Nicola Meeres

Chapter Contents

Introduction

The society in which we live is an increasingly litigious one and as such it is in the best interests of those working in the emergency department (ED) to keep up to date with the relevant areas of law. This chapter highlights the key areas where knowledge of law is essential and discusses some of the legal dilemmas that may arise. Attendance, assessment, treatment and care, consent to treatment, detention of patients, confidentiality, the police, the press and staff health and safety are considered.

Law in the UK

The four countries of the UK have developed separate legal systems. England and Wales have identical legal systems and whilst the law in Northern Ireland has developed along similar lines, Scottish law has not. In this chapter, the law stated applies to England and Wales: where there are marked differences in Northern Ireland and Scotland, these will be noted. Otherwise, the reader can assume that the law is broadly applicable across the whole of the UK.

The two main sources of law are statute law and case law. Statute law is created either by Acts of Parliament or through a system of delegated legislation. Statutory Instruments, or Rules, form part of delegated legislation and they empower statutory bodies to expand or amend law for enactment by the Secretary of State. Delegated legislation has become increasingly important due to the pressures on parliamentary time.

Case law has developed through the judicial system as judges make decisions on the interpretation of law within the court setting. Once an outcome has been reached then a precedent is set for all other judges to follow in similar circumstances. Decisions made are binding on all courts below that where the precedent was set. For example, decisions made by the House of Lords are binding on all lower courts in the UK, but the House of Lords can overturn its own decisions and The European Court of Justice can set precedent for member states. Case law is of particular relevance to health care (Montgomery 2002).

Department of Health circulars and the Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives are not legally binding but they are recommended practice. The Nursing and Midwifery Council was established under the Nursing and Midwifery Order (2001), came into being on 1 April 2002 and has authority to prepare rules that carry the weight of law. The Code (Nursing and Midwifery Council 2008) is ‘about being professional, about being accountable, and being able to justify your decisions’, laying a moral responsibility rather than a statutory duty on members of the profession. A marked failure to abide by The Code could, in turn, lead to the Nursing and Midwifery Council using its disciplinary function, with legal implications of removal of the nurse’s name from the register.

Classification of law

Law may be classified in various ways; one of the main divisions of law is civil and criminal law. Criminal law is concerned with the relationship between the state and individuals. Criminal offences are committed against the state and are punishable by the state, e.g., drug offences and theft. Civil law is concerned with the rights and duties of individuals towards each other. Legal action is taken by a private citizen rather than the state, and a successful outcome results in an award of monetary compensation only, e.g., a patient suing a hospital for damages following some harm that has resulted from treatment or the lack thereof. Some civil wrongs can also be crimes, e.g., assault and battery and gross negligence, which could become manslaughter.

Probably the two most relevant areas of civil law in the ED are firstly negligence, as this relates to the standard of care given to the patient. And secondly the law on assault and battery, as this is relevant to the patients’ rights and encompasses where the giving of consent may act as a defence against a charge of assault and battery.

Attendance

There is a clear legal duty on the hospital running an emergency service to see and treat all those who attend. Purely by virtue of their coming within its doors, the hospital accepts responsibility, even without formally admitting them. A failure to treat those who present themselves could be negligence.

Many people who attend the ED are under the influence of alcohol and/or drugs and can be both difficult and disruptive. Healthcare professionals have an obligation to undertake clinical assessment before any decision not to treat is made, even in circumstances where a patient is uncooperative. For example, a hypoglycaemic patient will present as aggressive and uncooperative, often appearing drunk; left untreated hypoglycaemia is life-threatening. The onus is on the nurse to ensure sufficient history or investigation has taken place to determine whether there is a clinical cause for the behaviour. Once such assessment has taken place and the outcome been documented, removal or refusal to treat can be ordered with the support of security staff or the police when appropriate.

In such situations, security staff are allowed to use reasonable force to protect themselves, prevent injury or damage to property and to use reasonable force to contain uncooperative persons until the police arrive. Theoretically this situation could possibly give rise to a claim of assault and battery against security staff and/or the police; however, where reasonable force as opposed to excessive force can be identified, this is unlikely to happen or to be upheld.

The situation would be different if those causing these difficulties were not there as patients, but as friends or relatives, or if the patient had already been seen and treated. In this case, the individuals can be asked to leave; a failure to do so would mean they were then trespassing on hospital property and can be evicted.

