Protocol 02 Consent/Refusal of Care 07/31/2020
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Questions and Answers

What is the primary condition in which a patient may be considered incompetent to refuse medical care?

  • Refusal of treatment by family members
  • Age under 21 years
  • Having an advocate present
  • Altered mental status (GCS < 15) (correct)
  • Which of the following groups is explicitly stated as being able to refuse medical care?

  • Individuals with a legal guardian present
  • Married minors
  • Mentally competent adults (correct)
  • All individuals over 25 years of age
  • Under what condition might Implied Consent be invoked?

  • When the medical personnel are unfamiliar with the patient
  • When no adult consent can be obtained for a minor (correct)
  • When the patient is conscious and coherent
  • When the total refusal of care is voiced by family members
  • What is one reason a patient under 18 may be treated without consent?

    <p>They are an emancipated minor</p> Signup and view all the answers

    Which circumstance does NOT qualify a patient for treatment under Implied Consent?

    <p>Having altered mental status revisited by a psychologist</p> Signup and view all the answers

    What documentation is essential in supporting the decision to treat a patient under certain circumstances?

    <p>Detailed ePCR entries</p> Signup and view all the answers

    Which of the following does NOT represent a reason a patient might be deemed incompetent to refuse care?

    <p>Failure to meet financial obligations</p> Signup and view all the answers

    When is it appropriate to restrain a patient during treatment?

    <p>When they exhibit violent behavior towards staff</p> Signup and view all the answers

    Under which circumstances may Fire Rescue personnel take action without informed consent?

    <p>The patient is intoxicated and has a life-threatening condition.</p> Signup and view all the answers

    What documented score is required for a patient to refuse treatment or transport?

    <p>GCS of 15</p> Signup and view all the answers

    Who is authorized to impose the Baker Act?

    <p>A sworn law enforcement officer</p> Signup and view all the answers

    In the context of patient refusal, what is a necessary action if a patient cannot sign their release?

    <p>Obtain a witness signature and document it.</p> Signup and view all the answers

    Which of the following resources can Fire Rescue personnel consult when facing difficult patient refusal situations?

    <p>On-duty EMS Field Supervisor</p> Signup and view all the answers

    What information must be documented on the ePCR after utilizing the Baker Act?

    <p>Name and agency of the person imposing the Baker Act</p> Signup and view all the answers

    If a patient who has consumed alcohol refuses treatment, what must Fire Rescue personnel assess?

    <p>The patient's ability to make an informed decision</p> Signup and view all the answers

    In cases of multiple patients refusing care due to an accident, what is the exception regarding ePCR documentation?

    <p>All patients can be listed in one ePCR without individual releases.</p> Signup and view all the answers

    What must Fire Rescue personnel do if an ALS patient refuses to be transported to the closest facility?

    <p>Transport them to their facility of choice if requirements are met.</p> Signup and view all the answers

    What condition must be met in order to consider that the patient meets the criteria for the Baker Act?

    <p>The patient must have a history of mental illness or harm risk.</p> Signup and view all the answers

    What is essential for Fire Rescue personnel to communicate to a patient refusing care?

    <p>The potential consequences of refusing treatment.</p> Signup and view all the answers

    What must be included when documenting a patient's refusal in the narrative section of the ePCR?

    <p>The cause of the patient's refusal.</p> Signup and view all the answers

    Which command prioritizes the stabilization of a patient's condition?

    <p>Examination, treatment, and transportation must alleviate or stabilize condition.</p> Signup and view all the answers

    What is the appropriate course of action for a family member wishing to refuse treatment for an adult patient?

    <p>Family members cannot refuse treatment for adult patients.</p> Signup and view all the answers

    Study Notes

    • Competent adults can refuse medical care, treatment, and transportation; consent is essential.
    • Consent may be implied through 911 requests, but verbal consent should always be verified if uncertain.
    • Conditions for refusal include being mentally competent and an adult (18+), with exceptions for certain minor statuses (emancipated, self-sufficient, married, military).

    Incompetence to Refuse Care

    • Incompetence to refuse care may arise from severe conditions, including:
      • Altered mental status (e.g., GCS < 15).
      • Suicide threats or attempts.
      • Severely abnormal vital signs.
      • Mental impairments.
      • Underage status (unless qualifying under exceptions).
    • Patients found unconscious presumed to consent to care; reasonable person standard applies.
    • Inability to obtain adult consent for minors allows for implied consent.
    • Reasonable measures, including restraint, may be employed if necessary.

    Incapacitated Persons Law

    • Allowed to treat without informed consent if:
      • Patient is incapacitated (intoxicated, drug-influenced).
      • Experiencing an emergency medical situation.
      • Treatment would be reasonable if the patient could consent.
    • Documentation of rationale is necessary.

    Baker Act Criteria

    • Imposed if:
      • A person is believed to be mentally ill and cannot determine necessary care.
      • Likely to suffer neglect or harm, or may harm self/others.
    • Only authorized by a judge, sworn law enforcement officer, physician, psychologist, or psychiatric nurse.

    Patient Refusal Protocol

    • Inform patients of potential consequences when refusing treatment.
    • Document that refusing individuals have a GCS of 15.
    • Assess decision-making capabilities if under the influence of substances.
    • Encourage family involvement to persuade patients to accept care.
    • E-PCR documentation is crucial; if a patient refuses to sign, a witness signature is required.
    • For multiple refusals in accidents, each patient requires a separate ePCR unless specific conditions apply.

    ALS Patient Transport Protocols

    • Patients refusing transport to the nearest facility must be assessed under the Incapacitated Person Law.
    • If compliant, explain seriousness and transport them to the nearest facility; if not compliant, respect their choice and ensure a signature on the refusal.
    • Family members cannot refuse treatment for adult patients, except in specific circumstances (e.g., valid DNR orders).

    Medical Support Resources

    • Difficulty in managing refusal cases may warrant consultation with:
      • On-duty EMS Field Supervisor.
      • Medical Control Physician (MCP) of the closest facility.
      • Medical Director or Assistant Medical Director via FAO for guidance.

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    Description

    This quiz covers the essential principles of medical consent and the rights of mentally competent adults regarding medical care. It outlines the importance of obtaining consent before treatment and the implications of requesting emergency services. Understanding these concepts is vital for healthcare professionals.

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