EMS In The News - Survivors of Overdose Deaths Have Everlasting Impact on Families

The following article by Sean Krofssik (2024) discusses the profound impact of overdose deaths on families, highlighting personal stories like Kass Kruh's, who lost both parents to overdoses.

Kruh shared her experiences during International Overdose Awareness Day, emphasizing the lasting trauma on children of addicts.

The event also featured recovery stories and statements from Connecticut officials who stressed the importance of support and prevention.

Connecticut's efforts in reducing opioid overdoses and utilizing settlement funds for addiction services were also addressed at the event.

For more details, you can access the full article here.

EMS In The News - The Challenges Facing Wyoming's Ambulance Services

"Most people expect an ambulance to arrive quickly when they call for help. But Wyoming’s EMS system isn’t funded like an essential service, and a critical failure can cost lives."

Madelyn Beck examines the dire situation of Wyoming's ambulance services, which are facing significant financial and operational challenges due to inadequate funding.

In many rural areas of Wyoming, ambulance services are struggling to maintain operations, as they rely heavily on local taxes, fundraising, and payments from patients and insurance companies, which are often insufficient to cover costs.

Beck's (2024) article highlights that while ambulance services are vital for emergency healthcare, they are not funded like other essential services such as fire and police departments. This has led to a critical point where some regions might lose these emergency services entirely unless the state intervenes.

The discussion revolves around whether the state should provide additional funding and support to these struggling services to ensure that residents have access to emergency medical care.

Lawmakers, healthcare professionals, and local officials are debating potential solutions, including state funding, regional consolidation of services, and changes in the payment structures to better support these crucial services.

Beck's (2024) article emphasizes the importance of addressing these issues to prevent life-threatening consequences for residents in emergencies.

For more details, you can access the full article here.

 

EMS In The News - WREMS Enhancing Backcountry Rescue Operations

The Wilderness Medical Team, a specialized unit within Wyoming Regional EMS (WREMS), is making significant strides in enhancing backcountry rescue operations through rigorous training, strategic partnerships, and innovative medical practices.

The Campbell County Health article highlights how the team members are trained in wilderness medical care and maintain physical fitness to handle challenging environments. They collaborate closely with Sheridan Area Search and Rescue (SASAR) for seamless integration during emergencies. 

Since June 2023, the team has responded to multiple incidents and continues to provide vital medical support in remote areas.

For more details, you can access the full article here.

EMS Legislation - Good Samaritan Laws: Origins, Functions, Violations, and Compliance

Origins of Good Samaritan Laws

Good Samaritan laws are designed to protect individuals who provide reasonable assistance to those who are injured, ill, or otherwise incapacitated. 

The concept originates from the biblical Parable of the Good Samaritan, which tells the story of a man who helps a stranger in need. 

In modern legal contexts, Good Samaritan laws were created to encourage bystanders to assist in emergencies without fear of legal repercussions if their help inadvertently causes harm.

The first Good Samaritan laws in the United States were enacted in the mid-20th century, reflecting a societal desire to foster a sense of community responsibility and reduce the fear of legal liability for those willing to help others in distress.

These laws vary by state but generally offer legal protection to non-professional rescuers and, in some cases, to professional emergency responders acting in good faith.

Functions of Good Samaritan Laws

Good Samaritan laws serve several key functions in emergency situations:

Encouraging Assistance in Emergencies: By offering legal protection to those who voluntarily provide aid, these laws encourage more people to step forward and help in emergency situations. 

This can be especially critical in the initial moments following an accident or medical emergency when immediate assistance can save lives.

Protecting Rescuers from Legal Liability: Good Samaritan laws are designed to shield individuals from legal liability for unintentional harm caused while rendering aid. 

This legal protection applies as long as the rescuer acts voluntarily, without expectation of compensation, and within the scope of their knowledge and abilities.

Promoting Public Confidence: By reducing the fear of lawsuits, Good Samaritan laws promote public confidence in providing emergency assistance. 

They create a legal safety net that reassures potential rescuers that they will not be penalized for trying to help others in good faith.