It is imperative that all incidents of this nature should be accurately and thoroughly documented.

Assessment

Most EDs have a system of assessing the urgency of patients’ conditions on arrival. The criteria used to allocate patients to certain treatment groups largely rely on some degree of diagnosis. For the nurse, the crucial issue of undertaking patient assessment is whether he has sufficient knowledge to make an assessment competently, act on this assessment and to know his own limitations. Assessing a patient as less critically ill than in fact is the case, with a subsequent delay in treatment, could result in negligence.

The Nursing and Miwifery Council’s Code (2008) makes a nurse undertaking such roles personally accountable for his practice, that is, answerable for all acts and omissions and for the maintenance of his/her professional knowledge and competence. However, The Code also states that the nurse must ‘recognize and work within the limits of his competence’.

If the nurse is required to carry out patient assessment, the manager must provide the necessary training and carry the legal responsibility of delegating appropriately, as there can be negligence in delegation (Cornock 2011b). In addition, where patient assessment is seen as part of the nurse’s role, the employer will be vicariously liable for any negligence of the employee. This employer liability arises from the old law of master and servant relationship, where the employer has to carry this legal responsibility by reason of having a contract with the employee. This vicarious liability may also exist with agency staff, but its extent may depend on the exact nature of the contract.

Under Section 2 of the Limitation Act (1980), a case for negligence must be commenced within three years of the date of the cause of the action or when the effects become apparent to the plaintiff (Pannett 1997). It may be considerably longer before the case comes to court. Section 14 of the Act also requires that the injury is significant and relates this to the plaintiff’s knowledge of the injury. The lengthy timescale underlines the importance of record-keeping for nursing and medical staff.

Treatment and care

A vitally important question is: what is the standard of care that is expected and must be reached in the ED in order to avoid potential legal repercussions? From a number of legal cases relating to medical care, it is clear that the standard must be safe care and one that is accepted as proper by a responsible body of medical opinion (Mason & McCall-Smith 2002). Reasonable, rather than excellent, skill is considered sufficient. The standard in the ED will be that considered acceptable and reasonable in the conditions and circumstances in which nursing care is given.

The standard must relate to the specialty to which it is applied. Thus, nurses new to emergency department work must be aware that inexperience can never be an excuse for negligence. This was stated very clearly in Wilsher vs Essex AHA (1988), when inexperience in the work of the neonatal intensive care unit was put forward as a reason for the doctor’s mistake in taking the wrong blood reading from baby Wilsher and subsequently prescribing the wrong level of oxygen (Tingle & Cribb 2002). Both appeal judges were emphatic that the standard of care must be that of the post held, not of the post-holder. The lesson to be learned from this is that adequate training and supervision are vital until the nurse is competent in the skills required.

The legal significance of the above applies to both the varied nature of the work as well as the range of skills of the workforce. For example, a number of people present to an emergency department with mental health problems; ideally these people should be cared for by Community Psychiatric Nurses (CPNs), but in reality most EDs do not employ CPNs directly. The general/adult trained nurses therefore have to manage these patients to the best of their ability. In these circumstances, the standard is probably not that of the CPN, but of a nurse experienced in dealing with the range of circumstances presented by those with mental health problems in this particular setting.

The importance of multidisciplinary teamwork is recognized in most patient care settings and is particularly relevant to emergency departments where a number of different professionals work together. Traditionally, doctors had overall legal responsibility for the patient, but care roles have become blurred and this is no longer the case. Patients can now be solely managed by other health professionals, who take responsibility for their care. Nurses should ensure that they are adequately trained and are working within parameters agreed with the organization, which the organization would then be vicariously liable for. In order to safeguard the different members of the team, care must be taken in delegating tasks to members, whether it is across professional boundaries or from more senior members of the nursing team to those more junior.

Three checks can be made in order to avoid negligence:

With regard to the safeguarding of vulnerable adults in hospital, the Department of Health (England) issued a guidance document entitled ‘No Secrets’ (Department of Health 2000) and the Care Standards Act (2000) included a scheme to protect vulnerable adults. The Protection of Vulnerable Adults (POVA) scheme has been replaced by the Vetting and Barring Scheme regulated by the Independent Safeguarding Authority, although this is currently under review (Home Office 2011). The Safeguarding Vulnerable Groups Act (2006) contains a scheme for vetting and barring those unsuitable for working with vulnerable adults, including health and social care workers (British Medical Association 2012).

