Chapter 4 Medical, Legal, and Ethical Issues
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Questions and Answers

What are the three aspects of orientation being assessed in a patient?

  • Location, date, immediate needs
  • Date, time of day, consent
  • Name, age, medical history
  • Name, location, time of day (correct)

    • In which situation can a minor typically give consent without parental approval?

  • For vaccinations
  • For treatment related to substance abuse (correct)
  • For non-emergency medical treatments
  • For routine check-ups

    • Under what circumstances may a patient be involuntarily transported?

  • If they request to go to the hospital
  • If they pose a threat to themselves or others (correct)
  • If they are a minor without parental consent
  • If they are unable to provide medical history

    • What is the appropriate position for a restrained patient being placed on a gurney?

    <p>Face up in semi-Fowler's position</p> Signup and view all the answers

    How often should distal functions be checked for a restrained patient?

    <p>Every 15 minutes</p> Signup and view all the answers

    What must a patient demonstrate to legally refuse care and transport?

    <p>They must be able to give their consent.</p> Signup and view all the answers

    Which condition describes difficulty in forming words and speaking?

    <p>Dysarthria</p> Signup and view all the answers

    In a situation where a patient refuses care, what is the most appropriate action for the EMT to take?

    <p>Document the refusal and any relevant details.</p> Signup and view all the answers

    What can impact a patient's decision to refuse transport to the hospital?

    <p>The presence of family and friends.</p> Signup and view all the answers

    Which of the following is a serious consequence of a patient refusing care and transport?

    <p>Potential for worsened health outcomes.</p> Signup and view all the answers

    What should be obtained from witnesses when a patient refuses care?

    <p>Their first and last names and signatures.</p> Signup and view all the answers

    What legal term describes the situation if a patient is forced into an ambulance against their will?

    <p>Assault or battery.</p> Signup and view all the answers

    What primarily establishes the boundaries of an EMT's job responsibilities?

    <p>National Standard curriculum and state regulations</p> Signup and view all the answers

    Which of the following best describes the term 'standard of care' as it pertains to EMTs?

    <p>The general expectations of care by an EMT with similar training</p> Signup and view all the answers

    What is implied consent in the context of emergency medical treatment?

    <p>Consent when a patient is unresponsive or altered mentally</p> Signup and view all the answers

    Which entity typically does NOT set regulations that define the scope of practice for EMTs?

    <p>Private insurance companies</p> Signup and view all the answers

    Which statement about the relationship between the National Standard curriculum and state regulations is true?

    <p>State regulations may match or be more restrictive than the National Standard curriculum.</p> Signup and view all the answers

    What document confirms a patient's decision not to be resuscitated?

    <p>Final attestation form</p> Signup and view all the answers

    Which of the following is NOT a component required to prove a claim of negligence against an EMT?

    <p>The EMT was off duty during the incident</p> Signup and view all the answers

    What is the primary responsibility of an EMT upon being dispatched to a call?

    <p>To provide care to the patient</p> Signup and view all the answers

    What is 'duty to act' in the context of EMTs?

    <p>The obligation to provide care to a patient</p> Signup and view all the answers

    What typically happens if an EMT is found negligent in their duties?

    <p>They may lose their license</p> Signup and view all the answers

    Who can serve as a witness for a patient refusing care, if no family or friends are available?

    <p>Law enforcement</p> Signup and view all the answers

    What is a primary consideration when documenting a patient refusal?

    <p>Thoroughly fill out all details in the patient care report</p> Signup and view all the answers

    What does a Do Not Resuscitate (DNR) order permit healthcare providers to do?

    <p>Avoid performing CPR while maintaining airway and comfort</p> Signup and view all the answers

    When is it recommended to start resuscitation despite the presence of a DNR?

    <p>If there are doubts about the patient's decision</p> Signup and view all the answers

    What should be done if the patient refuses to sign the patient refusal form?

    <p>Document the refusal to sign clearly</p> Signup and view all the answers

    What type of order is a POLST?

    <p>Physician Order for Life-Sustaining Treatment</p> Signup and view all the answers

    What must healthcare providers ensure when encountering patients with a DNR in a clinical setting?

    <p>Maintain compliance with the DNR and document appropriately</p> Signup and view all the answers

    What is the primary function of an Advanced Health Care Directive?

    <p>To outline the patient's desires when they cannot speak for themselves</p> Signup and view all the answers

    What action is advised if a patient is left in a dangerous location after refusal of care?

    <p>Assist them in moving to a safer place</p> Signup and view all the answers

    In case of an incapacitance and no DNR, what should a healthcare provider do?