Supporting Professional Responders: In some states, Good Samaritan laws also extend protection to professional emergency responders, such as EMS providers, when they provide care outside of their official duties. 

This can include off-duty situations or when responding spontaneously to emergencies.

Potential Violations of Good Samaritan Laws

While Good Samaritan laws offer significant legal protection, there are certain situations where these protections may not apply:

Gross Negligence or Willful Misconduct: Good Samaritan laws typically do not protect individuals who act with gross negligence, recklessness, or willful misconduct. 

If a rescuer’s actions go beyond simple negligence and demonstrate a disregard for the safety of the person they are trying to help, legal protections may be voided.

Expectation of Compensation: If a rescuer expects to receive compensation or reward for their assistance, the Good Samaritan protections may not apply. 

These laws are intended to cover voluntary, uncompensated assistance only.

Actions Beyond Scope of Training: If a rescuer provides care or performs medical procedures that exceed their level of training or competence, and these actions result in harm, Good Samaritan protections may not cover them. 

It is crucial for rescuers to act within their knowledge, abilities and scope of practice.

Failure to Obtain Consent: When possible, rescuers should obtain the consent of the person they are assisting. If the person is unconscious or unable to consent, implied consent is generally assumed. 

However, if a rescuer provides aid against the explicit wishes of a conscious and competent person, Good Samaritan protections might not apply.

Working Within the Good Samaritan Legislative Framework

EMS providers should be aware of how Good Samaritan laws apply to their actions and the actions of bystanders in emergency situations:

Understanding Legal Protections: EMS providers should familiarize themselves with the specific Good Samaritan laws in their state. 

Understanding the scope of legal protection can help them navigate situations where they might provide off-duty assistance or guide bystanders in emergencies.

Acting Within Scope of Training: When providing aid, EMS providers must ensure they act within the scope of their training and certification. 

This includes understanding the limits of their skills and avoiding procedures or interventions that they are not qualified to perform.

Encouraging Safe Bystander Assistance: EMS providers often arrive on the scene where bystanders are already providing assistance. 

It’s important to encourage safe and appropriate help while also being aware of the potential for harm if bystanders are acting beyond their capabilities.

Communicating Clearly: EMS providers should communicate clearly with bystanders and patients about what assistance is being provided and ensure that actions are understood and consensual when possible. 

Clear communication helps manage expectations and reduces the risk of misunderstandings or unnecessary complications.

Documenting Actions: If an EMS provider assists in an off-duty capacity or in a situation not covered by their employer, they should document their actions carefully.

This documentation can be valuable if questions arise about the care provided or if there is any need to refer back to what occurred during the emergency.

Promoting Education and Awareness: EMS providers can play a role in promoting public education about Good Samaritan laws and emergency response skills. 

By encouraging the public to learn basic first aid and understand the legal protections available to them, EMS providers help foster a more prepared and confident community.

By understanding the origins, functions, potential violations, and compliance requirements of Good Samaritan laws, EMS providers can better navigate their roles in emergencies, both on and off duty. 

These laws are a critical part of the legal framework that supports emergency response efforts, ensuring that those willing to help are protected and encouraged to act in the best interests of those in need. 

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ogilvie, W. A., Moy, H.P., & Goldstein, S. (2023) EMS Legal and Ethical Issues. Treasure Island, Florida: StatPearls Publishing. Accessed August 11, 2024

EMS Legislation - COBRA: Origins, Functions, Violations, and Compliance

Origins of COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was enacted in 1985 as a federal law in the United States. 

While COBRA encompasses a wide range of provisions, it is primarily known for allowing employees and their families to temporarily continue their health insurance coverage after losing their job or experiencing another qualifying event, such as a reduction in work hours or a change in family status (like divorce or the death of the covered employee). 

This legislation aimed to provide a safety net for individuals who might otherwise lose their health insurance, ensuring that they could still access medical care while transitioning between jobs or adjusting to life changes.

