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 (D)</p> Signup and view all the answers

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

    <p>Every 15 minutes (C)</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. (C)</p> Signup and view all the answers

    Which condition describes difficulty in forming words and speaking?

    <p>Dysarthria (D)</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. (C)</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. (D)</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. (D)</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. (A)</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. (D)</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 (A)</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 (C)</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 (D)</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 (B)</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. (A)</p> Signup and view all the answers

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

    <p>Final attestation form (C)</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 (C)</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 (D)</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 (A)</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 (C)</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 (D)</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 (A)</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 (D)</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 (C)</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 (B)</p> Signup and view all the answers

    What type of order is a POLST?

    <p>Physician Order for Life-Sustaining Treatment (C)</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 (C)</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 (B)</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 (D)</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 (C)</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 (B)</p> Signup and view all the answers

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

    <p>False (B)</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 (A)</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 (B)</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 (B)</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 (A)</p> Signup and view all the answers

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

    <p>False (B)</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 (A)</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 (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

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

    <p>True (A)</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 (A)</p> Signup and view all the answers

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

    <p>False (B)</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 (B)</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 (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

    A patient can refuse to sign the patient refusal form.

    <p>True (A)</p> Signup and view all the answers

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

    <p>False (B)</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 (A)</p> Signup and view all the answers

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

    <p>False (B)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

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

    <p>True (A)</p> Signup and view all the answers

    Flashcards

    Scope of Practice

    A set of guidelines and legal regulations that define the actions an EMT can perform while providing medical care.

    Standard of Care

    Standards of care refer to what actions are expected of an EMT with similar training in a similar situation. It ensures patients receive the best possible care.

    Consent

    Verbal or non-verbal agreement from a patient to receive medical treatment, assessment, and transport.

    Implied Consent

    If a patient is unconscious or unable to make decisions due to altered mental state, we can assume consent to provide care.

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    Alert and Oriented

    A state of awareness where a person knows who they are, where they are, and what time it is. They can respond to questions and engage in conversation.

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    Orientation

    The ability of a person to understand and respond to questions about their identity, location, and the current time. This assesses their mental state and level of consciousness.

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    Emancipated Minor

    A legal status granted to a minor who has been deemed capable of making their own decisions and taking care of themselves. This often involves specific legal processes and documentation.

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    5150 Hold

    A legal hold that restricts a person's freedom for a limited period, typically 72 hours, to undergo mental health evaluation. It's used when a person is considered dangerous to themselves or others.

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    Refusal of Care Form (AMA Form)

    A legal document signed by the patient refusing medical care and transportation, acknowledging they understand the potential risks of their decision. It's our documentation of their refusal, proving we met all necessary steps.

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    Neurological Deficits

    Indicators of neurological issues, like slurred speech, difficulty walking, or facial drooping. These situations require immediate care and potentially override the patient's refusal.

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    Wrongful Imprisonment

    A legal term for when a patient is restrained or kept against their will. This applies if we transport them despite their refusal, and it's a very serious offense.

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    Persuading Patient Refusal

    The process of attempting to convince a patient to accept care and transport, even after they initially refuse. It involves clear communication, compassionate listening, and understanding their reasons.

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    Online Medical Direction (Contacting Medical Control)

    A process of contacting medical control (doctors) over the radio or phone for guidance on how to handle a patient refusal. They might talk to the patient or offer advice on how to proceed.

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    Further Care

    The final goal in a refusal situation, ensuring the patient receives necessary medical attention, whether by ambulance or a personal vehicle.

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    Negligence

    A legal term that describes actions that should have been done but were not, or were done incorrectly. It can apply to EMTs not fulfilling their duties or providing substandard care.

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    Duty to Act

    A legal concept that implies responsibility to provide assistance or care to a patient based on your professional role as an EMT. This obligation exists while on duty.

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    Res Ipsa Loquitur (the thing speaks for itself)

    A legal term describing a situation where a patient's injuries are so obviously caused by negligence that it is clear the EMT acted improperly.

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    Torts

    A legal claim filed against an EMT for their negligence, often seeking financial compensation for damages.

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    Final Attestation

    A form intended to confirm a patient's decision to decline resuscitation in the event of a medical emergency. It ensures their wishes are documented and respected.

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    Patient Refusal

    When a patient refuses medical care, you must ensure they understand the risks and potential consequences. This is documented on a patient refusal form.

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    Witness to Refusal

    A witness is essential when a patient refuses treatment. It could be a family member, friend, or even law enforcement. Avoid using your partner if possible.

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    Documenting Refusal

    If a patient refuses care, document everything thoroughly in your patient care report, including the assessments you performed.

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    Advance Directive

    A legal document that allows individuals to express their wishes regarding medical treatment in case they become unable to make those decisions.

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    Do Not Resuscitate (DNR)

    A type of Advance Directive that clearly states a patient's wishes to not receive cardiopulmonary resuscitation (CPR) if they stop breathing or their heart stops.

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    Physician Orders for Life-Sustaining Treatment (POLST)

    A medical order that outlines the level of life-sustaining treatment a patient wishes to receive in case they become incapacitated, such as artificial ventilation or feeding.

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    DNR/POLST Form

    A form that provides clear instructions on what actions to take or avoid during a medical emergency, based on a patient's Advanced Directive.

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    When in Doubt, Resuscitate

    When in doubt about whether to initiate resuscitation procedures, always err on the side of performing CPR as irreversible brain damage can occur within minutes of circulation stopping.

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    Home DNR Response

    If you encounter a patient without a pulse and not breathing at home, begin CPR unless they have a DNR. Then, call 911 for assistance with death determination.

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    Aid in Dying (Aid-in-Dying)

    A legal process that allows a terminally ill patient to receive medication that helps end their life on their own terms.

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    Refusal of Care

    The legal process where a patient, meeting specific criteria, refuses medical care and transport. This must be documented with a signed "Refusal of Care" or "Against Medical Advice" (AMA) form.

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    Online Medical Direction

    Contacting medical control (doctors) for advice on how to handle a patient refusal. They may provide guidance, speak to the patient directly, or offer alternative options.

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    Unwanted Patient Care and Transport

    The potential legal consequences of providing unwanted care and transport, including wrongful imprisonment, abduction, and even kidnapping. This emphasizes the importance of obtaining consent before any action.

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    Refusal Form (AMA Form)

    The legal document signed by a patient who's refusing care, confirming they understand the risks of their decision and acknowledging the EMT's attempts to persuade them. This helps protect the EMT legally.

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    Res Ipsa Loquitur

    The legal principle that the injury itself clearly indicates negligence, like a broken bone from a dropped object.

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    Civil Lawsuit or Tort

    A legal concept where the EMT is sued for their actions or inaction leading to patient harm.

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    DNR (Do Not Resuscitate)

    A final document signed by the patient refusing any life-saving treatments, like CPR, if their heart stops.

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    Patient Refusal Form

    A legal document signed by a patient refusing medical care and transportation. It acknowledges they understand the potential risks of their decision.

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    Aid in Dying

    When a patient requests a medication to end their life on their own terms, it's a legal process that requires specific conditions and adherence to local regulations.

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    LA County EMS Policy 815

    LA County EMS policy 815 outlines the steps for responding to patients requesting 'aid in dying' medications. Conscious patients trigger different protocols than unconscious patients.

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    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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