Nurses’ prescribing powers

Many emergency nurses are either supplementary or independent prescribers. An independent prescriber takes responsibility for the clinical assessment of the patient, establishing a diagnosis and the clinical management required, as well as prescribing where necessary (Department of Health 2004). A supplementary prescriber works with an independent prescriber to implement an agreed patient-specific clinical management plan.

Legislation in the form of a Statutory Instrument has extended nurses’ prescribing powers (Medicines for Human Use 2005). The changes, which came into force on the 1st May 2006 in England, allow qualified nurse independent prescribers to prescribe any licensed medicine for any medical condition within their competence, including some controlled drugs. This is a significant change, as independent prescribers can now prescribe from the British National Formulary based on their clinical competence rather than from the nurses’ formulary. Both independent prescribers and supplementary prescribers are now able to prescribe opiates in some circumstances.

Death and organ donation

Laws and policies governing the use of organs for transplantation are evolving rapidly in response to sensitivity to ethical concerns and increasing shortages of transplantable organs (Price 2012). There are a number of legal issues surrounding death in the ED: the first is the legal definition of death. The determination of brainstem death requires confirmation of the ‘irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe’ and relies on the fact that key components of consciousness and respiratory control, the reticular activating system and nuclei for cardiorespiratory regulation, reside in the brainstem (Smith 2012). Although this still stands as the total stoppage of circulation of blood and cessation of animal and vital body functions, the concept of brain-stem death is now accepted by the courts. There will not, therefore, be a legal difficulty in turning off a life-support system once brainstem death has been diagnosed. In situations where death has not occurred but prognosis and quality of life are so poor that to continue with treatment seems to have no useful purpose, the law accepts decisions not to do so. Appropriately qualified healthcare professionals can verify that death has taken place; however, brain-stem death can only be certified by a doctor.

Organ donation can create legal as well as ethical dilemmas in an emergency department (Wilkinson 2000). The Human Tissue Act (2004) makes consent a fundamental principle. If the deceased has not given consent before death, then the consent of a nominated representative is required; in the absence of this, then it will be the consent of a ‘qualifying relative’ that is needed. These ‘qualifying relatives’ relationships are ranked in order when consent is being sought to use tissue or organs for scheduled purposes (Box 39.3).

Patient property

The same rules apply for the care of property in the ED as in a ward, but the clinical condition of some patients demands the nurse to become a ‘bailee’ for the property of those unable to take this responsibility themselves; this may be involuntary bailment (Dimond 2008). The task of checking property soon after arrival in these cases is important, due to the open nature of the environment and the high risk of theft. Preferably, two people should together check, list, sign and ensure valuables are locked away safely. When death occurs, valuables should not be given to relatives, but again the proper hospital procedures should be followed.

In an emergency, such as cardiac arrests, clothing may have to be cut off, but this should only be done as a last resort. If clothes are heavily contaminated by blood or parasites and need to be destroyed, the patient’s permission should be sought where possible and documentation of items destroyed should be made. Additionally, where there is a possibility of legal action, for instance, following criminal activity, resulting in alleged stabbings, gunshot wounds or sexual assault, care must be taken to cut and bag clothing, in ways that will enable forensic examiners to undertake their role to the satisfaction of the courts. Where items may form part of a criminal investigation, it is important that these are bagged in paper rather than plastic bags due to risk of degradation of material evidence.

Consent to treatment

For treatment to be given, a patient’s consent must be gained in order to avoid being sued for assault and battery. For this consent to be legally effective, the patient must be able to understand and come to a decision about what is involved. Under common law, the patient has the right to give or withdraw consent for treatment or a procedure at any time.

Consent can be given in writing, orally or be assumed from the patient’s actions, e.g., from the fact that the patient voluntarily attends the ED. However, Cable et al. (2003) argue that the nurse must not assume that a patient is giving consent by virtue of his or her voluntary attendance. Listening to each patient’s responses and observing his or her non-verbal behaviour is an essential part of the process of ensuring that legally valid consent is also informed consent. Dimond (2005) cautions that where there is a dispute, written consent is the preferred evidence that consent was given. However, the signature on the consent form should not be seen as the consent itself, but evidence that, following a process of communication between the health professional and the patient which was understood by the patient, consent was given to the proposed intervention. The Department of Health (2001b) has also been keen to promote best process in securing informed consent following recommendations that emerged from the Bristol Royal Infirmary Inquiry Report (Department of Health 2001a, Vincent 2010).