Functions of COBRA

COBRA serves several important functions within the healthcare system:

Continuation of Health Coverage: COBRA allows individuals who have lost their job, experienced a reduction in work hours, or faced other qualifying events to continue their employer-sponsored health insurance coverage for a limited period, typically 18 to 36 months. 

This may help prevent gaps in healthcare coverage during times of transition or uncertainty.

Protecting Access to Healthcare: By ensuring continued access to health insurance, COBRA helps individuals maintain access to necessary medical care, medications, and treatments without disruption. 

This is particularly important for those with ongoing medical conditions who need consistent care.

Promoting Stability for Families: COBRA’s provisions extend to covered family members, ensuring that spouses, children, and other dependents also have access to continued health insurance coverage in the event of job loss, divorce, or other qualifying circumstances.

Providing a Transitional Safety Net: COBRA serves as a bridge for individuals transitioning between jobs, giving them time to secure new employment with health benefits or to find alternative insurance coverage without losing access to essential healthcare services.

Potential Violations of COBRA

There are several ways COBRA provisions can be violated, which can affect both employers and beneficiaries:

Failure to Provide Notice: Employers are required to notify eligible employees and their dependents of their right to elect COBRA coverage within a specific timeframe after a qualifying event. 

Failing to provide timely or adequate notice is a common violation of COBRA.

Improper Denial of Benefits: Denying COBRA benefits to eligible individuals or failing to offer coverage that matches the employee’s prior insurance plan constitutes a violation. 

This can occur if employers attempt to cut costs by not offering the full range of benefits previously available.

Inadequate Coverage Options: Employers must provide continued coverage that is identical to what the employee had before the qualifying event. 

If the coverage is reduced or altered in a way that disadvantages the beneficiary, it can be considered a violation.

Failure to Maintain Coverage: Employers are responsible for maintaining the health insurance coverage of COBRA participants. 

If the employer fails to pay premiums or otherwise maintain the coverage, resulting in a lapse, this violates COBRA regulations.

Working Within the COBRA Legislative Framework

EMS providers, while not directly responsible for administering COBRA benefits, should understand the basic requirements and implications of COBRA for several reasons:

Awareness of Patients' Rights: EMS providers may encounter patients who are utilizing COBRA coverage and should be aware of the rights these patients have to ensure they receive appropriate care without unnecessary complications or misunderstandings.

Understanding the Continuity of Care: Knowing that COBRA provides a mechanism for continued health coverage helps EMS providers understand a patient’s insurance status during transitions. 

This can be critical when verifying insurance coverage or when discussing follow-up care and hospital admissions.

Navigating Patient Transitions: EMS providers can play a role in advocating for patients who are undergoing significant life changes, such as job loss or divorce, which might qualify them for COBRA coverage. 

Providers can guide patients toward resources or social services that can assist with securing or understanding their insurance options.

Proper Documentation and Communication: EMS providers should ensure thorough documentation of patient interactions, especially in situations where insurance coverage might be in question or when patients express uncertainty about their coverage status. 

Accurate information can help hospitals and other healthcare facilities verify coverage more efficiently.

Compliance and Education: EMS agencies should educate their personnel about COBRA to enhance their understanding of how this law might impact the patients they serve. 

Although direct compliance with COBRA is typically the responsibility of employers and insurers, having knowledgeable providers can contribute to a smoother care experience for patients.

By understanding COBRA’s origins, functions, potential violations, and the ways it intersects with healthcare delivery, EMS providers can better serve their patients and ensure that they are advocating for the rights and benefits available to those in transition. 

While EMS providers do not administer COBRA benefits directly, their awareness of the law and its implications can help in providing empathetic, informed care to all patients.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ogilvie, W. A., Moy, H.P., & Goldstein, S. (2023) EMS Legal and Ethical Issues. Treasure Island, Florida: StatPearls Publishing. Accessed August 11, 2024

EMS Legislation - EMTALA: Origins, Functions, Violations, and Compliance

Origins of EMTALA

The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by the U.S. Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). EMTALA was established in response to growing concerns about "patient dumping," a practice where hospitals denied emergency medical treatment or transferred patients without insurance or adequate financial means. 

