The purpose of the legal, political and regulatory environment in EMS is to offer the managers with the foundation necessary to determine the legal issues that influence the delivery of EMS. There are several legal issues or concepts which impact the EMS organizations. For this discussion, we only focus on two them namely forms of consent and refusal of care.
Consent refers to the act of giving an assent, approval or permission for something to take place. The following are the forms of consent. The doctrine of implied consent may hold when the patient is unconscious and unable to speak. Under this form, the assumption is that the patient is capable of permitting when awake (Steer, 2015). The assumption also holds even when the patient was adamant about getting care before becoming unconscious. The underlying fact is that when the patient faces the reality of death, he/she is likely to change the mind. The EMS provider assumes the role to initiate care by the way reasoning that the victim or patient experiences medical emergency and because of the condition cannot express consent and would do so when given that chance. It is, however, inapplicable in instances when the health care proxy is available or an advanced directive. In such occasions, the consent of the health care proxy should prevail. Otherwise, the express will of the patient ends up prevailing as indicated in the advanced directive (Steer, 2015). Therefore, the EMS team gives the consent when the patient illustrates/manifests elements of emergency when the patient is in a condition that does not allow them to do so.
The consent may be express. Here, the permission is given either verbally or in written form by the person requiring emergency services. It is given a mentally competent and conscious adult who understands all the questions asked by the EMS team and provides responses by way of permission for them to start treatment. It is in contrast with the implied consent which based on assumptions from the conduct of the patient (Steer, 2015). It is the most valued form of approval compared to others. It follows after all the circumstances surrounding the situation has been made clear together with their consequences to make an informed consent.
Emancipated minor consent is another form where the patients under the age of majority obtain the permission to give their informed consent. The patient gives express or implied consent on how they would like to have treatment. It only happens when they can understand the consequences surrounding their decisions. They should not have any impairment of their judgment that could arise from alcohol or drugs. It is given by the youths below the age 18 who get married with the permission from their parents, and thus both the husband and wife are presumed to be an adult and for health care treated as emancipated minors. Also, in the cases of adolescent females who are mothers, they are pre-summed as adults and therefore, give consents on their behalf as well as for their children (Bigham et al. 2014). In addition to that, it may be provided by the adolescent who lives away from home and lacks support from the family by way of getting permission through a court petition.
Lastly, there is the pediatric consent. It occurs to children because of their age, and thus their parents or legally appointed guardian are called upon to consent. Therefore, the parent or the legally appointed guardian consent on behalf of their children for them to get treatment. The assumption behind it is that getting consent from a parent to treat a child is similar to getting another one to treat an adult (Bigham et al. 2014). Therefore, the parent of the child should have a proper understanding of the consequences of their decision to accept or refuse treatment. In case the pediatric consent is needed, and there is no parent, other people may be called upon to act on such as teachers, guardian, and relative just to mention a few.
The patient gives refusal of care at any time when in the ambulance or the hospital. Even after consenting to obtain medical attention, the patient has the right to refuse care at any time in either written or verbal form. The EMS officers should explore the reasons behind the patient’s refusal of care to determine and solve the issues (O’Keefe & Harrington, 2015). For instance, some patients would refuse care because of fear of who will meet their medical bills. It is, therefore, vital to ensure they understand that their health is far much important compared to the financial considerations. In instances when the patient remains resistant, the EMS service providers should complete their diagnosis and description to the injuries or illnesses sustained and the potential consequences that can arise if they not treated on time.
After noting down the list of all the foreseeable complications that can arise if the patient is untreated, the EMS should ensure the patient reads them and countersign them. In case, the patient cannot read or understand English; then there should be an interpreter of the text to the patient to ensure that they understand the foreseeable consequences of their refusal (Marco et al. 2017). When they remain adamant even after knowing the consequences of their decision, the providers should advise them to seek alternative medical attention either from private healthcare institutions or by calling the EMS if they change their mind (Marco et al. 2017). Also, the EMS agencies concerned should ensure that the patient consents refusal through the standard form from the attorney’s office or have a witness of an adult person who is a non-interested party.
In conclusion, understanding the regulatory framework that governs the conduct of the EMS is important as it ensures maximum care delivery to the patients as well as avoiding liabilities. For example, understanding the ways of obtaining informed consent and who should give provides the individuals seeking immediate medical attention acquire it faster and following the required protocols. Also, in instances the patient refuses care even after consenting, the framework outlines the procedure to follow so that future consequences of the decision made by the patient cannot affect the EMS providers.
- Bigham, B. L., Jensen, J. L., Tavares, W., Drennan, I. R., Saleem, H., Dainty, K. N., & Munro, G. (2014). Paramedic self-reported exposure to violence in the emergency medical services (EMS) workplace: a mixed-methods cross-sectional survey. Prehospital emergency care, 18(4), 489-494.
- Marco, C. A., Brenner, J. M., Kraus, C. K., McGrath, N. A., Derse, A. R., & ACEP Ethics Committee. (2017). Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations. Annals of Emergency Medicine.
- O’Keefe, S. D., & Harrington, L. (2015). Capacity and Refusal of Care. EMS Medicine, 156.
- Steer, B. (2015). Paramedics, consent and refusal–are we competent? Australasian Journal of Paramedicine, 5(1).