needed
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Document if there is a delay to scene
response
Attempt to verbally calm patient
If restraints are used, document reasons
they were used, time applied, type applied
and patient's response
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Monitor and document distal circulation
61
Behavioral Emergencies cont’d
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Consider medical causes of behavioral
disorders
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Hypoxia
Substance abuse/overdose
Excited delirium/hyperthermia
Neurological causes – CVA, head injury
Metabolic problems - hypoglycemia
62
Control of Behavioral Emergencies
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For severe anxiety or agitation
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Versed 2 mg IN
 IN route avoids exposure to needles
 If needed, may repeat Versed 2 mg IN
every 2 minutes titrated to desired effect to
max of 10 mg
If additional sedation needed
 Valium 5 mg IVP over 2 minutes and repeat
as needed to max of 10 mg
Or
 Valium 10 mg IM
63
Transport Destination
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All emergency departments in Region X are
able to receive patients with behavioral
emergencies in need of psychiatric referral
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All patients need an ED assessment before
admission to a psych unit
Psych unit destination dependent on variety of
stipulations
 Diagnosis, age, medical condition, insurance
Patients from one ED (even with a psych unit
in the facility) may be transferred elsewhere
64
Voluntary Admission
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Patient requesting or willingly goes to
psych unit
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Many patients may refuse admission at the
door to the psych unit
ED will always fill out involuntary papers so
patient does not have a choice to be admitted
for an evaluation period
65
Involuntary Admission
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Patient being admitted against their will to
a psych unit for an evaluation
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Committal papers will be completed by ED
staff
EMS will be asked to add comments of what
they heard or witnessed directly
Hearsay is not allowed
 If police or family are the ones hearing threatening
or incriminating comment, they must be the ones
to complete the appropriate section of the
involuntary paperwork
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66
Involuntary Admission
Documentation
67
Involuntary Admission
Documentation
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Information is filled in by persons who
directly witness the behavior or hear the
comments made
May use work address and phone number
68
Restraints
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Personal safety must always be observed
Combative patients may need to be
restrained
All attempts must be made to avoid injury
to the patient or EMS personnel
If possible, contact Medical Control before
restraining patient or as soon as possible
after restraints applied
If restraints applied, do not compromise
the patient's ability to breath
69
Restraints cont’d
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Attempt to avoid aggravating any injury or
illness
Prevent positional asphyxia in restrained patients
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If any patient is handcuffed, law enforcement
MUST ride in the back of the ambulance

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Never place a restrained patient prone
EMS should not accept the handcuff key
Need detailed documentation and documented
contact with Medical Control
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Monitor distal circulation to extremities
Monitor respiratory status
70
Restraint Guidelines
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Have enough personnel to quickly and
safely apply restraints
Use soft, humane restraints
Restrain face-up
Restrain major muscle groups (i.e.:
biceps) so they can’t pull against restraints
Monitor patient continuously; especially
watch if agitation and struggling suddenly
stop – are they cooperating or declining?
71
Advanced Directives
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Document created to indicate the patient’s
preference for future medical care
Used when the patient is unconscious or
otherwise unable to express choice of treatment
Multiple forms in practice and State specific

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Do Not Resuscitate orders, durable power of attorney
for healthcare, living wills, and organ donor cards
For wishes to be honored, valid form must be
with the patient
72
Living Wills
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A short form stating you do not want lifesustaining treatment if you have a
terminal illness
Not a physician order
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Cannot be recognized by EMS in State of
Illinois
73
State of Illinois DNR
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Medical treatment order completed in
advance indicating your wishes to
withhold CPR
A physician order requiring a physician's
signature
Form honored by all healthcare providers
Original should be kept by patient
Copies may be honored-can be any color
74
Components of Valid DNR
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Name of patient
Name and signature of attending physician
Effective date - There is no expiration
The words “Do Not Resuscitate”
Evidence of consent
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Signature of
Signature of
Signature of
Signature of
Signature of
patient OR
legal guardian OR
durable power of attorney OR
surrogate decision maker
witness
75
Durable Power of Attorney for
Healthcare

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Form not limited to situations of terminal
illness
Allows person to designate an agent to
make health care decisions on their behalf
in any situation where the patient is
unable to do so
Specific directions for decision making can
be listed
76
77
What would you do?




