Issues in the Job of a Paramedic - Essay Example

Issues in the job of a paramedic Issues in the job of a paramedic Introduction The paramedic is a strong pillar of the heath care system. His roleis changing and becoming indispensable to the community. An expanding scope for practice and involvement in primary health care especially in the rural areas are the relevant features. (Mulholland, 10th NRHC). Dispatching cases is the main part of his practice but in the rural areas, the additional portion is the community approach. The role becomes that of a multidisciplinary team member rather than just being part of an ambulance team in rural areas. Volunteers are trained and managed by the paramedic. Project management and using media within his practice is another part of his practice. Generally, the paramedic becomes a highly respected member of the community rather than turn out to be an anonymous person. His work and the speed with which he responds to a call together contribute to the picture of a saviour. The professionalism, the awareness of conforming to the multidisciplinary team and accountability make him what he is in the community (Mulholland, 10th NRHC). “Rural community engagement, emergency care, scope of extension of practice and primary health care” (RESP) have been included within the job description of a paramedic in the Australian Council of Ambulance Authorities (AAA.). The paramedic makes decisions of life and death under stress. However his practice does not only include only medical decisions (Steer, 2007). Culture, law and ethics problems infiltrate it creating impromptu problems which need to be solved under extreme pressure. Consent for adopting an intervention would depend on the patient. Refusal of care is a major problem that can stop him in his tracks (Steer, 2007). The paramedic must expect these and act shrewdly if he is to save that patient. His skillful application of the necessary rules or laws should smoothen the process. The case The patient could be in an inebriated state which can be interpreted as incompetence for giving consent. The situation can be explained and the possible reasons for the wheeze which has occurred. The outcomes too may be related. If the person does not still provide valid legal consent, the paramedic is facing the “Recipe of Difficulty”. He can enquire if the wheeze had occurred earlier and whether it is a habitual event. I f so, the patient may have the necessary medicines or inhaler with him to overcome the wheeze, the cause of which could be just bronchial asthma, and he may not have taken them when he was seen. The paramedic can encourage him to take the medicine or inhale it. If he claims that he does have bronchial asthma but has no medicines for it now on him, he can be encouraged to come to hospital for treatment. In case he worsens on the way, consent may be overlooked and the necessary done. The paramedic cannot be penalized for saving a life (Wallace, 2001). Legally he can stand by the Doctrine of necessity and ethically by the principle of Beneficence. If the patient falls down ill, he can be taken, treated and transferred to hospital. If the person is unable to make correct answers, he may be considered incompetent to provide consent and the treatment given without it. However if the history does not include bronchial asthma, the person may be having cardiac asthma for which the person requires immediate treatment. He must be warned and coaxed into giving the consent. If he still does give his consent, he may be taken for treatment against his will. Taking such a decision may be beyond the capacity of the paramedic who is not knowledgeable. The crime may be one of assault if the person is taken against his will; however there is always respite under the law that allows a paramedic to save a life through the Doctrine of Necessity. Consent The value of autonomy or self determination is expressed in the ability to give consent (Steer, 2007). It is a fundamental right in the ethical perspective. Seeking consent and obtaining it is a time-bound procedure when medical decisions are to be hastily implemented in life-saving interventions faced by the paramedic. Respecting the individual person for his right of exercising his will in providing consent is a duty of the paramedic. The person who gives consent becomes responsible for the medical decisions taken (Steer, 2007). The consent is crucial as otherwise the treatment accorded by the paramedic becomes a crime of assault, especially when the person needing treatment is in a position to give it as in this case. The legal perspective also condones the fundamental importance of the consent as most of the laws have consent as the central focus. When the consent is obtained, whatever the paramedic has given in the form of essential treatment prior to it changes from being a crime into legal medical treatment. Consent can be informed, understood, voluntary or made by an individual with legal capacity (Steer, 2007). In the informed consent, enough information about the treatment or procedures to be adopted will be provided to the person. His decision will be based on what he knows. The understood consent will be mentioning what the person has understood when he gives the consent. The consent must be voluntarily made and not as an outcome of threats or harassment or coercion. A conscious and competent adult of sound mind would be the right competent person. Young children, the mentally ill, unconscious person, head injured person, or drug addicted would be people who are not legally competent. The paramedics must be able to gauge what the legal capacity of the person is (Steer, 2007). When an unconscious person is to be treated, the paramedic goes by the Doctrine of Necessity as people need to be rescued and treated. The stressors that affect a paramedic vary according to the scene and role. Having been trained to respond immediately to emergencies, his duty and standard of care depends on his role and training (Steer, 2007). He has a legal obligation to act in a patient’s best interests and must help people who cannot help themselves. Even if consent is not obtained, he still has to think in terms of the patient’s best interests. The patient’s health may depend on what