Emergency medical technician’s have a legal responsibility to provide emergency medical technician care as an when called upon or when there is an opportunity to do so.  This responsibility is often called, “duty to act.”

The duty to act is a complex legal obligation that can be formal made or implied.  Formal obligations usually have specific clauses that detail when services are to be rendered and to what degree service will be provided.

An informal contract is usually not written.  This type of contract though not written is considered just as binding as a formally written contract.  An informal contract can be implied and occurs frequently in emergency calls.  An example of an informal contract is when someone calls for help on behalf of someone who is injured and unable to call themselves.

Being a licensed or certified emergency medical technician places this duty upon your shoulders.  As long as the minimum requirements for licensure or certification have been met there is an implied duty to act placed upon the emergency medical technician.  The specific duties that are expected may vary from state to state.

An emergency medical technician can be considered negligent if he or she fails to act on a formal or implied contract.  Negligence occurs when an emergency medical technician does not perform at an acceptable standard.  If this failure to perform causes the patient to suffer additional damage or injury the emergency medical technician may be considered negligent.  In order for negligence can be proven four criteria must be met.  First, there must be a duty to act.  Second, the emergency medical technician must have failed to act or provide an expected level of service.  Third, the patient must have suffered some type of physical or psychological injury.  And finally, the physical or psychological injury incurred must have been caused by the emergency technician’s action or inaction.

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Emergency medical technicians have more than just medical related responsibilities.  An emergency medical technician has legal responsibilities to patients, the medical director and the public. Generally, the legal responsibilities of an emergency medical technician are defined by each state legislature.  Most states refer to the regulations created by the United States Department of Transportation National Highway Traffic Safety Administration’s (U.S. DOT/NHTSA) National Standard Curriculum.

Emergency medical technicians are expected to provide at least a minimal standard of care.  State regulations can prohibit emergency medical technicians from performing certain skills.  State regulations will always supersede direction by the medical director.  Local medical community or state regulations can identify skills that are inappropriate for emergency medical technicians to provide in particular local or state areas.

Emergency medical technicians have a legal right to provide certain care under medical direction.  In many instances, on scene emergency personnel can not perform certain procedures unless the medical direction physician has been consulted first.  An example of several procedures that must be approved for care include assisting a patient with medications or advanced airway control procedures.  Permission may or may not be granted by the medical director.  Permission usually requires that certain protocols have been followed, the nature of the skill to be preformed, the emergency technician’s skill level, the condition of the patient and the physician’s comfort level with the technician’s abilities.

The method to obtain permission to provide certain types of care can depend on various factors.  The emergency technician may have to consult directly with a physician by radio, telephone, computer, or face-to-face if a physician is at the scene.  In some instances, permission to provide certain procedures can be given in advance by written protocols or standing orders.  This type of permission allows the emergency technician to provide specific skills before speaking with a physician if a patient shows specific signs and symptoms.

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Physicians monitor the care that is given to patients by emergency medical technicians.  This process is called medical direction or medical control and requires that physicians be involved in all aspects of prehospital care.  An emergency medical technician treating a patient may be required to seek medical direction authorization first.  The medical direction can be monitored in two ways- through direct medical direction or indirecte medical direction.

Direct medical direction allows for direct communication between the physician and the healthcare providers in the field.  This type of communication is accomplished via cellular telephone, radio, telephone land-lines or computer.  A physician may also be present at a scene as a bystander.  The physician will be able to speak directly with the attending physician at the hospital.  There are certain procedures that should be used when following the orders and advice of a physician at an emergency scene.

Indirect medical direction allows for other ways that physicians can influence medical care.  Physicians can assist by developing protocols and standing orders, providing and taking opportunities for continuing education, and participating in quality improvement.  This type of direction involves physician involvement that addresses needs beyond direct medical direction.

An emergency medical technician should interact with the medical director and attending physicians in a professional manner.  This relationship often begins when the emergency medical technician is a student.  As a student, he or she will be introduced to the protocols created by the medical director.  It is important to remember that the medical director is a valuable resource to the healthcare team.  His or her direction should be followed.

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The roles and responsibilities of Emergency Medical Technicians (EMTs) are always changing and evolving.  Regardless of the continual evolution of this profession, there are standard roles and responsibilities that will always remain an important aspect of an emergency medical technician’s profession.

Personal safety is the primary responsibility of each emergency medical technician.  To ensure personal safety each emergency medical technician should maintain a healthy lifestyle by remaining physically active, refraining from substance abuse.  Personal safety at a scene includes being aware of dangerous situations, hazardous environments or potentially hazardous situations before entering.