You are on the call of a patient who is arresting
or has arrested
The patient has a valid DNR
The family wants you to “do everything”
What do you do???




Families are known to panic and want resuscitation
performed
If you don’t start CPR, the outcome is death
If you start CPR, you can call Medical Control and get
further directions
This is a VERY tough spot to be in – the middle
78
Crime Scene





Do not enter a scene that is not safe
Your goal is patient care
You also need to consider preservation of
evidence when possible
Contact law enforcement if you believe a
crime has been committed
Do not move or touch anything at the
crime scene unless absolutely necessary
79
Crime Scene cont’d



Document anything moved for patient
care
Leave holes in clothing intact; cut around
them if necessary
Document and inform police if you need to
remove any items form the scene
80
Mandatory Reporting
Child Abuse and Neglect



Note environment, child’s interaction with
caregivers, discrepancies in history obtained,
signs of obvious injury
Treat obvious injuries
If caregiver refuses transport, remain at scene
and contact police for protective custody



ED MD may also place child in protective custody
Report suspicions to ED staff
Carefully document objectively
81
Child Abuse and Neglect cont’d

Report suspicions to Illinois Department of
Children and Family Services (DCFS)


24 hour hot line: 800-252-2283
A written confirmation of the verbal report
must be filed within 48 hours to DCFS
82
Mandatory Reporting
Elder Abuse and Neglect

Abuse


Any physical injury, sexual abuse, or mental
injury inflicted on a person, age 60 or older,
other than by accidental means
Neglect

A failure to provide adequate medical or
personal care or maintenance, which failure
results in physical or mental injury to a person
or in the deterioration of a person’s physical
or mental condition
83
Elder Abuse and Neglect cont’d


May occur in non-institutional or nursing home
setting
EMS is mandated to report suspected cases to
the Abuse Hot Line




M-F 0830-1700 – 800 – 252 - 8966
All other times – 800 – 279 – 0400
Objective and accurate documentation of any
physical findings is placed on the patient care
report
Verbally inform ED staff of suspicions
84
Elder Abuse and Neglect cont’d


From 2002 – 2011 there was a 47%
increase in reports of elder abuse & neglect
Resource – Catholic Charities



Offers senior case management services
For information and assistance:
847-546-5733
Can make home visits to assess the immediate
needs and make appropriate referrals
85
Domestic Violence

Illinois Domestic violence Act of 1986


Domestic violence, or intimate partner
violence, occurs when one person causes
physical or psychological harm to a current or
former intimate partner. It includes all acts of
violence within the context of family or
intimate relationships
National Domestic Violence Hotline at 800799-Safe (7233) provides crisis intervention
and referrals to in-state or out-of-state
resources, such as shelters or crisis centers 86
Domestic Violence cont’d

EMS is required to provide immediate and
appropriate referral information to a
patient who refuses transport



Usually in form of a brochure
If the patient is transported, the ED will
supply the information
The patient may refuse to take the
brochure

Fear of being discovered in their possession
87
Domestic Violence cont’d


If victim signs refusal, inform the patient
that EMS are mandated by the State to
report all cases of domestic violence to the
local police
Document conversation on the patient
care report
88
Resources





The following hotlines can help women
experiencing violence:
National Domestic Violence Hotline
800-799-SAFE (7233)
Illinois Department of Human Services Domestic
Violence Helpline
877-To End DV (877-863-6338)
Elder Abuse Hotline
888-800-1409
The Rape, Abuse, Incest National Network (RAINN)
(automatically transfers you to the rape crisis center
nearest you)
800-656-HOPE
89
Sexual Assault