Written consent is usually reserved for those treatments or investigations carrying a marked risk and is usually obtained by the person undertaking the procedure or by the doctor. The nurse may be able to help clarify a patient’s lack of understanding or assist the patient in finding out the information required, but the nurse must ensure that he or she is competent to undertake this role and that any information is accurate.

For most nursing actions, consent will be gained orally and this is better practice professionally than assuming consent. Oral consent should be recorded in the clinical record. It is not an unusual occurrence for patients to be brought into the department who are either unable or unwilling to give consent to treatment. As shown in Box 39.2, there are a number of legal ‘defences’ or reasons that treatment can be given, apart from consent, without there being a case for assault and battery.

When a patient cannot give a valid consent due to a lack of understanding, treatment that is urgent and necessary can still be given. Thus the unconscious, semiconscious or mentally confused patient can be treated on this basis.

Under the Mental Capacity Act (2005a), everything that is done for or on behalf of a person who lacks capacity must be in that person’s best interests. The Mental Capacity Act Deprivation of Liberty Safeguards (formerly known as the Bournewood Safeguards) was introduced into the Mental Capacity Act (2005b) through the Mental Health Act 2007 and has been in operation since April 2009. The Deprivation of Liberty Safeguards gives special protection to those who are unable to make a decision about the way they are being treated or cared for in a hospital.

In law, the health professionals care for patients in the absence of consent as part of their duty to care for them out of necessity in an emergency, and they would have to defend any subsequent action for trespass to the person on that basis. Those suffering the effects of alcohol or drugs could also be included in this category.

Under the Police Reform Act (2002), where the police believe that for a medical reason a person is incapable of giving valid consent to having a blood specimen taken, following involvement in a road traffic accident, the police may now request that a blood specimen be taken by the medical practitioner and stored. However, if the medical practitioner in charge of the patient believes that this would be prejudicial to the proper care and treatment of the patient, then the request can be objected to and it will not be carried out.

With a child it is usual, if the child is under 16, for the consent of the parents or guardian to be sought. In the case of unmarried parents, only the mother’s consent is legally binding unless the father has legal guardianship. If the situation is too urgent to await the arrival of a parent, the child can give consent if she has sufficient understanding, or the urgency and necessity rule can be used. The Children Act (1989) also makes it clear that the child’s wishes are paramount and no court direction overrides the child’s right of refusal to be examined provided she has sufficient understanding. A ‘Gillick competent’ minor is deemed to have sufficient understanding and intelligence to enable him to understand fully what is proposed (Gillick vs W. Norfolk & Wisbech Area Health Authority [1985]).

‘Gillick competence’ (also called Fraser Guidelines) relates to the particular child and the particular treatment: there have been cases where a 17-year-old has been found to be insufficiently competent to refuse medical treatment, while in other cases much younger children have been deemed sufficiently competent. Under the Sexual Offences Act 2003, it is a criminal offence to procure sexual intercourse with a child under 16 years. Thus contraceptive treatment should also be given on clinical grounds (Carvalho et al. 2011). In order to protect nurses from being accused of breaching the Sexual Offences Act 2003, the Fraser Guidelines have been extended and may mean not telling the child’s parents about the treatment if it is deemed it is in the interest of the child’s welfare not to do so.

Predicaments can arise in any of these situations when relatives either take a different view from the patient or claim that the patient, if mentally capable, would have refused consent. The often-quoted example is of the unconscious patient who is a Jehovah’s Witness and requires a blood transfusion. The ED team can still proceed on the basis that, as this is an unforeseen emergency, it would be impossible to know the patient’s wishes if faced with possible death.

Relatives may also expect to be in the position of giving consent on behalf of an adult patient unable to do so. There is no legal basis for asking relatives for their consent in these circumstances. They may be consulted about the patient’s preferences, but the decision to proceed with treatment will be a medical one on the basis of urgency and necessity. The Nursing and Midwifery Council (2008) also supports the notion of proceeding if it is in the patient’s ‘best interests’, stating ‘You must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency’. While this guidance creates an ethical dilemma for healthcare practitioners, in terms of the law, both a decision to treat and a decision not to treat based on evidence of the patient’s beliefs would be acceptable.