The safety of fellow crew members, patients, and bystanders is also the responsibility of an emergency medical technician.  Each team member should be looking out for each other’s well-being.  Paying close attention to scene safety and how your co-workers are handling stress is extremely important.  This also pertains to the patients you treat.  You are responsible for providing the best possible care as well as preventing further injury from hazards that may be present at the scene.

Emergency medical technicians are responsible for assessing a patient’s needs and providing appropriate medical care based upon what was determined from the assessment.   An accurate assessment allows the emergency medical technician to administer appropriate emergency care.  Without an accurate assessment the patient’s condition could become more serious.

After a patient has been evaluated and treatment has begun the emergency medical technician must prepare the patient to be transported to the appropriate medical facility.  An emergency medical technician should know how to lift and move patients safely without hurting themselves or the patient.  To do this the emergency medical technician should assess the environment, clear away any dangerous debris and use safe lifting and moving techniques.

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The most important step in specimen collection is verifying a patient’s identity.  If a specimen is obtained from the wrong patient there can be serious consequences.  This is especially true of specimens that are obtained for type and crossmatch prior to blood transfusion.  Incorrectly identifying a patient or specimen is a serious infraction that could lead to dismissal of the person responsible.  The person responsible may even have a malpractice lawsuit filed against that person.  Incorrect specimen or patient identification can have far reaching consequences.  This is why it is important to follow standard identification procedures whether you are a paramedic, phlebotomist technician, nurse, or any other allied health field.

Verifying the patient’s name and date of birth is one way to help you identify a patient.  Ask the patient to state his or her full name and date of birth.  You should never say the patient’s name for them.  For example, never say, “Are you Mr. Jones?”  If a person is hard of hearing, very ill or sedated, he may agree to anything asked.

After the patient verifies his or her name verbally and that verification matches the information on the requisition, check the patient’s identification band or bracelet.  Hospital patients are usually required to wear an identification band on their wrist.  The wrist band generally lists the patient’s name and hospital identification number or medical record number.  The patient’s birth date, age, room number, bed designation and physician may also be included on the writs band.  Be sure that the patient name, medical record number, and date of birth or age on the wrist band match the information on the requisition exactly.  Very often patients with similar names are staying in the hospital at the same time.  This is especially common when there are accidents involving family members, like fathers and sons, or multiple-birth babies, and relatives that are involved in transplant procedures.  It is even possible that two totally unrelated patients have the same name and birth date.  This is why the medical record number must be verified as well.

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Whenever a patient is determined to be in respiratory distress the emergency personnel should administer oxygen as soon as possible.  This is extremely important if the patient is having difficulty breathing.

To administer oxygen a nonrebreather mask must be placed on the patient with oxygen flowing at a rate of 15 L/min.  There are two types of oxygen masks that can be used.  The nasal cannula maks should only be used for patients who can not stand to have a mask on their face.  In most cases, a regular oxygen mask should be used.

Infants or small children who need oxygen administered should be kept calm during while oxygen is being administered.  Children should be allowed to stay with their parents.  It is important to keep children from experiencing further distress that could worsen the respiratory problem.

Respiratory emergencies are serious and can get worse quickly or cause cardiac arrest.  Patients who are in respiratory distress should be transported immediately to an emergency department for care.  During transport, the patient should be allowed to assume any position that they find comfortable.  Most patients do not like to lie on their backs.  Sitting upright is usually the position most preferred.

Patients who are in respiratory distress may stop breathing.  Emergency medical technicians (EMTs) should be prepared to ventilate a patient who either stops breathing or who can not breathe on their own.  There are several methods available to artificially ventilate a patient.  EMTs can use mouth-to-mask, bag-valve-mask, and flow-restricted oxygen-powered ventilation devices.  When artificial ventilation is used, the patient should be assessed to ensure that each breath is being delivered equally.

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Emergency medical technicians (EMTs) may encounter patients with respiratory problems that often require the use of a prescribed inhaler. When an EMT is acquiring information about the patient’s medical history and performing a physical examination, he should determine if the patient was prescribed an inhaler by a physician. EMTs do not generally carry inhalers in their Basic Life Support kits. However, an EMT can assist a patient with their own prescribed inhaler. Most inhalers distribute medications known as beta-agonist bronchodilators. These types of drugs affect the tissues of the lungs when the patient inhales. The medication is absorbed into the tissues of the lungs and helps the bronchioles to dilate and decrease resistance inside the airways. Some prescribed inhalers are called metered-dose inhalers. These types of inhalers deliver a set amount of medication each time the inhaler is used. There are many generic names for the types of medications used. Some common medications include albuterol, isoetharine, and metaproterenol. Steroid drugs are often used for lung inflammation and are also available in inhalers. EMTs should always consult direction before helping a patient administer inhaler medication because some medications should not be used during severe respiratory distress. There are certain indications that should be evident before an inhaler is used. These indications must include the following criteria: 1. A patient must exhibit signs of respiratory problems or distress. 2. A patient must have his own physician-prescribed inhaler. 3. The EMT must obtain authorization from medical direction to help the patient with inhaled medication.

