title: Ethical challenges in Emergency Medical Services: controversies and recommendations.
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.
authors.affiliation: 1 Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan USA.
authors.forename: Torben K
authors.initials: TK
authors.lastname: Becker
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Aswegan
authors.forename: Eileen F
authors.initials: EF
authors.lastname: Baker
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Bookman
authors.forename: Richard N
authors.initials: RN
authors.lastname: Bradley
authors.forename: Robert A
authors.initials: RA
authors.lastname: De Lorenzo
authors.forename: David J
authors.initials: DJ
authors.lastname: Schoenwetter
mesh_terms: D000552:Ambulances / Q000941:ethics; D032921:Consensus; D004632:Emergency Medical Services / Q000941:ethics*; D017408:Guidelines as Topic; D006801:Humans; D018447:Medical Futility / Q000941:ethics; D061214:Patient Safety; D010561:Personnel Staffing and Scheduling / Q000941:ethics; D016079:Refusal to Treat / Q000941:ethics; D013997:Time Factors; D014187:Transportation of Patients / Q000941:ethics / Q000379:methods; D014481:United States