Aircraft Accidents and Emergency Management, Live With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. AB - Decision-making is central to the everyday practice of paramedicine. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. Copyright 2023 Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. They must also deliver care that is consistent with ethical. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. Paramedics have professional duties toward vulnerable persons. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. This is not the case. The ethical principle of non-maleficence means that paramedicine practitioners should discuss the probable negative consequences of their decisions and prevent them in order not to harm the patients. Professional practice framework, professional rights and responsibilities, record keeping, governance. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Confidentiality, capacity and consent. Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. A significant ethical consideration for clinicians when treating older patients is their capacity. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . 4 Conducting ethical research in paramedic practice. However, children's life experiences, maturity and understanding differ from one individual to the nextdepending on factors such as their age, culture, health, upbringing, background and environmentsand their ability to process healthcare-related information also varies. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. In this case, both ethical and legal principles are important. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. A sixth theme of ethical complexity was pervasive across these five themes. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. care passports). Such a position will help improve the system and lead to effective and fruitful results. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). A consensus among paramedic supervisors B. Legal & Ethical issues associated with paramedic practice during COVID19. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. This is a part of and more. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. Don't hesitate and rely on professionals! Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. A person's capacity depends upon the nature of their disability. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. Therefore, it is important to consider those principles more precisely. The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? There were no obvious physical causes for John's behaviour at this stage. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. The use of the other sections of the MHA can require much more time (Hawley et al. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. This exploratory case study utilized semi-structured interviews of thirteen North. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). This will also help you learn important concepts for the exam. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). N2 - Decision-making is central to the everyday practice of paramedicine. This was because of current UK law and a lack of access to a GP respectively. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. The provider must be always stalwart in the face of challenges to. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Paramedics interact with these patients every day, often during times of such vulnerability. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. Major incident clinical . A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). keywords = "Ethics, Decision making, paramedic, complexity". Summary. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). The ethics in paramedicine has become a field of interest for many scientists and researchers. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. Although provider judgment plays a large role in the . Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Methods Paramedicine presupposes direct interaction with individuals. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. abstract = "Decision-making is central to the everyday practice of paramedicine. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. Utilizing a priority dispatch system allows dispatchers to send response . B. Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. B. EMTs are not liable for any actions that are accurately documented. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. @article{6040c026e1e34bd9b7239761b13480e7. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Practical decision-making strategies are provided and illustrated by brief examples. MA Healthcare Ltd In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). C. Follow to your local protocols and contact medical direction if unsure how to proceed. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. B. crew control. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics.

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