An EMT is dispatched to the home of a 71-year-old man found unconscious. Immediately, an EMT must begin to evaluate scene safety, airway, breathing, circulation and blood sweep. In order for an EMT to provide proper care and have an efficient primary assessment, they must also take legality into consideration.
Since the 71-year-old patient is unconscious, implied consent is assumed. But, at times, the legal issues EMT’s are confronted with are not as straightforward. Legal situations, such as consent, refusal, advance directive, negligence, medical direction, patient confidentiality, and more, determine the level of care an EMT can provide for their patient, therefore making it an important part of emergency medical treatment.
An EMT’s top priority is to advocate for their patient and provide for immediate, life threatening issues. In order to do this, an EMT needs consent or “a patient’s permission to receive care or treatment” (Kolmetz, EMT-P).
There are several different types of consent which can be applied to varying situations; there is expressed consent, informed consent, and implied consent.
Expressed consent, is “consent given by a person who is of legal age and of sufficient mental capacity to be considered competent” (Kolmetz, EMT-P). An important part of expressed consent is legal age, because depending on the state, the legal age may vary. Usually, the age for a minor is 18 or in many states, such as New York, “eighteen years of age or older, or is the parent of a child or has married” (DOH).
Therefore, if an EMT goes to help a patient who is mentally capable in NY, who is sixteen years-old but has a child, they could go off of expressed consent rather than having to listen to their legal guardians.
Another important part of consent is informed consent, “meaning the person understands the risks and benefits of treatment and refusal of treatment” (Kolmetz, EMT-P).
So, if a person was shot, but was eupnea, had a clear airway, normal circulation with a good cap refill, alert and oriented and fully understood that this could be an immediate threat to life, they could refuse help. But, if one of these things were compromised, such as if they were bleeding out, this could lead to an altered mental status and therefore they could not consent because they do not fully grasp the severity of their situation.
Lastly, implied consent “assumes that an unconscious person or a parent/guardian would consent to the treatment if the person were conscious or the parent/guardian were available” (Kolmetz, EMT-P). Implied consent would allow an EMT to treat a minor who was home alone and there was no guardian to give consent for them.
It is because of consent an EMT is allowed to help their patients, whether it is expressed or implied.
An obstacle an EMT may face is if a patient is refusing care, but in order for a patient to do so they must meet certain criteria that must be documented. The criteria are that a patient must be of legal age to consent, competent and oriented, fully aware of risks and benefits of both treatment and refusal of treatment, alternative options, resources consulted, and document witnesses (Kolmetz, EMT-P).
The reason for such criteria, is because EMT’s do not want to be held liable if a person dies after refusing treatment. “Patient refusal are the greatest liability to patient care”, the legality behind a patient refusing care affects EMT’s because, legally, they can no longer do anything to help their patient unless the patient’s condition worsens (Hayes, NREMT-P).
Proper documentation for patient refusal is of utmost importance because if not done correctly, an EMT can be charged for negligence. EMT’s arrive at a scene to help a patient and if they refuse and the EMT’s fail to gather correct documentation, they have failed their duty to act, caused the patient harm, and have caused a breach of duty.
The basis for the right to refuse treatment is backed by several judicial cases, such as Union Pacific Railway Co. v. Botsford and Schloendorff v. Society of New York Hospital.
During the Union Pacific Railway Co. v. Botsford case, Botsford sued the railroad because she sustained permenant brain and spinal cord injuries while on the railroad car. She claimed that it was a result of the railroad’s negligence in construction. As a result of her claims, the railroad company wanted to surgically examine her injuries without her consent.
The ruling of this case helped further established a patient’s right to refusing care, stating that, "No right is held more sacred or is more carefully guarded by the common law than the right of every individual to the possession and control of his own person, free from all restraint or interference of others unless by clear and unquestionable authority of law"(Standler).
Another case which established a patient’s right to refuse care is Schloendorff v. Society of New York Hospital. During this case Schloendorff was admitted into the hospital with stomach problems, but doctors later diagnosed her with a fibroid tumor. Doctors recommended that Schloendorff have surgery to remove the tumor, but she declined.
Despite saying no, while under anesthesia, doctors preformed surgery to remove the tumor. After the surgery Schloendorf developed gangrene in her left arm and had to have several fingers amputated. As a result, Schloendorf sued the hospital, and the justices found that this procedure in which the plaintiff did not consent constituted medical battery.
The court stated that “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault for which he is liable in damages. This is true except in cases of emergency where the patient is unconscious and where it is necessary to operate before consent can be obtained” (Standler).
These court cases helped established, that under law a patient has a right to refuse medical treatment if they are informed and meet the criteria, therefore affecting how an EMT can help a patient.
In order for an EMT to help their patient to the best of their ability, they need the patient’s consent, whether it is expressed or implied, the patient must be informed. Similar to if the patient does decide to refuse medical assistance, they must be informed and meet the criteria. Although consent and refusal protect a patient’s right, they can act as a hindrance to an EMT’s ability to help their patient. In the vast amount of knowledge, it takes to be an emergency medical technician, dealing with state and local protocol act as a legal precaution. EMT’s have a duty to act and legal issues of consent and refusal can interfere with that.