Health carers also face a difficulty when caring for a patient who is still conscious but is refusing treatment following a drug overdose. The Mental Health Act (1983), as amended by the Mental Health Act (2007), may appear to provide a treatment pathway by placing the patient under the emergency section of the Act and then giving treatment against her will, but it would be wrong to assume that all those attempting suicide are mentally disordered under the terms of the Act. It is also unlikely the Act could be applied, as assessment of the patient’s mental state could be impaired by the drugs taken. An apparently irrational refusal can still be a competent one and the decision whether to treat or not may then become an ethical one. Proceeding against the patient’s will lays the carers open to an action for assault and battery; however, in reality, the likelihood of a patient’s bringing and pursuing any such action through the courts is low. Abiding by the patient’s wishes, on the other hand, whilst legally correct, places a responsibility on the healthcare practitioner to ensure that the patient understands the potential outcome of no treatment; the healthcare practitioner then has to make a professional decision based on what they perceive the patient’s state of mind to be.

In many of these predicaments, the legal difficulty may be one of balancing patients’ rights against a possible accusation of negligence in failing to act. Whatever is decided, both arguments should be considered and, if they are particularly contentious, a written record should be made of how the decision was reached.

Detention of patients

As well as times when it is legally acceptable to treat without the patient’s consent, there are also occasions when individuals can be detained against their will (Dimond 2008). Of relevance to the healthcare worker in the ED are the following: patients may be detained under Section 4 of the Mental Health Act (1983), as amended by the Mental Health Act 2007. Admission to hospital for assessment in cases of emergency lasts for 72 hours. The grounds for using this order are an urgent necessity that the patient should be admitted and detained for assessment and that compliance with the normal procedure would involve undesirable delay. The recommendation of only one medical practitioner is required. There will be arrangements made for an on-call psychiatrist to attend the ED.

The only other section likely to be met is Section 136. This order can be invoked by the police on finding a person in a public place who appears to be suffering from a mental disorder and in immediate need of care or control. Such a person has to be taken to a designated place of safety; ideally this would be attached to a mental health unit, but in some localities this would be an emergency department. Some patients may be mentally confused due to physical illness, e.g., hypoxia following heart failure. The patient can be detained in the short term for emergency treatment, the law accepting the necessity for this. A failure to do so could be deemed negligence.

Much rarer is the situation of an individual with a certain infectious disease potentially dangerous to others who refuses to stay for treatment. An order made by a magistrate or sheriff can be issued to detain the person, who will then be rapidly transferred to an appropriate unit.

The police may detain a person in the ED. For example, the patient may have been injured at the time of arrest. In this case it is the police’s responsibility to detain, never the nurse’s. Even if the police request the nurse to assist them in preventing the patient leaving the department, he should refuse to become involved. The fact that someone is a detained prisoner does not lessen her right to treatment, confidentiality or refusal to consent to procedures.

Confidentiality, the police and the press

Patient information is generally held under legal and ethical obligations of confidentiality (Department of Health 2003). Professionally, nurses are required to treat information about patients as confidential and use it only for the purposes for which it was given and to protect information from improper disclosure at all times: Nursing and Midwifery Council Standards of Conduct, Performance and Ethics (2008). Both the Data Protection Act (1998) and the Human Rights Act (1998) seek to preserve and protect the privacy and confidentiality of the individual. The Freedom of Information Act (2000) gives a general right of access to all types of information held by public authorities. However, there are a number of situations where disclosure of information without the patient’s consent can be made. These include the following:

If the nurse has to give evidence in court, privilege on the basis of professional position cannot be claimed and the nurse will have to give the information required. The courts can also order the release of medical and nursing notes prior to the court case. The public interest would cover situations where serious harm is feared to the patient or another person, or in a child protection situation (Dimond 2005). Most departments will have clearly laid down guidelines to follow if symptoms point to child protection concerns. The disastrous consequences of not taking action have been well publicized, as has the distress caused to both child and parents when action has been taken on grounds that are later found to be unsubstantiated. A team approach is usually seen as essential.

Under the Prevention of Terrorism Act (2005) it is an offence for any person having information that he or she believes may be of material assistance in preventing terrorism or apprehending terrorists to fail, without reasonable cause, to give that information to the police.

While nurses have an obligation to provide police with a statement regarding their own actions and observations, they do not have to provide a statement regarding the patient’s medical condition. This can be referred on to the clinician in charge of the patient’s care. While inter-agency cooperation is important, healthcare professionals should not feel pressurized into providing statements immediately. In most circumstances, it is quite acceptable to arrange a mutually agreeable time for statements. This enables the health professional to organize their thoughts and seek advice about confidentiality and disclosure if needed.

