REFUSAL OF SERVICE

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Questions and Answers

What should be assessed first during a patient examination?

Past medical history and present illness

Patient's vital signs

Medic alert jewelry or tags (correct)

Patient's grooming and hygiene

Which of the following factors should be considered as risk factors for patient vulnerability?

Age and functional impairment (correct)

High socioeconomic status

Employment status

Healthcare access

What immediate information should be gathered if a change in mentation is observed?

Family medical history

Time of the last meal

Previous hospital admissions

Duration of the change and interventions provided (correct)

During a physical exam, which finding should be specifically assessed related to respiratory function?

Capnography waveform Signup and view all the answers

Which aspect is important in assessing patient decisional capacity?

Patient's cognitive impairment Signup and view all the answers

What should be considered if physical exam findings are deemed grossly abnormal?

They may require aggressive treatment Signup and view all the answers

Which part of the physical exam assesses the likelihood of a stroke?

Visual deficits and motor/sensory reflexes Signup and view all the answers

What type of screens should be considered during a mental health assessment?

qSOFA and stroke screens Signup and view all the answers

What should be done if a patient exhibits agitated delirium and refuses cooperation?

Refer to Psych/Behavioral Health Emergencies SOP Signup and view all the answers

Who must consent to medical treatment for a minor in Illinois?

A parent or guardian Signup and view all the answers

What factors are considered when a guardian requests transport to a facility other than the nearest one?

Patient’s medical stability and location of primary care practitioner Signup and view all the answers

What is the status of an emancipated minor regarding medical consent?

They have the same rights and responsibilities as an adult Signup and view all the answers

What should EMS personnel first determine when called to assist a minor?

The severity of the patient's health problem Signup and view all the answers

Which of the following is NOT a consideration for OLMC when approving transport requests?

The age of the patient Signup and view all the answers

What should EMS personnel institute as needed before determining legal consent status for a minor?

Provide appropriate emergency resuscitative care Signup and view all the answers

What policy does a guardian's request to transport a patient to another facility fall under?

Consent/Dissent to Care Policy Signup and view all the answers

What is required for an adult with legal and decisional capacity who refuses assessment, care, and/or transportation?

Disclosure of risk Signup and view all the answers

Which personnel are sufficient for processing a refusal of service for adults or minors receiving BLS care?

An EMT Signup and view all the answers

What aspect of insight is assessed in a patient regarding their situation?

Understanding relevant information Signup and view all the answers

When a refusal of care is contested by EMS, what is the documentation requirement?

It must be documented as AGAINST MEDICAL ADVICE Signup and view all the answers

What level of staffing is required to process an ALS care refusal?

At least one Paramedic or PHRN Signup and view all the answers

What must EMS personnel do when encountering a patient who refuses care?

Attempt to convince the patient to receive needed care Signup and view all the answers

Which of the following is NOT assessed when determining a patient's insight?

Past medical treatment history Signup and view all the answers

What documentation is needed for a refusal of care when two EMS practitioners witnessed the risk disclosure?

The refusal form signed by the witnesses Signup and view all the answers

What does a refusal of care from the EMS System imply about potential consequences?

It may lead to worsening of the condition or even death. Signup and view all the answers

Who is released from liability when an individual or their guardian refuses care?

The EMS System and its associated personnel. Signup and view all the answers

What does the document state about the evaluation provided by EMS personnel?

It is not a substitute for medical evaluation by a doctor. Signup and view all the answers

What must an individual demonstrate to refuse care according to the document?

Capability of making a rational decision on their own behalf. Signup and view all the answers

What is a potential consequence mentioned for refusing transportation?

Suffering from a loss of function. Signup and view all the answers

What does the phrase 'hold them completely harmless' imply about the responsibility of the EMS System?

The EMS System is fully relieved from any claims or liability. Signup and view all the answers

What is the effective date of the policy regarding consent/dissent to care?

September 14, 2023 Signup and view all the answers

What does the policy imply about the relationship between EMS evaluations and treatment by a private practitioner?

Further care may be advised by EMS if necessary. Signup and view all the answers

What is required for documenting a patient's refusal of care and/or transportation?

The patient's signature on a Release of Liability form Signup and view all the answers

If a patient refuses to sign the paper Release form, what must be done?

Check the 'Refusal to Sign a Release Statement' and have it witnessed Signup and view all the answers

How must electronic signatures be documented if a patient refuses to sign?

Using a timestamp and a specific signature reason Signup and view all the answers

What is required in addition to the patient's signature on the Release form?

At least two witness signatures Signup and view all the answers

Which personnel is responsible for obtaining the patient's signature?

The EMS provider who provided disclosure of risk Signup and view all the answers

What should be done with call information for all refusals?

It must be posted in the EMS software as soon as possible Signup and view all the answers

Who can be a second witness for a patient's refusal?

Another crew member or a police officer Signup and view all the answers

What must EMS personnel do when a patient refuses electronic signing?

Select 'Patient Unable or Refused to Sign' in the signature panel Signup and view all the answers

Study Notes

Patient Assessment and Evaluation

Inspect for medical alert jewelry, body art, odors on breath, poor grooming, skin edema, discoloration, lesions, or rashes to identify potential health issues.
Evaluate patient’s vulnerability factors: age (young/old), dementia, functional impairment, malnutrition, and substance use disorders.
Gather comprehensive medical history, including the nature and duration of changes in the patient's condition. Focus on signs and symptoms (S&S) surrounding events of altered mentation.

Physical Examination

Conduct physical assessments: glucose level, SpO2, ETCO2 values & waveform, ECG if necessary, and test pupils, eye movements, and sensory/motor responses.
Look for signs of pain through facial expressions, body movements, muscle tension, or vocalizations.
Perform stroke, suicide, and qSOFA screenings as indicated.

Decisional Capacity Assessment

Evaluate memory (immediate, recent, remote), insight, and the patient’s ability to understand their situation and consequences of decisions.
Determine if patients can articulate safe alternatives to recommended care.

Emergency Medical Services (EMS) Response

EMS has an obligation to persuade patients for necessary assessment and care, especially if they display agitated delirium or combative behavior.
Document refusals of care as “Against Medical Advice” if contested, requiring dual witness signatures—one must be an ALS provider.

Adults with decisional capacity who refuse care must be informed of the risks involved.
Minors require parental consent unless they are emancipated; EMS must assess health issues first under Emergency Doctrine and Implied Consent.

Liability Release

Patients or guardians must acknowledge and release the EMS system from liability when refusing care, understanding they could suffer adverse health effects.

Documentation Requirements

Ensure that patients sign the Release of Liability form; electronic forms must be time-stamped.
In case of refusal to sign, complete “Refusal to Sign a Release Statement” requiring two witnesses.
Document all refusals in EMS software within two hours post-incident, ensuring all details are captured accurately.

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Description

This quiz covers essential techniques for assessing patient health, focusing on various physical indicators such as hygiene, odors, and skin conditions. It also addresses the evaluation of patient vulnerability based on age, cognitive impairments, and past medical history. Prepare to enhance your skills in comprehensive patient evaluation.