The primary purpose of EMTALA is to ensure that anyone coming to an emergency department (ED) is stabilized and treated, regardless of their insurance status or ability to pay.

Functions of EMTALA

EMTALA serves several crucial functions in the healthcare system, especially in emergency care settings:

Ensuring Access to Emergency Care: EMTALA mandates that all patients presenting to an emergency department with an emergency medical condition must be given a medical screening examination to determine if an emergency medical condition exists. 

This requirement applies to all patients, regardless of their ability to pay, citizenship, or insurance status.

Preventing Patient Dumping: EMTALA prohibits hospitals from refusing to treat patients in an emergency setting or transferring them to another facility based on their inability to pay. 

If a patient requires treatment to stabilize an emergency condition, the hospital must provide that treatment or transfer the patient only after stabilization and with the patient’s consent or if the benefits of transfer outweigh the risks.

Obligating Hospitals to Stabilize Patients: Once an emergency medical condition has been identified, EMTALA requires hospitals to provide necessary stabilizing treatment. 

This means that hospitals must address and manage a patient’s emergency medical condition to prevent material deterioration.

Ensuring Proper Transfer of Patients: If a transfer to another facility is necessary, EMTALA requires that it be conducted safely. 

The transferring hospital must provide medical treatment within its capacity to minimize risks to the patient’s health and ensure that the receiving facility has accepted the patient along with having the necessary space and qualified personnel to treat them.

Potential Violations of EMTALA

EMS providers ned to be aware of the following potential violations of EMTALA:

Failure to Provide a Medical Screening Examination: Refusing to evaluate a patient who comes to the emergency department is a direct violation of EMTALA. 

This includes not providing appropriate screening to determine if an emergency medical condition exists.

Inappropriate Transfers: Transferring a patient without stabilizing their condition, or without the consent of the patient or a physician certifying that the benefits of transfer outweigh the risks, violates EMTALA. 

This also includes not arranging for appropriate and safe transportation or failing to provide medical records to the receiving facility.

Refusal of Treatment Based on Financial Status: Refusing to treat or delaying treatment of a patient in an emergency situation due to their insurance status or inability to pay is considered patient dumping and a violation of EMTALA.

Improper Documentation: Failure to properly document the reasons for a transfer, including patient consent and the medical necessity for transfer, can result in a violation of EMTALA.

Working Within the EMTALA Legislative Framework

EMS providers play a critical role in ensuring compliance with EMTALA by adhering to the following:

Understand the Scope of EMTALA: EMS providers should be familiar with the basic requirements of EMTALA, including the obligation of hospitals to provide emergency care regardless of a patient’s financial status and the importance of ensuring that patients with emergency conditions are not transferred until stabilized.

Recognize Emergency Medical Conditions: EMS providers should be trained to identify potential emergency medical conditions and understand when a patient needs to be transported to an emergency department. 

It is also crucial to understand the receiving hospital's obligations under EMTALA once the patient arrives.

Proper Communication: EMS providers must communicate effectively with hospital staff when transferring patients to ensure that the hospital is prepared to provide the necessary care. 

They should provide all relevant patient information and medical records to facilitate appropriate treatment upon arrival.

Safe and Appropriate Transfers: When a transfer is necessary, EMS providers should ensure it is conducted safely, with appropriate medical personnel and equipment. 

They should verify that the receiving facility is equipped to handle the patient’s condition and has agreed to the transfer.

Documentation: Thorough and accurate documentation is essential. EMS providers should document the patient's condition, the reasons for transfer, and the communication with the receiving facility. 

Proper documentation helps protect against EMTALA violations and ensures continuity of care.

Stay Updated on EMTALA Requirements: As healthcare laws and regulations evolve, EMS providers should stay informed about any changes to EMTALA. 

Regular training and updates on EMTALA compliance can help ensure that EMS providers are prepared to handle emergency situations in accordance with the law.