While there is a need for valid sharing of information between health professionals to ensure the safe care of patients, the Caldicott principles (NHS Executive 1997) should be followed (Box 39.4).

The healthcare worker in the ED is sure to have a certain amount of contact with the police and, possibly, the press. It is important to be aware of the respective rights of patients, hospital employees and police in these circumstances. The police have a number of powers regarding search and arrest and these will apply to a hospital in the same way as to a private dwelling because hospitals are Crown property, not public property. Police can enter premises without a search warrant if the person they wish to search for is suspected of an arrestable offence. An intimate search of body orifices can be authorized if the person concerned is likely to have concealed an item to injure herself or others, or for drugs. Police are entitled to use reasonable force in carrying out an intimate search.

In relation to arrest, police may arrest without a warrant if they suspect that an arrestable offence has been, is being or is about to be committed. Examples of an arrestable offence are unlawful possession of drugs, rape and most offences of violence (English & Card 2003). If the police suspect that an individual who is currently a patient in the ED has committed a serious offence, the staff should not hinder the police in their work, but should ensure the medical condition of the individual is not jeopardized.

A final situation where patient confidentiality may be put at risk is through press enquiries. Most hospitals will have strict rules on which staff are allowed to talk to the press. It is wise for staff always to refer these enquiries to the appropriate senior member of staff.

Staff health and safety

Both verbal abuse and physical violence against staff are not unusual occurrences in the ED. Police attendance at such incidents can be requested and the nurses involved will need to make statements to the police. However, quite often no charges will be brought against the individual.

The law can be relevant in a number of ways. First, violent actions could be the crime of assault, battery or causing grievous bodily harm. However, the police are often unable to charge a person on the basis of these crimes as there is often some doubt as to whether the person intended to commit the crime. Proving intention is necessary for a successful prosecution. If the patient is mentally ill, drunk or under the influence of drugs, they could claim that they could not form the necessary intention. Increasingly, however, courts take a poor view of acts of violence carried out under the influence of drink or drugs that offenders have taken to deprive themselves of their self-control or their knowledge of what they were doing. There are moves to try to bring nurses into line with the police, in as much as when a police officer is assaulted, it is automatically a criminal offence.

For most criminal charges, not only is self-induced intoxication no defence but, if the offender claims that she/he only did it because of intoxication, the prosecution are absolved from proving any mental element and need simply prove that the act was done. It is thus easier to obtain a conviction. It also underlines the need for clear, contemporaneous notes to be taken by staff and witnesses in case of legal action being taken. If injuries are sustained, the statement will provide evidence of the event and the nurse may be able to claim from the Criminal Injuries Compensation Authority even in the absence of a successful prosecution.

Assault and battery are also civil wrongs. This means the nurse could sue the individual through the civil courts for damages. In this context, intention does not have to be proved, so evidence of the incident would lead to a successful legal action. It is rare, however, for nurses to take this route. Finally, the nurse could complain to the employer that there has been a failure to provide a safe working environment, under common law, the Occupiers Liability Act (1957) and the Health and Safety at Work etc. Act (1974). However, the employer only has to take reasonable steps to ensure the health, safety and welfare of the employees. It is difficult for the employer to create a totally safe environment in EDs, because of the nature of the work undertaken and the open access of the department to the public. If the employee considers further measures should be taken, she should consult the health and safety representative of her trade union or professional body.

Other health and safety issues in the ED are very similar to those elsewhere, e.g., infection risks, moving and handling patients and fire hazards. European Union Directives, laid out in a number of UK Health and Safety (General Provisions) Regulations (1992), have resulted in the broadening of the requirements and improved protection of staff in the area of safety. The provision of training and adequate equipment are key elements of any statutory requirements. Health and Safety issues are examined in detail in Chapter 40.

Conclusion

In the medico-legal sense, the ED has been described as the most dangerous part of a hospital (Knight 1992). It is therefore important for all emergency nurses to have a working knowledge of the law if they are to try to prevent legal problems arising in the first place. This chapter has introduced the main areas of law relevant in emergency care and discussed the implications for emergency care practitioners. Like practice, however, the law is constantly evolving and it is in the nurse’s best interest to maintain an up-to-date knowledge of the law.

References