When in doubt, always err on the side of life. That's what we do as health care providers. The unique aspect of being a health care provider whether you are a nurse, EMT or First Responder is that you never really leave the job. At any moment, no matter where you are, you could be called upon to save someone's life. But there is a myth that a gray area exists somewhere between delivering life saving care and violating health care policy. There is no gray area.
It's chilling to think that you could be held legally liable or even face criminal charges for doing your job as you were trained in an effort to save a patient's life. The reports of health care providers placed in this situation are frightening to the rest of us in the field. The best way to protect yourself and your license, as a health care provider, is to be aware of the laws governing your state and the policies of your place of employment.
DNR
Do Not Resuscitate orders have often been the focus of confusion in the health care field and is the classic gray area scenario. Again, there is no gray area here and the DNR aspect of patient care is there to clearly define your role as a provider in the event of the existence of a DNR order. If a DNR order exists you can not provide life saving measures to the patient. The patient, or those responsible for the patient, have expressed their wishes to not have life saving care should their heart stop or they stop breathing. DNR is a legally binding expression of the patient's and/or family's will.
The first thing you do as an EMS provider when you arrive on a scene is to ensure your scene is safe. Many elder care facilities may have policies in place regarding the care of their patients in cardiac arrest or have stopped breathing These policies may protect the employees of the facility but they do not protect you. The DNR order must be with the patient upon your arrival for you to be legally relieved of your responsibility to provide care. If the nurse informs you of a facility policy to deny care but cannot provide a DNR, your scene just became extremely dangerous. You must obtain documentation from the nurse that he/she refused to allow you to treat the patient. Annotate this in your own report and make your on duty medical control physician aware of the situation. Remember, their facility policy does not protect you as an arriving EMS provider.
Working For an Elder Care Facility or Home Health Agency
Nurses should be aware of a facility's policy on patient care before they accept employment. As mentioned earlier, different facilities have different policies regarding patient care but all these policies are written to protect the facility not the nurse. Being aware of your legal responsibility to your patient as outlined by your state is the best protection from liability. When a facility's policy deviate from those you are obligated by the state to follow you should not work there.
Good Samaritan Laws
Good Samaritan Laws are generally accepted provisions by the state that protects you as a health care provider in the event you happen upon a patient in need of life saving care. DNR and facility policy do not apply if the situation is spontaneous and occurs outside of a care facility. You are expected to perform life saving care as would be reasonably expected of any health care provider possessing the same skills and training. In the unlikely event this patient has a DNR with them in clear view of you at the scene of the incident then the DNR would apply.
The purpose of this discussion is to help remind us that there is no gray area. Those licensed and employed in the health care field must be aware of their state's laws regarding patient care as much as they are expected to remain current with their medical training. The same advice for protecting yourself from a potentially dangerous scene will protect you from the medical/legal dangers as well. Being prepared is the best protection
Sources/Resources
Previously Posted on FullofKnowlege.com
Edenjaid worked in EMS for 6 years and studied in Health Sciences at University of West Alabama
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