Legal

Medical negligence insurance for paramedic professionals

  • July 2018

Medical negligence insuranceThe cover is generally described as Medical Malpractice insurance—but can often be referred to as Medical Liability insurance, Medical Indemnity, Clinical Negligence cover or Professional Indemnity. Its overriding objective is to insure the health professional against claims arising from wrongful advice or negligent treatment.

Does precedence trump in the origins of confidentiality?

Good clinical practice has to be entwined with good ethical practice. Therefore, it follows that the clinical acumen of a modern paramedic develops at the same rate as their moral and ethical practice. As a newer profession, paramedics have relied on rules and codes from others to help maintain this balance, but their ancient and basic structure fails to address the nuances of modern practice. The paramedic profession has required a heuristic approach, as well as relying on the precedent of modern laws and codes, to underpin practice while simultaneously recognising the limitations of oath-based principles. This response has been necessary to address the increasingly complex and complicated situations paramedics encounter in their clinical environment.

Amended police powers under the MHA 1983

Paramedics are frequently called to people with acute mental health problems and often assist in caring for and transporting individuals subject to police powers under the Mental Health Act 1983, sections 135 and 136. Those powers will change when Chapter 4 of the Policing and Crime Act comes into force this autumn. In this short article featured for World Mental Health Day, Richard Griffith considers the impact of amendments to police powers on paramedic practice under the Mental Health Act 1983 introduced by the Policing and Crime Act 2017, Part 4, Chapter 4.

Emotional labour in paramedic practice: student awareness of professional demands

Purpose:The purpose of this study was to explore student paramedics' awareness of the emotional demands of their future role, particularly regarding the delivery of compassionate care.Problem:There is a dominance of nursing literature in the discourse around compassionate care and emotional labour, and a paucity of research in the paramedic literature.Methods:A survey was issued to a small convenience sample of paramedic students. Excel was used to organise data collected, which was then presented graphically as tables and charts.Results:Key findings were drawn out and it was found that there were some correlations between the literature reviewed and results generated.Conclusion:Student paramedics had identified factors affecting their emotions in placement very early on in their studies. There was evidence of students covering up their emotions whilst in placement. The research reinforced the need for further larger scale and longitudinal studies.

Live tweeting by ambulance services: a growing concern

Despite advances in technology being a driver of paramedic professional development, particularly over the past decade, the introduction of new forms of technology appears to have presented paramedics with some professional challenges. Paramedics, pre-hospital clinicians, and ambulance service providers in both the United Kingdom and Australia, have begun using social media technology to communicate what they do to the general public. Unfortunately some of the material that has been communicated appears to breach professional standards of practice, and therefore has the potential to cause harm to the patient, the individual paramedic, and the paramedic profession more broadly. This article will present the rationale behind why this behaviour is unprofessional, ethically and legally unsound, and why it must cease. We offer a tool that will assist paramedics, and other healthcare professionals, to practise safe and professional social media use in their workplace.

Future of digital technology in paramedic practice: blue light of discernment in responsive care for patients?

This discussion explores the significance of digital technology to responsive patient care in applied paramedic practice. The authors' previous research identified the relative ambiguity of the role of digital technology in facilitating and supporting patients in practice, and the findings revealed the relative transferability of this finding to wider allied healthcare clinical and professional practice. The discussion encompasses two key debates, namely a) How best the quality of the digital technology patients engage with can be discerned with regard to the vast availability of information and b) what the fundamental pedagogical implications to the way paramedic education in the UK is currently delivered might be in relation to equipping the future paramedic workforce to empower patients and their families and carers in emergency situations. The discussion paper concludes with an overview of the tensions that unregulated apps pose in practice and how engaging with the public about the use of digital technology could be a key aspect for review in UK undergraduate curricula and staff development.

Community paramedics: need of legal education specific to the pre-hospital non-emergency environment (discussion based on Texas)

Emergency medical services (EMS) have responded to the Affordable Care Act's target to reduce healthcare spending and focus on preventative health by developing community paramedicine programmes in the USA. Currently in their infancy, these community paramedicine programmes aim to utilise existing skills and knowledge to combat patient readmission to the emergency department, and empower the public to take control of their healthcare path. Paramedics are taken out of the pre-hospital emergency environment and placed into a new undefined prehospital non-emergency preventative health care territory. As EMS morphs into a preventative healthcare realm in Texas, questions of community paramedicine healthcare designation and legal ramifications arise. Community paramedic knowledge of these healthcare designations and legal ramifications is indispensible to the success of such a programme.