By understanding the origins, functions, potential violations, and compliance requirements of EMTALA, EMS providers can help ensure that all patients receive the emergency care they need, regardless of their financial or insurance status. 

Adherence to EMTALA not only protects patient rights but also upholds the ethical standards of emergency medical care. 

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ogilvie, W. A., Moy, H.P., & Goldstein, S. (2023) EMS Legal and Ethical Issues. Treasure Island, Florida: StatPearls Publishing. Accessed August 11, 2024

EMS Legislation - HIPAA: Origins, Functions, Violations, and Compliance

Origins of HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. Its primary goal was to improve the portability and continuity of health insurance coverage for individuals changing or losing their jobs. 

Over time, HIPAA evolved to address the need for standards in protecting sensitive patient health information, particularly as digital records became more common. 

The HIPAA Privacy Rule and the HIPAA Security Rule, which were introduced in 2003 and 2005 respectively, established national standards for the protection of health information and set the foundation for how healthcare providers, including EMS providers, handle patient information.

Function of HIPAA

HIPAA serves several key functions in the healthcare environment:

Protecting Patient Privacy: HIPAA’s Privacy Rule sets standards for protecting patients' medical records and other personal health information (PHI). It limits the uses and disclosures of PHI without patient consent, except in specific, defined situations.

Ensuring Data Security: The HIPAA Security Rule outlines safeguards that healthcare providers must implement to protect electronic protected health information (ePHI). 

These safeguards include administrative, physical, and technical measures designed to prevent unauthorized access and breaches.

Facilitating Information Flow: While HIPAA is focused on safeguarding information, it also recognizes the need for healthcare providers to access and share health information for patient care, billing, and other essential functions. 

HIPAA provides a framework that allows the necessary flow of information while protecting patient rights.

Improving Accountability: HIPAA holds healthcare entities accountable for protecting patient information and provides enforcement mechanisms for addressing violations. This includes penalties for non-compliance, which can be significant and include both civil and criminal penalties.

Potential Violations of HIPAA

EMS providers must be aware of several HIPAA violations that can occur in the course of their duties:

Unauthorized Disclosure of PHI: Sharing patient information without consent or beyond what is necessary for the care of the patient can lead to violations. 

This includes discussing patient details in public areas, sharing information with unauthorized individuals, or failing to secure physical or electronic records.

Inadequate Safeguards: Failing to implement appropriate security measures to protect PHI, such as leaving patient records unsecured or using unencrypted communication methods, can result in violations.

Lack of Training and Awareness: EMS providers who are not adequately trained in HIPAA compliance may inadvertently violate HIPAA regulations by mishandling PHI.

Improper Access: Accessing patient records without a legitimate need related to patient care or operations is considered a breach of HIPAA. 

This includes curiosity-based access to records that are not necessary for a provider’s duties.

Working Within the HIPAA Legislative Framework

EMS providers must adhere to HIPAA’s requirements to ensure compliance and protect patient information:

Training and Education: Regular training on HIPAA requirements and the importance of patient privacy is essential. EMS providers should be familiar with their agency’s policies on PHI and know how to handle patient information securely.

Minimize PHI Exposure: EMS providers should only access, use, or disclose the minimum necessary PHI to perform their duties. Avoid discussing patient information in public areas or with unauthorized individuals.

Secure Communication: When transmitting patient information, use secure methods such as encrypted emails or communication platforms that comply with HIPAA standards. 

Avoid using personal devices for transmitting PHI unless properly secured and approved by the agency.

Document Handling: Physical documents containing PHI should be kept secure and out of public view. Electronic devices should be password-protected, and PHI should not be stored on personal devices without proper security measures.

Incident Reporting: Promptly report any potential HIPAA violations or breaches to the appropriate department or compliance officer within the organization. 

This allows for quick corrective action and minimizes potential harm.

Stay Informed: HIPAA regulations can change, and it is important for EMS providers to stay informed about updates and revisions to ensure ongoing compliance.

