Assignment This Week: Students Will Create A PowerPoint To A

Assignmentthis Week Students Will Create A Powerpoint To Address The

This week students will create a powerpoint to address the following questions… Case Study: A mother expecting her first child miscarried at home on June 22, 2010. The pregnancy was six months along. An ambulance was called at 4:57 a.m. The EMTs helped the mother to the stretcher and then went inside to retrieve the fetus from the bathroom floor. The baby was seen moving its head.

The EMTs requested ALS to the scene. The baby was placed inside a small container. The ALS personnel visually assessed the fetus and stated the fetus was “non-viable”. There was never a fetal heart check in the field. Mother and fetus were transported to the hospital arriving at 5:16 a.m.

At the hospital, a nurse noticed that the fetus was warm and had a heartbeat. The baby was raced to the special care nursery and placed on a warmer. The staff then proceeded to resuscitate the baby. The baby was dusky and noted to have a heart rate of 30 with respirations of 6-8 at 5:40 a.m., and cardiopulmonary resuscitation was initiated. The oxygen saturation was 2-10%.

The baby was intubated at 5:55 a.m. At 6:05 a.m., the blood pressure was 44/24. By 6:15 a.m., the baby was on a ventilator with oxygen saturation of 96%, a heart rate of 102, but remained dusky. By 6:30 a.m., the baby’s heart rate was 120 and blood pressure 52/24. At 7:45 a.m., the baby was transported to a Boston hospital NICU for further care and treatment.

Unfortunately, the baby died on August 10, 2010 at age 1 month and 16 days, not from prematurity but rather from brain damage due to lack of oxygen. The plaintiffs’ claimed the accepted standard of care for basic and paramedic emergency medicine technicians in Massachusetts in 2010 required basic and paramedic EMTs to provide appropriate evaluation and treatment by following established protocols. It is beyond the scope of practice for EMTs at any level to make determinations in regard to viability of a patient. As a result of the negligence, the baby was improperly designated as “non-viable”, was placed in a Pizzeria Uno’s delivery plastic bag inside of a box with a lid on it further depriving the baby of oxygen, and as a result was not resuscitated for the first several minutes of life.

Paper For Above instruction

The case involving the at-home miscarriage and subsequent neonatal death presents significant ethical challenges rooted in emergency medical response practices, legal standards, and moral principles. This complex situation, set in Massachusetts in 2010, highlights the critical responsibilities and limitations faced by emergency medical technicians (EMTs), as well as the profound ethical implications related to the concepts of autonomy, nonmaleficence, beneficence, fidelity, and justice. In this paper, I will analyze the facts of the case, explore the key ethical issues, examine professional scope of practice and ethical codes, and evaluate the ethical decision-making involved, concluding with recommendations for improvements to emergency response protocols and ethics oversight.

Facts of the Case

The case revolves around a woman experiencing a second-trimester miscarriage at home, which resulted in the fetus being retrieved by EMTs responding to her emergency call. The EMTs, upon arriving at the scene, retrieved the fetus and initially assessed it as “non-viable” without conducting formal fetal heart checks, based on visual assessment. The vital actions taken by the EMTs were governed by protocols that restricted their ability to determine viability. The fetus was transported with minimal regard for its oxygenation status, placed in inappropriate packaging, and not resuscitated until reaching the hospital. Despite initial efforts, the infant suffered brain damage due to oxygen deprivation and subsequently died at one month and sixteen days old.

This incident involved multiple parties, including the mother, EMS personnel (basic and advanced EMTs), hospital staff, and legal representatives. It raises questions about the manner in which emergency protocols are applied, the scope of EMT practice, and the ethical responsibilities of responders to provide appropriate care. Geographically, the events took place within the state of Massachusetts, where EMS protocols are regulated by state authorities and individual facilities. The timeline is also significant, beginning with the distress call at 4:57 a.m. and ending with the infant’s death on August 10, 2010.

Ethical Issues: Autonomy, Nonmaleficence, Beneficence, Fidelity, and Justice

The core ethical issues in this case relate to several fundamental principles of medical ethics. Respect for autonomy is challenged because the mother’s wishes regarding her fetus may not have been explicitly documented or understood by EMS personnel; instead, they relied on visual assessment and protocols to guide actions. Nonmaleficence, the obligation to do no harm, is violated when the fetus was not properly assessed or resuscitated, contributing to oxygen deprivation and brain injury. Beneficence requires the EMTs and hospital staff to act in the best interests of the fetus and mother, which was compromised by premature declaration of non-viability and inadequate initial care. Fidelity emphasizes the duty to remain faithful to professional standards and patient trust, which was undermined when the fetus was improperly handled and denied appropriate intervention. Justice involves the fair and equitable treatment of all patients; in this case, the fetus was denied potential lifesaving procedures based on flawed assessments, raising questions about bias and protocol adherence.

Major Principles, Rules, and Values

Key principles include respect for life, nonmaleficence, and justice. The rules involve adherence to established protocols, scope of practice regulations, and professional ethics codes. Values such as respect for patient dignity, transparency, accountability, and compassion guided the responses of EMS and hospital staff. The violation of these values, particularly in the misclassification of the fetus’s viability and the neglect of proper resuscitative efforts, contributed significantly to the adverse outcome. Ethical practice demands that responders prioritize the well-being of all patients, regardless of age or developmental stage, unless clinical guidelines explicitly limit intervention.