Patient confidentiality and safety: a classic conundrum

Paramedics frequently have to balance patient confidentiality and patient safety. Patient information is subject to legal, ethical and professional obligations of confidentiality and should not be disclosed to a third party for reasons other than healthcare, without consent. Whilst there is an imperative to preserve the professional/patient relationship, there are occasions where this is not possible. This article considers circumstances when confidential patient information may be disclosed without the consent of the patient and discusses the legal, ethical and professional aspects of decision making in this context. A clinical example from practice is presented where an ambulance crew was called to a 50-year-old man with type I diabetes, which is normally well controlled with insulin. He is employed as a van driver, but has experienced two sudden hypoglycaemic episodes in 3 weeks rendering him unconscious. Once treated, he declines transport to hospital, any onward referral or to inform the Driver and Vehicle Licensing Agency (DVLA) through fear of having his driving licence suspended.

Principlism: when values conflict

To ensure morally justified decisions, clinicians are encouraged to apply ethical theories and frameworks. Beauchamp and Childress’ ‘Four Principles’ approach to medical ethics, or ‘Principlism’ for short, is highly regarded as a simple methodology for considering ethical dilemmas, and is common to many undergraduate clinical programmes. On occasion, ethical dilemmas are complex and one or more of the four principles come into conflict with each other. Critics of the approach have suggested that there is a lack of guidance on how to resolve this conflict.This paper will argue that principlism facilitates an organised and thorough method of reflecting upon an ethical problem and is well suited to the pre-hospital setting. The problem of how to resolve conflicts between the principles will be explored, demonstrating the merit of the approach through its application to a real-life moral problem from the pre-hospital setting.

Informed consent in paramedic practice

Informed consent is a concept that has grown in importance over the last 40 years. It is now a key concept in modern healthcare practice and underpins all patient encounters. Any consent to assessment or treatment should be gained in an informed manner and failing to do so can lead the clinician open to accusations of negligence. Despite this many clinicians have only a vague or incorrect understanding of the concept of informed consent and what does, and does not, constitute it. The following article attempts to clarify the latest thinking in English law regarding informed consent drawing largely from the United Kingdom Supreme Court (UKSC) ruling on the subject in 2015. There then follows a discussion of a number of areas where paramedic practice in particular may be failing to meet modern standards of informed consent. It will be argued that consent in paramedic practice is often poorly sought and documented and that paramedic practice often becomes ‘defensive’ and in doing so fails to meet the required standards for informed consent.

Crisis resource management in relation to empowering people to speak up in emergency medical service clinical practice settings

Teamwork and effective communication have been identified as key principles in Crisis Resource Management (CRM) in the context of emergency care medicine. The aim of CRM is to ultimately improve patient safety and prevent at-risk situations or events. These principles optimise patient safety and benefits.Pre-hospital emergency care in Qatar is provided by the national Ambulance Service (HMCAS). Their operations are labour intensive, and depend on the professional readiness and communication of their culturally diverse practitioners. Structures within HMCAS are hierarchical, which may be a deterrent to effective communication in Qatar. Emergency medical care (EMC) practitioners may not be forthcoming with their concerns to the detriment of patient safety. These factors can create an environment which is not conducive to effective communication, and may inherently suppress free expression of speech in emergency situations and day-to-day working practices.Managers should therefore be encouraged to create an environment whereby practitioners can speak up, irrespective of culture, nationality, or the presence of more senior or experienced colleagues.CRM principles are well incorporated as part of the EMC's orientation programme and specialised professional development courses. Regular training involving all role players (including supervisors) in different settings, and appropriately simulated scenarios that call for application of CRM principles is required to further improve the quality of EMC service in Qatar.

Creating a safety net for patients in crisis: paramedic perspectives towards a GP referral scheme

An innovative policy implemented by a UK Ambulance Service allows paramedics to refer patients to a GP Acute Visiting Service scheme. Initial evidence suggests that this alternate route of care can decrease hospital admission rates, decrease A&E waiting time and provide substantial savings for the NHS. However, there are many unrecognised barriers to referral that are not captured by the quantitative analysis. The goal of this qualitative-observational study was to gain insight into the GP referral scheme from a paramedic's perspective. All notes were transcribed, coded and analysed using a Grounded Theory approach. Four main themes emerged: 1) barriers to referral including wait time, process, and lack of confidence, experience and training 2) approaching the patient with the GP referral scheme in mind 3) frustrations with GP decision making and 4) awareness/understanding of the scheme's impacts. This study provided valuable insight into the paramedic's perspective of the GP referral scheme. Maximising understanding of the scheme, investigating the GP's perspective in decision making and ensuring knowledge and accountability of paramedics, GPs and the public were identified as solutions to strengthen and increase referral rates and scheme success.

The ethical and legal dilemmas paramedics face when managing a mental health patient

This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. 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. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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.

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