By understanding HIPAA’s origins, functions, potential violations, and how to operate within its framework, EMS providers can effectively protect patient privacy, maintain trust, and avoid costly penalties associated with non-compliance.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Ogilvie, W. A., Moy, H.P., & Goldstein, S. (2023) EMS Legal and Ethical Issues. Treasure Island, Florida: StatPearls Publishing. Accessed August 11, 2024

EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part Two

In addition to the foundational ethical principles that guide EMS providers in delivering patient care, there are several other key ethical concepts that are equally important in the practice of prehospital medicine. 

These concepts focus on ensuring fairness, respect, honesty, integrity, and advocacy in all interactions with patients. 

EMS providers frequently encounter diverse populations and situations that require a deep commitment to ethical standards, reinforcing the importance of treating every individual with dignity and fairness, while also advocating for those who cannot speak for themselves. 

Part Two explores five additional ethical principles that are vital for EMS providers to uphold in their daily practice.

6. Justice

As it pertains to healthcare, justice refers to the level of fairness by which medical services are distributed. 

In EMS, medical care is provided on an emergency basis equally to all persons in need regardless of race, sex, religion, or socioeconomic status. 

Systems of triage also observe the ethical principle of justice when determining each patient’s priority for care depending on the urgency of their needs.

7. Respect For Persons

Simply tending to an emergency medical need is not enough; patients must be afforded dignity and respect. In our often dark and gloomy profession, it is easy to fall into the trap of viewing our patients as cargo to be transported. 

This is a natural psychological self-defense reaction that EMS providers must guard against in order to maintain ethical healthcare practices.

8. Honesty

EMS providers must be truthful in all dealings. Lying can at best destroy any trust built between EMS and the public, and at worst result in legal ramifications for the provider and the agency. 

Honesty must be exercised in our documentation, and in our direct communication with our patients and other healthcare providers.

9. Integrity

An EMR with integrity adheres to ethical principles despite any pressures or temptations to do otherwise. 

The provider must be always stalwart in the face of challenges to their ethics, and make only decisions that they know to be good and true.

10. Advocacy

One of the best ways we can care for our patients is to be their advocate. Advocating for a patient may simply entail making phone calls to coordinate assistance for them, or contacting their primary care physician to help clarify any confusion the patient may have about their doctor’s instructions. 

In some situations, the patient may be unable to advocate for themselves at all, such as in cases of child or elder abuse, and it becomes the legal and ethical responsibility of the EMS provider to advocate for the patient’s safety and well-being.

Conclusion

EMS practice is inherently complex and challenging, demanding not only clinical skills but also a steadfast commitment to ethical principles. By upholding justice, respect for persons, honesty, integrity, and advocacy, EMS providers can ensure they are delivering care that is fair, respectful, and protective of patient rights. 

These ethical principles are crucial in fostering trust, maintaining professional standards, and advocating for the well-being of all patients, especially those who are most vulnerable. 

As EMS professionals continue to serve on the front lines of healthcare, their adherence to these ethical guidelines is essential in upholding the integrity of the profession and ensuring that all patients receive equitable and compassionate care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024

EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part One

Ethics play a crucial role in the field of Emergency Medical Services (EMS), where decisions must often be made quickly and under pressure. 

As prehospital care responders, EMS providers are frequently faced with challenging situations that require a strong understanding of ethical principles to ensure that patient care is delivered effectively and compassionately. 

Ethics in EMS encompass various concepts that guide providers in respecting patient rights, ensuring informed decision-making, and protecting their confidentiality, all while striving to do good and avoid harm. 

This piece outlines part one of essential ethical principles that every EMS provider should understand to provide the highest standard of care in prehospital settings.

1. Autonomy

Also known as self-determination, autonomy refers to the right of the patient to make decisions about their own medical care. In EMS, we often encounter this ethical concept when well-meaning family members attempt to supersede the wishes of a patient who is otherwise capable of making their own choices. 

Aside from situations where an inability to make appropriate decisions has been demonstrated (e.g. threat of suicide), a patient who is alert, oriented, and able to comprehend the gravity of their situation has the right to determine the course of their own medical care.