Scope of Practice for EMTs in Massachusetts

In Massachusetts, the scope of practice for EMTs is mandated by state regulations and includes the assessment, basic life support, and transport of patients. EMTs are trained to perform critical interventions such as CPR, airway management, and stabilization but are explicitly prohibited from making definitive diagnoses of viability or prognostic judgments. Their scope is dictated primarily by state EMS protocols, which aim to standardize responses while protecting responders from liability and ensuring patient safety. However, variations exist across states; for example, some states allow for more advanced assessments or interventions by paramedics, reflecting differences in training, resources, and legal frameworks.

In this case, the EMTs acted within their scope by retrieving and transporting the fetus, but their decision not to perform additional assessments or resuscitative efforts aligns with the limitations of their scope. They lacked legal authority or clinical training to assess viability, emphasizing the importance of adhering to established protocols.

Professional Code of Ethics for EMTs

The National Association of Emergency Medical Technicians (NAEMT) Code of Ethics emphasizes core principles such as respect for patient autonomy, nonmaleficence, beneficence, fidelity, and justice. Each principle is reflected in ethical EMT practice:

• Autonomy: Respecting patient wishes and providing honest information. For instance, in cases where patients can express preferences, EMTs should honor their choices within legal bounds.
• Nonmaleficence: Avoiding harm by performing assessments and interventions appropriately. For example, avoiding unnecessary packaging or mishandling of vulnerable patients or fetuses.
• Beneficence: Acting in the patient’s best interest; providing prompt, appropriate care. For example, initiating resuscitation when indicated.
• Fidelity: Maintaining trustworthiness and confidentiality. For instance, following protocols accurately and documenting actions thoroughly.
• Justice: Ensuring equitable treatment; providing equal care regardless of patient age or condition. For example, not denying resuscitation solely based on fetus viability assumptions.

These principles serve as guides for ethical decision-making, emphasizing the importance of adherence to standards, respectful communication, and professional integrity.

Supporting or Contesting the EMTs’ Decision

Based on the scope of practice and ethical guidelines, I support the EMTs’ decision not to attempt resuscitation or determine viability at the scene. Their actions were aligned with legal and professional standards—conducting assessments within their training, following protocols, and recognizing the limits of their authority. Attempting to resuscitate or evaluate viability without proper expertise could have caused additional harm and liability. The improper classification of the fetus as non-viable and substandard handling, however, indicate systemic failure and underscore the importance of protocols and ongoing training. If I were present, I would emphasize the importance of involving medical control or following regional protocols strictly to prevent misclassification and ensure appropriate care.

Recommendations for Ethical and Protocol Improvements

If I were part of the ethics committee, I would recommend revisiting EMS protocols to clarify procedures for fetal assessment, especially in cases of second-trimester losses. Provider education should include ethical considerations regarding viability and emergency interventions for fetuses, emphasizing the importance of not prematurely declaring death without proper diagnosis. Additionally, protocols should require documentation and communication with medical control before making critical judgments about viability or initiating resuscitation efforts, where applicable. Implementing specialized training modules on fetal emergencies and reinforcing a culture of ethical accountability are crucial for improving patient outcomes and reducing legal risks. Regular audits and case reviews can help identify systemic flaws and promote continuous improvement.

Conclusion

The tragic case underscores critical ethical considerations within emergency medical services, ranging from respecting patient autonomy to ensuring nonmaleficence and justice. While EMTs operate within strict protocols that restrict their capacity to assess viability and make clinical judgments outside their scope, the systemic issues related to protocol clarity, training, and ethical oversight must be addressed. Ensuring that practitioners adhere to ethical principles and professional standards is vital in preventing similar tragedies in the future. Ongoing education, clear protocols, and ethical accountability are essential components of effective emergency response systems that honor the dignity of all patients, including the most vulnerable such as fetuses.

References

• American Medical Association. (2016). Code of Medical Ethics. AMA Journal of Ethics.
• Bronstein, A. C., et al. (2020). Fundamentals of Emergency Medical Services. Elsevier.
• Lubin, N., & Meyers, J. (2016). EMT negligence lawsuit settles for $1 million. Medical Malpractice Trial Report.
• National Association of Emergency Medical Technicians. (2019). NAEMT Code of Ethics.
• Massachusetts Department of Public Health. (2010). EMS Protocols and Scope of Practice.
• American College of Obstetricians and Gynecologists. (2012). Fetal viability and prenatal considerations. Practice Bulletin No. 135.
• Gadow, S. (2018). Ethical Issues in Emergency Medicine. Emergency Medicine Clinics of North America.
• World Medical Association. (2017). Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects.
• Smith, J. P., et al. (2015). Legal and Ethical Aspects of Neonatal Resuscitation. Journal of Medical Ethics.
• Vanderpump, R. (2019). Ethics in Emergency Medical Services. Journal of Paramedic Practice.