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An advance directive is a written document that states the type of care a patient want to receive, or not receive should they become unable to communicate their wishes later on.  There are three types of advance medical directives that every emergency medical technician should be aware of.

Living Wills

A living will is written document that a person can have created to describe the type of life-sustaining treatment he wants or does not want should the patient become unable to communicate these wishes himself.  A living will can deny resuscitation or specify the length of time and effort that will be permitted for this effort.  The types of care that are usually chosen are compassionate care (which allows for care that provides only nourishment, water and possible brain relief), basic life support, or the request for every possible procedure that is available.  This document can also specify the number of times that resuscitation attempts will be allowed.

Durable Power of Attorney

A Durable Power of Attorney is an advanced directive that identifies a guardian to make medical decisions on behalf of the patient.  The guardian can either be an individual or a group of persons depending on the will of the patient.  Terminally ill patients often have this type of advanced directive.

Do Not Resuscitate Orders

Do Not Resuscitate (DNR) orders are a type of advanced directive that is usually made by a physician at the request of the patient.  This document will usually state whether any lifesaving measures are permitted for the patient.  The DNR orders must be on hand at the time that the patient refuses treatment for this directive to be upheld.  In the event that the directive is not physically present, CPR or other lifesaving measures must be given.

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An adult patient that is considered mentally competent and able to understand the consequences of their decisions has the legal right to refuse medical treatment at any time.  If a patient is forced to receive treatment against his or her will there is a good chance that legal charges will be filed against the emergency medical team.  Transporting a patient without consent can also be considered kidnapping or false imprisonment.

If a patient is competent and refuses treatment, the emergency medical team should try to convince the patient of the importance of receiving treatment or at least going to the hospital for further evaluation.  This will prevent the EMT from being considered negligent and having legal charges filed against him or her in the future.  Also, before an EMT leaves a patient who refuses treatment, the EMT should inform the patient of any potential risks and consequences for refusing treatment or transport.  While the EMT is explaining the risks and urging the patient to reconsider help, the EMT should be evaluate the patient’s mental state to ensure that the patient is mentally competent and not under the influence of drugs, alcohol or mental illness.

If a patient obviously needs medical treatment and transport to a hospital but continues to refuse help, the EMT should consult with the medical director.  The medical director may have suggestions that could help change the patient’s mind.  In some instances, calling for police support is necessary.  The decision not to provide treatment or transportation for a patient should be discussed with other EMS officials.  Whatever the decision, it is important to document the situation completely and accurately.  If treatment is refused, a “release from liability” form should be signed by the patient.

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Emergency medical technicians (EMTs) are obligated to offer medical care to people in need.  This care can be refused by competent adults.  Children and mentally incompetent individuals who need medical care do not have the same legal rights as fully competent adults.

If a child requires medical attention, a parent, legal guardian or an adult relative can give consent.  Adult relatives are only able to provide consent if the parent or guardian is unavailable.  An EMT is obligated to treat a child even if the child refuses treatment as long as the parent or legal guardian consents.  If the parent or legal guardian refuses treatment for the child, the EMT is must comply unless the child’s welfare is clearly in danger.   If a parent refuses care for a child in a life-threatening situation, an EMT should seek ask for police assistance to place the child into protective custody.  When this occurs, the child becomes a ward of the state, and there is implied consent that the child should receive treatment.  The use of implied consent can also be used if a child does not have a parent, legal guardian for adult relative on hand to give expressed consent.    Only emancipated minors are given the legal right to make their own decisions.  In most states, an emancipated minor is usually any minor who is either in the military, married, pregnant, or living on their own and able to provide financially for themselves.  Each state will have different qualifications for emancipation.

A mentally incompetent adult has the same restrictions and rights as a child.  An EMT must obtain consent from a legal guardian in order for treatment to be given.  Any patient that is physically, emotionally or developmentally unable to make rational decisions can usually be considered incompetent.  A mentally incompetent adult may also be someone who is under the influence of drugs or alcohol.  In this instance, treatment can be administered under implied consent, unless there is a family member available to provide exact consent or to deny consent.

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