Respect the victim’s modesty
Attempt to have same-sex caregiver if possible
Avoid touching the patient other than care
necessary to provide
Attempt to preserve evidence
Contact police of the locale where incident
occurred
Transfer sheet patient lying on to the ED cart

There may be evidence on this sheet
90
Resource for Sexual Assault Cases

Jennifer Slominski, RN, SANE-A

SANE coordinator at Advocate Condell


Sexual assault nurse examiner
Available for in-service at departments

Presents 1 hour program explaining her role with these
patients and provides information to help with care provided
to the patient in the field
 Contact
Jennifer at 847-990-2070
 [email protected]
91
Dealing with Families at a Death
Scene

Do you have resources through your
department?





Chaplains
Family’s church
Most hospitals offer patient
representatives of chaplaincy services
Need to be gently honest with family
members without offering false hope
Every situation is different and may be
handled differently
92
Illinois Safe Haven Law





Written to provide a safe alternative to
abandonment of newborns 30 days old or
younger
Infant may be handed over to personnel at any
hospital, police station, or staffed fire station –
no questions asked
Your department should have informational
packet that can be handed to caregiver
Caregiver can provide anonymous medical
information without asking for names
EMS to complete an assessment on newborn
and transport to the hospital
93
Illinois Safe Haven Law cont’d




EMS to assess the infant and transport to the
hospital
DCFS is called by the hospital and takes charge
of the infant
If infant is abandoned for more than 60 days,
the parent voluntarily gives up parental rights
and infant is placed for adoption
Save Abandoned Babies foundation –
 312-440-0229
94
Your Job in EMS




EMS providers are strong role models
Must live life in a manner above the
typical expectations
EMS profession must put others before
them each time
You’re a great person; you’ve had great
training but…

Hard to get or stay hired if you are a felon!
95
Liability

Biggest causes of EMS liability are
preventable

Ambulance collisions
Can be open to civil and criminal liability
 Operate your vehicle with due regard to the safety
of others


Patient refusals
Have you tried your best to convince the patient to
be transported?
 Have you documented in detail?

96
You know this…


If you treat people with compassion and
consideration, the situation usually goes
well
The public responds more favorably to the
way they are treated than to being treated
by the smartest EMS person
97
Documentation

Patient Run Reports

Often the only document indicating history of
a call
What was done on a call
 How it was done on a call
 Why it was done on a call



Best to leave no blank areas
Make sure times flow in an orderly fashion
and make sense

Includes dispatch time with treatments
98
Liability Prevention and Risk
Management

Training



Quality improvement



Know your protocol
Avoid deviations from the standard of care
Making sure you do the right thing every time
Treat people as you would like to be treated
Protect yourself

Maintain personal commitment to ethics,
integrity, and competence
99
Case #1


Fagocki v. Algonquin/Lake in the Hills Fire
Protection District 469 F.3d 623 (7th Cir. 2007)
Background

EMS responded for a female having an allergic
reaction
 The jaw was clenched. After 2 unsuccessful
attempts to intubate, the patient received 3 rounds
of medication to relax her jaw in order to be
intubated
 Upon Ed arrival, the ETT was found in the
esophagus
 The patient suffered severe, irreversible brain
damage and dies 2 ½ years later
100
Case #1 Outcome


The courts decided that the improper tube
placement was not willful and wanton
conduct (movement in a traveling
ambulance was not negligence).
EMS Systems Act protected the
defendants from liability
101
Case #1

What could you do to protect yourself
following intubation of patients?

