Ethics/Practice of EM/Medical Legal Flashcards

• <12 yo = Can’t be capable
• 12-13 yo = <2 years older
• 14-15 yo = <5 years older
• 16-17 yo = Anything not exploitive (eg. sex trade)
• >18 yo = Fully capable

• Collecting the tubes/sample/tissue
• Analyzing/interpreting the tubes/sampes
• Inputting the results

1. Legal Guardian (parent)
2. Appointed Power of Attorney
3. Consent and Capacity Board representative
4. Spouse/Partner
5. Child >16/Parent not estranged
6. Parent with right of access
7. Sibling
8. Another relative
9. Public Guardian and Trustee

Adverse Event

• Injury that was caused by medical management, both preventable and non-preventable

Intrinsic Source of Error

• Part of the nature of emergency care/can’t change it
• Examples
  1. Decision burden
  2. Patient factors (delirium, language, acuity)
  3. Uncertainty
  4. “Low signal to noise” eg. a 2/10 SAH headache

Extrinsic Source of Error

• Resource constraints
• Preventable
• Examples
  1. ED design
  2. Crowding
  3. Fatigue
  4. Teamwork
  5. Information gap

Violation Producing Factors

• Make someone more willing to break protocol
• Violations undermine safety
• Opposite to workarounds which increase safety
• Gender
• Maladaptive behaviour
• Over/underconfidence
• Authority gradient

1. Humanity - you’re there to address suffering
2. Neutrality - never take a side
3. Impartiality - aid is base on need alone
4. Independence - autonomous from influence

g = Delta(v²) / (Stopping distance * K)

It means that the G force is inversely related to the stopping distance

All human beings are born free and equal in dignity and rights and are entitled to life, liberty, security of person, and “a standard of living adequate for… health and well-being

Approach to injury prevention that demonstrates interaction

Column Headings

• Host
• Agent/Vector
• Environment

Row Headings

• Before event
• During event
• After event

Tenants

• Injuries are preventable
• Injuries follow patterns
• Can’t rely on human factors alone

Safe

• Avoiding harm from care that is meant to help patients

Effective

• Care based on scientific knowledge

Patient-centered

• Care that is responsive to and respectful of individual patient preferences, needs, and values

Timely

• Reducing waits for those who receive and give care

Efficient

• Avoiding waste of equipment, supplies, ideas, and energy

Equitable

• Care not different due to personal characteristics

Impartiality

• Would you the doctor accept this action done to you?

Universality

• Would you the doctor feel comfortable with another doctor doing this if they were seeing a similar patient?

Interpersonal Justifiable

• Would it be accepted by your peers?

1. Capable patient
2. Voluntary
3. Informed about risks/benefits
4. Specific to situation and treatments
5. No misrepresentation

Autonomy

• Patients can make their own decisions about themselves

Beneficence

• Do good

Non-maleficence

• Don’t do evil

Distributive Justice

• Resources are allocated to all

1. Cancer
2. Heart Disease
3. CVA
4. Injuries
5. Chronic lower respiratory disease

Errbuddddy get in the back until 13 yo

• <9 kg (usually <1 year old)
• Rear-facing seat
• 9-18 kg (<6 years old)
• Forward-facing seat
• 18-36 kg (<8 years old)
• Booster seat

• OMA/CMA
• CPSO
• Talk to them privately
• Speak with site chief

1. First attend to their safety/care
2. Plan this disclosure
3. Invite
4. Actually do it
   * Sympathize, outline the investigative process
5. QI review
6. Conduct the post-analysis disclosure
   * What was learned, what’s changed, you’re sorry
7. Document

1991 Harvard Medical Practice Study

• 4% of hospitalized pts had significant adverse events
• 30% of adverse events from “human error”
• Only 3% of adverse events occurred in the ED
• 90% of ED adverse events were “preventable”

2000 Institute of Medicine Report

Failures or “errors” were the result of intrinsic properties of
the processes of care in which health care professionals work

Efforts to reduce failures should focus on changing the
processes of care, rather than identifying, retraining, and
punishing the workers