    <p>Initiate resuscitation immediately</p> Signup and view all the answers

    The National Standard curriculum provides the most specific regulations for EMTs, which must be followed without exception.

    <p>False</p> Signup and view all the answers

    Implied consent is applicable when a patient is conscious and responsive.

    <p>False</p> Signup and view all the answers

    State regulations for EMTs typically do not exceed the guidelines established in the National Standard curriculum.

    <p>True</p> Signup and view all the answers

    The standard of care refers to the minimum level of care that should be provided by EMTs in a given situation.

    <p>False</p> Signup and view all the answers

    For consent to be valid, patients must always be fully aware of their medical situation and treatment options.

    <p>False</p> Signup and view all the answers

    A patient must be legally able to consent, alert, and fully informed in order to refuse care and transport.

    <p>True</p> Signup and view all the answers

    If a patient refuses care, there is no requirement for any documentation to be completed.

    <p>False</p> Signup and view all the answers

    A patient exhibiting signs of neurological deficits should be treated under the concept of implied consent.

    <p>True</p> Signup and view all the answers

    An EMT can be accused of negligence if they fail to provide care or deliver care below the standard of care.

    <p>True</p> Signup and view all the answers

    Providing unwanted care and transport can be legally viewed as assault or battery.

    <p>True</p> Signup and view all the answers

    An EMT is obligated to provide care even when they are off duty.

    <p>False</p> Signup and view all the answers

    The final attestation form confirms a patient's choice regarding resuscitation.

    <p>True</p> Signup and view all the answers

    In many cases, it is acceptable for a patient to refuse ambulance transport if they agree to go to the hospital via a private vehicle.

    <p>True</p> Signup and view all the answers

    Proximate causation is not necessary to prove negligence in an EMT case.

    <p>False</p> Signup and view all the answers

    Even after persuading a patient to accept care, EMTs cannot be held liable in a refusal of care situation.

    <p>False</p> Signup and view all the answers

    If an EMT enters a situation and begins providing care, they must see it through until someone of equal or higher training takes over.

    <p>True</p> Signup and view all the answers

    Family members can be influential in persuading a patient to accept medical transport.

    <p>True</p> Signup and view all the answers

    Children and mentally incompetent adults typically cannot give consent for treatment.

    <p>True</p> Signup and view all the answers

    A 5150 hold allows a patient to voluntarily choose to receive mental health care.

    <p>False</p> Signup and view all the answers

    An emancipated minor can give consent for medical treatment without parental permission.

    <p>True</p> Signup and view all the answers

    Patients in restraints should be placed on the gurney face down to ensure stability.

    <p>False</p> Signup and view all the answers

    A patient can refuse emergency care even if they are under 18 years old.

    <p>False</p> Signup and view all the answers

    It is recommended to leave a patient in a dangerous location after they refuse care.

    <p>False</p> Signup and view all the answers

    A patient can refuse to sign the patient refusal form.

    <p>True</p> Signup and view all the answers

    Healthcare providers can administer chest compressions if there is a DNR present.

    <p>False</p> Signup and view all the answers

    In the absence of family or friends, law enforcement can serve as a witness for patient refusal.

    <p>True</p> Signup and view all the answers

    All patients must have an Advanced Health Care Directive to make end-of-life decisions.

    <p>False</p> Signup and view all the answers

    If there is doubt about a resuscitation decision, healthcare providers should always begin resuscitation.

    <p>True</p> Signup and view all the answers

    Patients with a DNR may still want certain medical interventions to be performed.

    <p>True</p> Signup and view all the answers

    Documentation of a patient care report should include detailed assessments and actions taken.

    <p>True</p> Signup and view all the answers

    A POLST form allows patients to outline their wishes for life-sustaining treatment.

    <p>True</p> Signup and view all the answers

    The Advanced Health Care Directive can indicate if a patient wants to be resuscitated.

    <p>True</p> Signup and view all the answers

    Study Notes

    Scope of Practice

    • EMT scope of practice is defined by national, state, county, and agency policies.
    • National Standard curriculum, set by the Department of Transportation and the National Highway Traffic Safety Administration, outlines the broadest scope.
    • State regulations typically match or are more restrictive than national standards.
    • County regulations or protocols usually don't exceed state regulations.
    • Agency policies and regulations are the most specific, adhering to county regulations.
    • California Code of Regulations (CCR), Title 22, Division 9, defines scope for EMTs and paramedics in California.
    • Scope of practice focuses on what EMTs can do.