Document thoroughly

Confirmation of tube placement




Chest rise and fall
5 point auscultation
ETCO2 confirmation
Capnography confirmation
Ongoing assessment of confirmation of tube
placement
 Immediate correction taken when complications
noted

102
Case #2


Fatal crash involving Ohio responder
Background



Volunteer firefighter was responding to the
station for a call in his private vehicle
He rear-ended another car killing the
passenger and injuring the driver
Did I mention, the volunteer was driving
98 mph
103
Case #2


Do you have department rules on
responding to the station?
Do you have department rules on
responding to calls or transporting to the
hospital emergency and non-emergency?
104
Case #2 Outcome


Pleaded guilty to misdemeanor charges of
negligent vehicular homicide and
attempted negligent vehicular homicide
Sentencing


Jail time, loss of driver’s license for 3 years,
$1.57 million settlement against driver and
Fire District
Ordered to do jail time but was granted work
release at his full time job (nuclear power
plant)
105
Case #3




5 Florida firefighters accused of ACLS
certification fraud
Altered medical cards discovered during
routine audit
ACLS cards boosted salaries by 10-15%
Firefighters charged with conspiracy to
commit perjury, official misconduct,
falsification of public records, and multiple
other offenses
106
Case #3 Outcome



Is it worth losing your job for forgery or
falsification of records???
The salaries ranged from $65,500 - $76,585
Punishment included misdemeanor charges
and fines and loss of employment or leave
without pay
107
Case #3




How do you validate attendance at your
programs?
How do you validate competency of skills?
What would you do if someone asked you
to sign them in for a program and they
never attended?
What would you do if someone exchanged
a quiz with you and asked you to fill in
correct answers for them?
108
Case #4




Kirwin v. Lincolnshire-Riverwoods Fire
Protection District
A woman died as a result of a severe
allergic reaction to walnuts
The family alleges that EMS committed
willful and wanton misconduct
Plaintiff alleges EMS failed to render
proper medical services which resulted in
the death of the patient
109
Case #4




Suit alleges EMS waited 7-8 minutes to
administer medications that would have
prevented anaphylactic shock and cardiac arrest
Trial court granted defendant’s motion to dismiss
plaintiff’s amended complaint without prejudice
Court found plaintiff had not sufficiently pleaded
willful and wanton conduct
On appeal, the dismissal of plaintiff’s complaint
was reversed
110
Case #4 - Outcome

After multiple delays and new trial dates, the
case was settled 6 years later for $175,000


Considered a minimal amount
Prosecuting attorney commented that there
would be no case but for the poorly written
patient care report
 Critical information was omitted or
contradictory
 The addendum submitted to address some
inaccuracies but was also poorly written by
same author
111
Case #4

Lessons learned?




Follow your Standard of Care
Know your SOP’s
Be prepared to act immediately in critical
situations
Write reports that are accurate, professional
and reflect level of care provided
112
Your Best Protection
Ongoing, documented training
Proper documentation
Doing the right thing at the
right time
113
Bibliography







Bledsoe, B., Porter, R., Cherry, R. Essentials of
Paramedic Care 2nd edition Update. Brady. 2011.
Limmer, D., O’Keefe, M. Emergency Care 12th
Edition. Brady. 2012.
Region X SOP’s IDPH Approved
January 6, 2012
CMC EMS System Operating Guidelines and
Infield Policies
http://www.iaff.org/tech/PDF/Monograph3.pdf
(IAFF legal implications)
http://www.cecc.info/resource-links/physiciansorder-for-life-sustaining-treatment-polst
114
Bibliography






seriousillness.org/beloit/downloads/AdvanceDir
ectiveIL.pdf
http://www.idph.state.il.us/public/books/guide_i
ndividual.htm
http://www.myillinoisdefenselawyer.com/ilcriminal-charges/financial-institution-fraud-badchecks/
http://statelaws.findlaw.com/illinois-law/illinoischild-pornography-laws.html
http://www.ilga.gov/legislation/ilcs/ilcs3.asp?Cha
pterID=53&ActID=1876
http://www.emsworld.com/article/10319448/geri
atric-abuse?page=8
115