First Responder EMS Curriculum for Training Centers in Eurasia

2. IntroductionLegal and ethical issues play an important role in the decisions that First Responders, otheremergency medical services (EMS) personnel, and medical care providers make wheneverthey deliver emergency care to patients. Although the legal considerations andconsequences vary by state, region, and country, certain basic principles apply from themoment contact is made with any patient. As long as the First Responder is aware of theissues addressed within this lesson, he/she can make correct decisions to benefit the patientat risk of illness or injury and to minimize the legal and ethical risks whenever he/sheprovides care.3. Scope of CareThe First Responder has legal duties to the patient, medical director, and the public. Theseduties are defined by state and local laws and enhanced by the oversight and guidance ofthe medical director. The scope of care is the accepted range of cognitive and technicalskills the First Responder may perform in providing interventions to care for the patient. Inother words, the First Responder may only perform those interventions that he/she has beentrained to perform under a standardized curriculum to provide for the well-being of thepatient. In essence, the First Responder functions as a direct extension of the medicalcontrol in the field. The medical director is responsible for the interventions performed inthe field. Guidelines and protocols established for the First Responder by the medicaldirector, and outlined in this course, provide the framework for acceptable actions the FirstResponder can take. Medical oversight and ongoing review and recredentialing are vitalelements in providing the best care possible for patients in the community.Basic ethical responsibilities will guide the First Responder in rendering care to allpatients. First, it is the responsibility of the First Responder to make the physical andemotional needs of the patient the first priority. Mastering the necessary skills to functionas a First Responder is also a vital component. Performance will be enhanced throughcontinuing education, reviewing performances, seeking ways to improve response time,and improving communication, all of which ultimately result in improved patient outcome.Honesty and integrity in reporting events also is crucial for continuing improvement ofpatient care.4. CompetenceCompetence is defined as the ability of a patient to understand the questions of the FirstResponder and to understand the implications of decisions made. The First Responder’sfirst task is to determine whether a patient is competent to consent to or refuse care. Inmost cases, if the patient understands the nature of his/her illness or injury and thenecessity to receive emergency care, he/she is competent to allow or refuse your intendedintervention. Certain cases, however, may prevent you from determining competence,including intoxication from alcohol, drug ingestion, serious injury rendering the patientconfused or unconscious, and mental incompetence.5. ConsentBefore providing care, the First Responder must obtain consent from the patient, parent, orlegal guardian. A competent patient has the right to make decisions regarding care,including refusal of care. The patient must consent to emergency medical care on the basisof the information provided to them by the First Responder and accept the intendedinterventions being offered.22First Responder EMS Curriculum/AIHA, July 2002