2. Informed Consent

A patient exercising autonomy can only make appropriate decisions regarding their medical care if they possess enough information to make informed choices. 

It is, therefore, the ethical obligation of EMS providers to present a full and accurate picture to our patients of the risks and benefits of their self-determined healthcare decisions.

3. Confidentiality

Information received while in a patient-provider relationship must remain protected from those who do not need to know. Consequences for the negligent disclosure of private medical information include embarrassment to the patient; the erosion of trust between EMS providers and the public we serve; and hefty fines to the agency. 

In the case of HIPAA violations, fines can be as high as $50,000 per infraction, with a maximum penalty of $1.5 million per year.

4. Beneficence

The term beneficence describes actions that are carried out for the benefit of others. Administering D50 to a hypoglycemic patient while on the scene, instead of immediately transporting them to the hospital while unconscious, is an example of beneficence in EMS. 

In this situation, providing IV dextrose with the knowledge that the patient could very likely return to consciousness and be left safely in their home is beneficial in terms of lower cost to the patient, and less of their time wasted waiting for an unnecessary ER evaluation.

5. Non-Maleficence

Primum Non Nocere - first, do no harm - is the original guiding principle of medicine. If faced with a choice between doing nothing or taking an action that will cause more harm, the correct decision in most cases is to take no action. 

Similarly, if inaction would likely result in harm befalling a patient, EMS providers are obligated to take appropriate steps for the protection of those in our care.

Conclusion

Ethical considerations are integral to the practice of EMS and are essential for maintaining trust between providers and the communities they serve. By adhering to ethical principles such as autonomy, informed consent, confidentiality, beneficence, and non-maleficence, EMS providers ensure that they are making decisions that respect patient rights and promote well-being. 

Understanding and applying these concepts helps providers navigate the complex and often unpredictable nature of prehospital care, ultimately leading to better patient outcomes and a more ethical healthcare environment. 

As the field of EMS continues to evolve, ongoing education and reflection on ethical practices will remain vital for all providers.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024

EMS Airway Management - The 9 P’s of Rapid Sequence Intubation (RSI)

The 9 P’s of Rapid Sequence Intubation (RSI) is a systematic approach that EMS providers use to ensure the safe and effective management of airway control in critically ill or injured patients. 

Here's what EMS providers need to know about each step:

1. Plan

• Strategic Planning:
  • Assess the need for intubation based on the patient's condition, such as respiratory failure, decreased level of consciousness, or impending airway compromise.
  • Consider alternative airway management strategies in case RSI fails (e.g., supraglottic airway, surgical airway).
• Backup Plan:
  • Establish a clear plan for what to do if initial attempts at intubation fail, including calling for additional help or preparing for an alternative airway.

2. Preparation

• Drugs:
  • Prepare and draw up all necessary medications for induction (e.g., etomidate, ketamine) and paralysis (e.g., succinylcholine, rocuronium).
  • Check drug dosages based on the patient’s weight and condition, and label syringes clearly.
• Equipment:
  • Ensure all airway equipment is ready, including laryngoscope blades, endotracheal tubes (ETTs) of various sizes, stylets, and backup devices like the iGel.
  • Check the functionality of suction devices, bag-valve masks (BVMs), and capnography monitors.
• People:
  • Assign roles to team members, ensuring clear communication about who will administer medications, who will perform the intubation, and who will monitor the patient.
  • Designate someone to manage the patient’s cervical spine if trauma is suspected.
• Place:
  • Prepare the environment by ensuring adequate space, lighting, and a stable surface for the procedure.
  • Ensure that all necessary equipment and personnel are within reach.

3. Protect the Cervical Spine

• Cervical Spine Precautions:
  • If trauma is suspected, manually stabilize the cervical spine to prevent movement and further injury.
  • Consider in-line stabilization while maintaining the cervical collar and minimizing neck movement during intubation.