decision the paramedic makes in the light of refusal of care by the patient. By an act of commission or omission, he cannot be negligent. Legally, the Doctrine of Necessity allows a paramedic to care for a patient even if he does not provide consent. Ethically speaking, the principle of Beneficence allows him to do good and helps him escape any legal action. Promoting beneficence is a morally accepted action which is also praiseworthy. However health care staff are not expected to always act with beneficence especially if it means harm to the patient (Bosek and Cashman, 2008). Refusal of care This is just one of the many problems in the Recipe of Difficulty faced by paramedics. Life-and-death situations where time is the significant factor could be one type of problem (St.eer, 2007). Emotional scenes may affect the performance of the paramedic or disturb his judgements. Inability to reach a diagnosis or gauge the age or medical history of an unconscious patient is another kind of crisis. Limitations of resources lengthen the response times on occasions. Conflicts may arise between the patient or callers and the paramedics. Stressors from overwork or fatigue could interfere with performance (Steer, 2007). Refusal of care involves the patient not giving consent for treatment as in this case. The refusal could be due to “age, cost, convenience, initial presenting condition and pressure from physicians” (Steer, 2007). The competent adult can refuse treatment by the Medical Treatment Act of 1988. A properly appointed person also can make the refusal. The expert and one other person must sign the refusal document to make it valid. The paramedic’s duty is bound by the consent of the person he collects for treatment. The ethical perspective of the right to refuse has the principle of Autonomy behind it. If a person has mental illness, his consent may not be valid by the Mental Health Act of 1986. A person having a mental disorder is incompetent and the refusal can be over-ridden (Goroll and Mulley, 2009). The incompetence can be confirmed by the physician and the psychiatrist. If any doubt arises, the decision is made by the institutional ethics committee or the judiciary. A parent cannot refuse care for his child. These two incidents of refusal do not hold good and the paramedic can give the necessary treatment. In an emergency, the paramedic can treat. The State is custodian for the child so the paramedic can give treatment as he is the co-custodian of the State. Paramedics sometimes have difficulty in deciding whether a problem is classified under ethical or legal or clinical. Then he finds it difficult to decide between giving care and not doing so. The option that he has is to refer the case to another person with greater expertise but if the referral is through a phone call, the decision may not suffice as the referee is not on the scene. Summarising, the paramedic has to be clinically, legally and ethically competent (Steer, 2007). Paramedics need to be proficient in their practice and they need support. They must be able to clear any doubts about the legality of their response to a person who calls them on an emergency especially when a person other than the patient is the decision maker. Their education must make them equipped for handling moral and legal issues. Their knowledge and skills must be so developed that their competence flourishes: previous experiences of paramedics and their outcomes must be discussed. Sufficient time must be allotted for the study. Critical thinking on moral and legal issues must be encouraged at seminars and continuing education programmes. Adequate knowledge and understanding can reduce the impact of the stressors in the practice. In handling cases of refusal of consent, care must be taken to check for the competency of the patient in refusing care especially when he is mentally not ill. He may be in a situation where he is speaking but may be medically in a delirious stage going onto unconsciousness or in a hypoglycemic state where he may not respond in a normal manner though people around do not understand this. The paramedic should rule out the possibility of such conditions by eliciting the history of underlying diseases and similar episodes and looking through the records of the patient. The paramedic could be accused of medical negligence, especially when another team is called a little later in an emergency situation. A terminally ill person who is fit to give consent can refuse to be taken away to hospital if he desires to die at home. The relatives should not then be allowed to refuse his staying behind though they do not want him to die there. The patient’s wishes have to be respected by the Medical Treatment Act of 1986: the ethical principle of non maleficence must be complied with. Patients must never be assaulted or their liberty questioned in the performance of duty. Conclusion The paramedic has an indispensable role in the community as a person responding swiftly to emergency health calls. The duty of this responsible member makes time-bound life and death decisions under conditions of stress. The Recipe of Difficulty has described six problem situations of decision-making that the paramedic may face. The refusal of care by a patient, one of them, still allows the paramedic to attend to the patient who has refused consent for treatment. The Doctrine of Necessity legally and the ethical principles of Autonomy, Beneficence and Non-Maleficence in the Medical Treatment Act, 1986 (Vic) come to his support. References: Bosek, M.S.D. and Cashman, G.S. (2008). “Ethical Obligations and Concerns when trying to achieve a patient’s wishes” JONAS Healthcare Law, Ethics and Regulation, Vol. 10, No. 3, Lippincott, Williams and Wilkins Goroll, A.H. and Mulley, A.G. (2009). “.Primary Care Medicine: Office Evaluation and Management of the Adult Patient”. Lippincott, Williams and Wilkins Mulholland, P. et al (2009). “Roles of the rural paramedic-much more than clinical expertise” 10th National Rural Health Conference, Australia Steer, B. (2007). “Paramedics, consent and refusal-are we competent”. Journal of Emergency Primary Health Care, Vol. 5, Issue 1 Wallace, M. (2001). “Health Care and the Law”. 3rd Ed., Pyrmont, NSW:The Law Book Company Read More