Podcast
Questions and Answers
Which of the following criteria is NOT essential for determining a patient's decision-making capacity when they refuse medical treatment or transport?
Which of the following criteria is NOT essential for determining a patient's decision-making capacity when they refuse medical treatment or transport?
- The patient has a Glasgow Coma Scale (GCS) score of 15.
- The patient's decision is influenced by the opinions of family members present. (correct)
- The patient can articulate a decision that remains consistent over time.
- The patient can justify their decision using logic aligned with their personal values.
Under what circumstance may a parent or legal guardian NOT refuse care on behalf of a minor?
Under what circumstance may a parent or legal guardian NOT refuse care on behalf of a minor?
- When the parent disagrees with the treatment plan but does not suspect abuse or neglect.
- When the parent is not available to provide consent for emergency treatment.
- When the minor is an emancipated minor and can provide state-issued identification.
- When abuse or neglect of the minor is suspected. (correct)
An adult patient with a history of anxiety expresses a desire to refuse ambulance transport after a minor car accident, appearing nervous, but oriented. Vital signs are stable. Which of the following actions should the EMS provider prioritize?
An adult patient with a history of anxiety expresses a desire to refuse ambulance transport after a minor car accident, appearing nervous, but oriented. Vital signs are stable. Which of the following actions should the EMS provider prioritize?
- Immediately contact online medical direction due to the patient's anxiety and refusal.
- Honor the patient's request and prepare a refusal form for signature.
- Assess the patient's understanding of the medical emergency, proposed care, and risks of refusal. (correct)
- Contact the patient's family to convince the patient to accept ambulance transport.
Which of the following scenarios requires EMS personnel to ensure that a patient is transported to a receiving facility, irrespective of the desire to refuse?
Which of the following scenarios requires EMS personnel to ensure that a patient is transported to a receiving facility, irrespective of the desire to refuse?
Which action is MOST important for EMS providers to take when an individual refuses care and/or ambulance transport?
Which action is MOST important for EMS providers to take when an individual refuses care and/or ambulance transport?
An intoxicated patient insists on refusing transport after falling and hitting their head. Besides treating any immediate life threats, what should the EMS provider do FIRST?
An intoxicated patient insists on refusing transport after falling and hitting their head. Besides treating any immediate life threats, what should the EMS provider do FIRST?
A 16-year-old requests refusal of care for a broken arm. What should the EMS providers do to proceed with the refusal?
A 16-year-old requests refusal of care for a broken arm. What should the EMS providers do to proceed with the refusal?
What is the PRIMARY reason for EMS providers to assess a refusing patient’s understanding of their medical emergency?
What is the PRIMARY reason for EMS providers to assess a refusing patient’s understanding of their medical emergency?
Which of the following best describes the required elements for a patient to demonstrate decision-making capacity?
Which of the following best describes the required elements for a patient to demonstrate decision-making capacity?
You are on scene with a patient who is refusing transport. You have already completed a thorough assessment, determined they have decision making capacity, and advised them of the risks of refusal. What is the next step?
You are on scene with a patient who is refusing transport. You have already completed a thorough assessment, determined they have decision making capacity, and advised them of the risks of refusal. What is the next step?
A patient with a court order for psychiatric care wants to refuse care. Can the patient refuse care?
A patient with a court order for psychiatric care wants to refuse care. Can the patient refuse care?
Under what condition can a patient be transported to the hospital?
Under what condition can a patient be transported to the hospital?
What is the first thing an EMS provider should do if someone refuses care?
What is the first thing an EMS provider should do if someone refuses care?
An adult patient is refusing care after a fall. The patient is alert and oriented but states that they are in too much pain to answer any questions. What should the EMS provider do next?
An adult patient is refusing care after a fall. The patient is alert and oriented but states that they are in too much pain to answer any questions. What should the EMS provider do next?
Why is it important to demonstrate and document decision-making capacity?
Why is it important to demonstrate and document decision-making capacity?
An EMS provider is called to a scene where a patient wants to refuse transport. The patient is alert and oriented to person, place, and time. What else needs to be assessed before allowing the patient to refuse care?
An EMS provider is called to a scene where a patient wants to refuse transport. The patient is alert and oriented to person, place, and time. What else needs to be assessed before allowing the patient to refuse care?
A patient wants to refuse care, but does not seem to understand what the EMS provider is explaining. What can the EMS provider do?
A patient wants to refuse care, but does not seem to understand what the EMS provider is explaining. What can the EMS provider do?
A patient is refusing care, but can’t seem to justify their decision with logic that fits their own value system. What should the EMS provider on scene do?
A patient is refusing care, but can’t seem to justify their decision with logic that fits their own value system. What should the EMS provider on scene do?
What should EMS providers do to make all reasonable efforts to avoid danger to themselves?
What should EMS providers do to make all reasonable efforts to avoid danger to themselves?
What must EMS providers do to ensure that the patient understands the risks and consequences of refusing care?
What must EMS providers do to ensure that the patient understands the risks and consequences of refusing care?
Flashcards
Decision-Making Capacity
Decision-Making Capacity
The ability to understand one's condition, treatment options, and risks of refusal.
Criteria for Decision-Making Capacity
Criteria for Decision-Making Capacity
Patient must be able to receive/comprehend information, process/deliberate, make/articulate a consistent decision, and justify the decision logically.
Requirements for Valid Refusal
Requirements for Valid Refusal
A person's judgment is not impaired by illness, injury or intoxication and has a normal GCS (15).
Exceptions to Refusal
Exceptions to Refusal
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Treatment for Minors
Treatment for Minors
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Refusal for Minors
Refusal for Minors
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Abuse/Neglect Exception
Abuse/Neglect Exception
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Informed Refusal
Informed Refusal
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Medical Direction
Medical Direction
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Study Notes
- If a person refuses care or ambulance transport, EMS should assess their decision-making capacity and document the encounter, including a signed refusal statement.
Decision-Making Capacity
- A person who is alert, oriented, understands their condition, and the risks of refusing care usually has the capacity to make medical decisions.
- This capacity requires all four criteria:
- Ability to receive and understand information needed for a decision.
- Ability to process and consider a decision and its consequences.
- Ability to make a consistent decision.
- Ability to justify the decision logically within their personal value system.
- The person's judgment should not be impaired by illness, injury, or intoxication.
- GCS score must be normal (15).
- Those with suicidal intent or a court order for psychiatric care cannot refuse transport.
- If the patient is in a healthcare facility and refuses transport, refer to the Healthcare Facilities guideline.
- All patients who request transport to the hospital will be transported.
Additional Information
- EMS providers should avoid danger to themselves.
- Obtain a complete set of vital signs.
- Perform an initial assessment, focusing on neurologic and mental status.
- Provide appropriate medical care with the person's consent.
- Ideally, a minor should have a parent or guardian to consent to treatment.
- EMS can provide emergency treatment if a parent is unavailable.
- A parent or guardian must refuse care on behalf of a minor.
- Parents cannot refuse care if abuse or neglect is suspected; notify law enforcement to help transport to the hospital.
- Emancipated minors need to show a state-issued emancipation ID.
- People must be informed of the risks of refusing medical care.
- Assess the patient’s understanding of the medical emergency: the possible medical problems, the proposed medical care, the benefits of medical care and risks of refusal.
- Contact online medical direction for patients with concerning presentation/evaluation who refuse treatment and/or transport.
- Online medical direction can be contacted at any time.
- A third party may help the patient with decision-making, if appropriate.
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