4. Positioning

• Optimal Positioning:
  • Position the patient in the “sniffing” position, with the head slightly elevated and the neck extended, to align the oral, pharyngeal, and laryngeal axes for better visualization during intubation.
  • In patients with suspected cervical spine injuries, maintain manual in-line stabilization without compromising the airway.
• Consider Post-Paralysis:
  • In some cases, optimal positioning is achieved after paralysis and induction to ensure proper relaxation of the muscles.

5. Preoxygenation

• Maximize Oxygen Reserves:
  • Preoxygenate the patient using a non-rebreather mask or BVM with 100% oxygen for 3-5 minutes to increase oxygen reserves and reduce the risk of hypoxia during the apneic period.
  • In spontaneously breathing patients, consider passive oxygenation via nasal cannula in addition to preoxygenation.
• Avoid Hyperventilation:
  • Ensure proper ventilation rate and tidal volume, avoiding hyperventilation which can cause hypoventilation.

6. Pretreatment (Optional)

• Medications for Specific Situations:
  • Atropine: May be used in pediatric patients to prevent bradycardia during intubation, especially in those under the age of 1.
  • Fentanyl: May be used in patients with increased intracranial pressure or cardiac conditions to blunt the sympathetic response.
  • Lidocaine: May be administered to reduce the risk of increased intracranial pressure during intubation, though its use is less common.
• Timing:
  • Administer pretreatment drugs 3 minutes before induction to allow them to take effect.

7. Paralysis and Induction

• Induction:
  • Administer the induction agent (e.g., etomidate, ketamine) rapidly to induce unconsciousness, followed immediately by the paralytic agent.
• Paralysis:
  • Administer the neuromuscular blocking agent (e.g., succinylcholine or rocuronium) to achieve complete paralysis, facilitating intubation.
• Sequence:
  • The sequence is critical: induction agent first to prevent patient awareness, followed by the paralytic to facilitate intubation.

8. Placement with Proof

• Intubation:
  • Insert the endotracheal tube (ETT) with the help of a laryngoscope, ensuring the tube passes through the vocal cords and into the trachea.
• Confirmation:
  • Confirm ETT placement by visualizing the tube passing through the vocal cords, auscultating for bilateral breath sounds, and using capnography to verify end-tidal CO2.
  • Look for chest rise, misting in the tube, and the absence of epigastric sounds to confirm proper placement.
• Secure the Tube:
  • Secure the ETT with a tube holder or tape to prevent dislodgement during transport.

9. Post-Intubation Management

• Ongoing Sedation and Analgesia:
  • Continue sedation and analgesia to keep the patient comfortable and prevent awareness during mechanical ventilation.
  • Administer medications such as midazolam or propofol for sedation, and opioids like fentanyl for pain control.
• Ventilation and Monitoring:
  • Ensure proper ventilation settings on the mechanical ventilator or BVM, and continuously monitor oxygenation, ventilation, and hemodynamics.
  • Regularly reassess ETT placement and patency, ensuring that the tube remains secured.
• Management of Complications:
  • Be prepared to manage any complications, such as hypotension due to sedatives, or difficulties with ventilation.

Conclusion

The 9 P’s of Rapid Sequence Intubation provide a comprehensive framework for EMS providers to manage critical airways effectively and safely. Understanding each step, from planning and preparation to post-intubation management, ensures that providers are prepared to handle the challenges of RSI in the field. 

Continuous training, adherence to protocols, and effective teamwork are key to successful outcomes in airway management.

Further Reading:

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson.

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Brown, C. A. (2022) Walls Manual of Emergency Airway Management (5th Ed). Philadelphia, Pennsylvania: Lippincott, Williams & Wilkins.

Fatolitis, N. (2022) Keys To Success For Airway Management. EMS Airway. Accessed July 26, 2024

NAEMT (2023) PHTLS: Prehospital Trauma Life Support (10th Ed). Burlington, Massachusetts: Jones & Bartlett Learning.

Nickson, C. (2024) Rapid Sequence Intubation (RSI). Life In The Fast Lane. Accessed July 26, 2024

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell.