Emt Basic

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6/7/10
Scope of Practice (also known as Scope of Care): what you are allowed to do. Refers to the level at which a particular individual has been trained to provide emergency medical care. • “Menu”… NOT an instruction manual

• what is available to you

Standard of Care: the care provided based on local laws, administrative orders, and guidelines and protocols established by the local EMS system Medical Director.

Each EMS System has a Medical Director, a physician who assumes the ultimate responsibility for direction or oversight of the patient care aspects of the EMS System.

Online: orders to perform a skill or administer care from the on-duty physician given by radio or phone to the EMT Personnel.

Offline: Standing orders (Scope of Practice) and protocols developed by an EMS System Medical Director to authorize rescuers to perform particular skills in certain situations without talking to the Medical Director.

PAC – Physician Audit Committee
Quality assurance / quality integrity

BSPC – Base Station Physician Committee
Establish Scope of Practice and write protocols

Levels of Care:
First Responder – Basic Life Support
EMT Basic – Basic Life Support
EMT Intermediate / Advanced – Advanced Life Support
EMT Paramedic – Advanced Life Support

Scope of practice will vary from county to county

Base station concept & misgivings:
• Extension of hospital
• Call directly to speak to a doctor

Legal Stuff: Civil / Tort Law
Consent
Competency to refuse: any competent person can refuse medical care Not competent:
1. A&O (Alert & Oriented) X 3 or less – person, place, time & event 2. 18 years or younger…unless emancipated minor
3. Cannot be impaired by ETOH (alcohol) or drugs

AMA – against medical advice
1. at scene …. If turnaround at scene without obtaining signed AMA, it can be viewed as abandonment 2. take patient to hospital but refuse individual treatment…i.e., patient refuses oxygen

Abandonment: to leave a sick or injured patient before equal or more highly trained personnel can assume responsibility for care. i.e., walk away from patient at hospital without proper turnover

Handoff report usually verbal

5150
• danger to themselves
• danger to others
• gravely disabled
Only PD or a MD can place a patient on a 72 hour 5150 psych hold

DNR (Do Not Resuscitate Order)
Valid only with patient signature, physician signature and date

Negligence:
• Duty to act: the first responder had a duty to act • Breach of duty: care for the patient was not provided to an acceptable standard of care…..action or omission • Damages: the patient was injured (damaged) in some way as a result of the improper care or lack thereof • Proximate cause: damage caused by breach of duty to act….a direct link can be established between the damages and the breach of duty on the part of the EMT

Good Samaritan Legislation
• When you are off duty & as long as your actions are within your scope of practice, you are immune from lawsuits

HIPAA – Health Insurance Portability & Accountability Act
Established rules about how patient medical information can be stored and shared. Cannot share any patient information EXCEPT with immediate family and/or doctors/EMT etc., directly involved with patient’s care

Legal – Criminal
• Assault
• Battery
• False imprisonment

Borrowed Servant Doctrine…if you are the crew transporting the patient, you have ultimate medical authority…..you are also responsible for any negligent acts done previously….you must identify and fix any negligent care

6/9/10
Primary Assessment
Scene Size Up
AVPU – Alert, Verbal, Painful, Unresponsive
ABC’s – Airway, Breathing, Circulation

You roll up on scene and assess
AX - Assessment
• Scene Size Up
• AVPU – Alert, Verbal, Painful, Unresponsive
• ABC’s
o...
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