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Ethical Challenges in Emergency Medical Services: Controversies and Recommendations

Published online by Cambridge University Press:  26 July 2013

Torben K. Becker ,
Marianne Gausche-Hill ,
Andrew L. Aswegan ,
Eileen F. Baker ,
Kelly J. Bookman ,
Richard N. Bradley ,
Robert A. De Lorenzo  and
David J. Schoenwetter
Torben K. Becker*
Affiliation:
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan USA
Marianne Gausche-Hill
Affiliation:
David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California USA and Los Angeles Biomedical Research Institute, Torrance, California USA
Andrew L. Aswegan
Affiliation:
Union Hospital, Elkton, Maryland USA and Cecil County EMS, Cecil County, Maryland USA
Eileen F. Baker
Affiliation:
Riverwood Emergency Services, Inc., Bowling Green, Ohio USA
Kelly J. Bookman
Affiliation:
Department of Emergency Medicine, University of Colorado, Aurora, Colorado USA
Richard N. Bradley
Affiliation:
Department of Emergency Medicine, Division of EMS and Disaster Medicine, The University of Texas Health Science Center at Houston, Houston, Texas USA
Robert A. De Lorenzo
Affiliation:
US Army Institute for Surgical Research, Fort Sam Houston, Texas USA
David J. Schoenwetter
Affiliation:
Geisinger Medical Center, Danville, Pennsylvania USA and Geisinger EMS and Geisinger Life Flight, Danville, Pennsylvania USA
*
Correspondence: Torben K. Becker, MD Department of Emergency Medicine University of Michigan 1500 East Medical Center Drive, B1-354TC Ann Arbor, Michigan 48109-0303 USA E-mail tbeckermd@gmail.com
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Abstract

Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. This article describes some of the common situations with ethical underpinnings encountered by EMS personnel and managers including denying or delaying transport of patients with non-emergency conditions, use of lights and sirens for patient transport, determination of medical futility in the field, termination of resuscitation, restriction of EMS provider duty hours to prevent fatigue, substance abuse by EMS providers, disaster triage and difficulty in switching from individual care to mass-casualty care, and the challenges of child maltreatment recognition and reporting. A series of ethical questions are proposed, followed by a review of the literature and, when possible, recommendations for management.

BeckerTK, Gausche-HillM, AsweganAL, BakerEF, BookmanKJ, BradleyRN, De LorenzoRA, SchoenwetterDJ for the American College of Emergency Physicians’ EMS Committee. Ethical Challenges in Emergency Medical Services: Controversies and Recommendations. Prehosp Disaster Med. 2013;28(5):1-10.

Keywords

disasterEmergency Medical Servicesethicsmass casualtyresuscitationtriage
Type
Special Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 5 , October 2013 , pp. 488 - 497
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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