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Legal and Ethical Aspects of Providing
Basic Life Support
Principle Key Points
Good Samaritan Principle Based on the
Biblical story. Prevents a
And Laws rescuer who has voluntarily helped a stranger in
need from being sued for “wrongdoing”
In most of North America, you have
no legal obligations to help a person in need. Since governments
want to encourage people to help others, they pass Good Samaritan
laws (or apply the principle to common laws).
You are generally protected from liability as long as you:
Are reasonably careful.
Act in “good faith” (not for reward)
Do not provide care beyond your skill level.
If you decide to help an ill or injured person, you must not
leave them until someone with equal or more emergency training
takes over (unless it becomes dangerous to stay).
Consent Consent means permission. A
responsive adult must agree to receive care.
To get consent, first identify yourself. Then tell the patient
your level of training and ask if it’s ok to help.
“Implied consent” means that permission to perform
care on an unresponsive patient is assumed. This is based
on the idea that a reasonable person would give their permission
to receive lifesaving care if they were able.
Children: Consent must be gained from a parent or legal guardian.
When life-threatening situations exist and a parent or legal
guardian is not available, care should be given based on implied
consent.
Elderly: If suffering from a disturbance in normal mental
functioning, like Alzheimer’s disease, a patient may
not understand your request for consent. Consent must be gained
from a family member or legal guardian.
Duty to Act A requirement to act toward
others and the public with the watchfulness, attention, caution
and prudence that a reasonable person in the same circumstances
would use. If a person’s actions do not meet this standard,
then the acts may be considered negligent, and any damages
resulting may be claimed in a lawsuit for negligence. If you
are a state-licensed healthcare provider, first responder
or other professional rescuer expected to give emergency medical
care, including CPR, you almost certainly have a duty to act.
However, BLS performed voluntarily on a stranger in need while
off-duty is generally considered a Good Samaritan Act.
Starting and Stopping CPR Start CPR
for all patients in cardiac arrest unless:
Signs of irreversible death are present, including:
Rigor mortis ( limbs of corpse stiff and impossible to move).
Lividity (settling of blood in lower
portions of body, causing a purplish red discoloration).
Conditions incompatible with life (decomposition, decapitation,
massive head injury, etc).
Providing CPR would put you in danger
of injury.
Patient has a valid DNR order
There are many patients (for example,
catastrophic natural disaster or terrorist attack). A patient
who is not breathing after two attempts to open the airway
is considered dead. This is because the time required to provide
rescue breathing and external chest compressions is not justified
when there are many patients needing first aid.
Principle Key points
Starting and stopping
CPR cont. Do not stop CPR until:
A healthcare provider or other professional
rescuer with equal or more training takes over or the patient
shows no signs of life.
You are exhausted or the scene becomes too dangerous to continue.
The doctor in charge of the patient
decides to order the resuscitation effort stopped (follow
local protocol. Standard operating procedures and/or medical
direction).
Note: Except when death is obvious,
irreversible brain damage or brain death cannot be reliably
assessed or predicted. Rescuers should never make an impulsive
decision about the present or future quality of life of a
cardiac arrest patient because such decisions are often incorrect.
Advanced Directives These are documents
authorized by state
And living wills law and are usually witnessed or notarized.
Also called a “durable power of attorney.”
They allow a person to appoint someone
as his or her representative to make decisions on resuscitation
and continued life-support if the person has lost their decision-making
capacity ( for example, if they are in a coma).
Essentially, advanced directives are
statements about what the patient wants done or not done when
they can’t speak for themselves.
Laws about advanced directives are
different in each state. You should be aware of the laws in
your state.
Do Not Resuscitate
The DNR/DNAR order is a kind of advanced directive. This is
a specific
not to have CPR performed.
In the United States, a doctor’s
order is required to withhold CPR. Therefore, unless the patient
has a DNR order, EMS providers and hospital staff should attempt
resuscitation.
Patients who are not likely to benefit
from CPR and may have a DNR order include those with terminal
conditions from which they are unlikely to recover.
Outside the hospital, healthcare
providers, first responders and other professional rescuers
should begin CPR if there is a reasonable doubt about the
validity of a DNAR order or advanced directive, the patient
may have changed his or her mind, or the patient’s best
interest are in question.
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