    Standard of Care

    • Standard of care defines expected patient treatment, incorporating scope of practice.
    • Standard of care includes using available resources for optimal patient care.
    • Local protocols, state and county regulations, and organizations' guidelines (e.g., American Heart Association) influence standard of care.
    • Standard of care dictates how EMTs should treat patients, based on best practices.
    • Patient consent is required for assessment, treatment, and transport.
    • Consent typically involves a verbal "yes", or implied consent for unresponsive/altered patients.
    • Implied consent applies if a patient doesn't respond or provides garbled, meaningless responses. Assess patient orientation (person, place, time). Do not ask about the president.
    • Minors and mentally incompetent adults require consent from parents, guardians, or legal caretakers.
    • Assess mental competency to ensure a patient can comprehend proposed actions.
    • Life-threatening situations allow immediate care.
    • Emancipated minors, minors with dependents or in military service, self-sufficient minors (15+ years, living apart with financial independence) can consent.
    • Minors can consent for pregnancy-related care, sexual assault care, abortion (if not married), communicable disease treatment, and mental health issues.
    • Legally able, alert, oriented, and informed patients can refuse care or transport.

    Involuntary Transport

    • Patients considered a danger to self or others can be transported involuntarily.
    • Involuntary transport often involves court orders, or mental health professionals/law enforcement involvement.
    • A 5150 hold (72-hour evaluation at mental health facility) often leads to involuntary transport.
    • Patient safety during transport requires restraints, ensuring face-up position and 15-minute checks of distal functions.

    Patient Refusal

    • Patient refusal involves signing an "against medical advice" (AMA) form.
    • Thorough documentation is crucial, including "patient refused to sign" if applicable.
    • Witnesses (e.g., family member, law enforcement) are necessary for patient refusal.
    • EMTs should persuade patients to accept care.
    • Inform patients about consequences of refusal, avoiding pressure.
    • Options exist for refusing transport (e.g., using personal vehicle to arrive at hospital).
    • Incomplete documentation can lead to legal challenges.

    Advanced Directives

    • Advanced directives include DNR (do not resuscitate), POLST (physician orders for life-sustaining treatment), and AHCD (advanced healthcare directives).
    • DNR/POLST/AHCD documents patient wishes for resuscitation in different medical situations.
    • Follow guidelines for actions (CPR, meds, etc.) when a patient has a DNR/POLST/AHCD.
    • In doubt, resuscitate unless a clearly documented DNR exists. Private and interfacility transport calls without a DNR mandate CPR.
    • Different styles of advanced directives exist, but all indicate treatment preferences.

    LA County Policies

    • Specific LA County policies govern transport refusals for infants and children.
    • Infants require base-station approval for transport refusal.
    • Children (13-36 months) require base-station authorization for transport refusal.

    Negligence

    • EMTs can be held liable for negligence in failing to meet the scope of practice or standard of care.
    • Negligence elements include duty to act, breach of duty (action or inaction), proximate causation, and patient harm.
    • Negligent acts may lead to financial compensation or license revocation.
    • Examples of negligence include inadequate equipment or care when necessary.

    Duty to Act

    • EMTs generally have a duty to act when on duty and dispatched to a call.
    • Off-duty EMTs typically do not have a duty to act.
    • Care initiated must be completed unless transferred to a suitably higher-certified level or there is official permission for abandonment.

    Good Samaritan Laws

    • Good Samaritan laws protect lay rescuers acting within training without compensation, excluding professional rescuers.
    • Gross negligence or violations of the law provide no protection under Good Samaritan laws.

    Confidentiality

    • HIPAA governs confidential patient information, limiting sharing to those in the continuum of care.
    • A court order or subpoena is required for sharing information to non-care providers.

    Special Situations

    • Medical alert tags/tattoos indicate conditions like heart problems or allergies.
    • Organ donor status is indicated by legal documents (e.g., driver's license).
    • Safe haven laws permit leaving infants/children at authorized locations for safety and protection; state/regional rules vary.
    • Crime scenes must involve law enforcement first, with responders obligated to preserve evidence. Preservation of evidence takes precedence during patient care.

    Mandatory Reporting

    • EMTs are required to report certain incidents (child/elder abuse, human trafficking, violence).
    • Mandatory reporting guidelines vary based on state/county regulations. Comprehensive documentation facilitates reporting.

    Ethical Responsibilities

    • EMTs are expected to be honest, respectful, fair, avoid harm, and report misconduct, keeping personal opinions separate.
    • Patient care prioritizes the patient's needs in the present moment; background or past actions are non-judgmental considerations.

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    Description

    This quiz tests your knowledge on the scope of practice for EMTs and the standard of care required in patient treatment. It covers national standards, state regulations, and local protocols that influence the expected practices for emergency medical technicians. Ensure you are familiar with the guidelines to provide optimal patient care.

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