Patient Refusal of Care Protocol

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Questions and Answers

Which condition is NOT required for a diabetic patient to sign a Patient Refusal Form?

The patient must have blood glucose levels returned to acceptable levels.

The patient must have a valid driver's license. (correct)

The patient must have immediate access to food.

The patient must be lucid and understand the risks of refusal.

In which scenario should paramedics contact Medical Direction immediately regarding refusal of care?

When a minor's refusal is in question based on paramedic judgment. (correct)

When multiple patients refuse care on the same report.

When an adult patient refuses transport.

When a patient is lucid and refuses care.

What is the primary purpose of documenting all names and addresses during a refusal of care situation?

To provide evidence in case of legal issues. (correct)

To confirm insurance information for the patients.

To ensure that future treatment can be tracked.

To identify potential follow-up medical care.

What is the significance of the patient's mental status in the refusal of care process?

It determines whether the patient can legally refuse treatment. Signup and view all the answers

Which statement about multiple refusals on an EMS Run Report is true?

A separate report must be filled for each individual patient. Signup and view all the answers

What should paramedics prioritize when handling a patient's refusal of care?

Convincing the patient to accept treatment, possibly involving family or friends. Signup and view all the answers

Which of the following factors does NOT contribute to determining if a patient can refuse care or transport?

The patient's medical insurance status. Signup and view all the answers

What should paramedics do first when encountering a patient who refuses assistance?

Ascertain whether the patient is conscious and aware. Signup and view all the answers

What is the minimum number of transport vehicles that should be maintained in reserve?

Two transport vehicles Signup and view all the answers

Which of the following items is NOT included in the MCI Kits for Responder Vehicles?

Survival blanket Signup and view all the answers

Who is responsible for coordinating the gathering of all pertinent documentation after an incident?

The Incident Commander Signup and view all the answers

What must be completed at the end of an incident according to the procedures outlined?

A Post-Incident Analysis (PIA) Signup and view all the answers

Which type of tags should be included in the MCI Kits for disaster management?

Disaster Management Systems (DMS) triage tags Signup and view all the answers

What should not be done to the victim's body at a crime scene?

All of the above Signup and view all the answers

Which personnel can modify the dispatch assignment for an Air Rescue?

Uniformed Fire Department Officers Signup and view all the answers

In what scenario is Air Rescue response necessary?

A level 1 trauma patient with ground transport over twenty minutes Signup and view all the answers

If a patient provides information about the crime while being transported, what is the procedure?

Inform law enforcement personnel immediately Signup and view all the answers

What is a requirement for additional units during an Air Rescue assignment?

Determined by incident circumstances Signup and view all the answers

What is prohibited regarding objects at a crime scene?

Handling any object left by the victim Signup and view all the answers

Which of the following situations requires Air Rescue due to accessibility issues?

A patient in an inaccessible area by ground Signup and view all the answers

What is one scenario that does NOT necessitate Air Rescue response?

Patient is stable and requires routine care Signup and view all the answers

What is the primary purpose of a Do Not Resuscitate Order (DNRO)?

To outline exceptions under which CPR is performed. Signup and view all the answers

Which form is officially recognized as the Do Not Resuscitate Order in Florida?

The Florida DNRO Form, DH Form 1896 Signup and view all the answers

What color paper must the Do Not Resuscitate Order Form be printed on?

Yellow Signup and view all the answers

What must EMS personnel do upon the presentation of a valid DNRO?

Withhold or withdraw cardiopulmonary resuscitation. Signup and view all the answers

What feature distinguishes the patient identification device associated with a DNRO?

It is a miniature version of the DNRO form. Signup and view all the answers

What action should be taken if a DNRO from another state is presented?

Contact Medical Control for direction. Signup and view all the answers

What is a condition for the reproduction of the DNRO form?

The reproduction must be of good quality. Signup and view all the answers

Which of the following statements is true regarding DNRO identification devices?

They are intended for portability and convenience. Signup and view all the answers

What is the primary responsibility of the Transport Officer during a mass casualty incident?

Coordinate victims and maintain records Signup and view all the answers

Who assists the Transport Officer specifically with paperwork and communications?

Documentation Aide Signup and view all the answers

What should the Medical Communications Coordinator do first upon arrival at a mass casualty incident?

Establish communication with Medical Control Signup and view all the answers

What document must the Transport Officer maintain to keep track of transported victims?

Hospital Transportation Log Signup and view all the answers

When communicating with Medical Control, which of the following information is essential for the Medical Communications Coordinator to relay?

Overall situation and categories of victims Signup and view all the answers

In what instance should air-transported victims be assigned to distant hospitals?

Unless the victims’ needs dictate otherwise Signup and view all the answers

What is the role of the Documentation Aide assigned by the Transport Officer?

Help with paperwork and communications Signup and view all the answers

What should the Transport Officer communicate to the Landing Zone Officer?

The number of victims to be transported by air Signup and view all the answers

Study Notes

Refusal of Care & Transport

Patients with diabetes who receive treatment may sign a Patient Refusal Form if the following conditions are met:
- The patient is lucid and can understand the risk/benefits of refusal
- The patient has blood glucose levels that have returned to acceptable levels
- The patient has immediate access to food
- The patient otherwise meets the criteria to refuse as outlined in the protocol
When refusal of care or transport of a minor is in question, contact Medical Direction immediately
The procedure does not allow for more than one refusal on a single EMS Run Report
Individuals who refuse ALL assistance, including proper evaluation, can be combined on a single report
Once an examination is begun on an individual, a separate EMS Run Report must be filled out
Any later refusal of care requires following the complete protocol
- Document all names, addresses, and witnesses
All measures should be taken to convince the patient to consent, including enlisting the help of family or friends

Do Not Resuscitate Order

All patients found in cardiac arrest will receive cardiopulmonary resuscitation unless an exception is met as outlined in the following:
Florida Do Not Resuscitate Order (DNRO) Form is the only form approved in the State of Florida
EMS shall withhold or withdraw cardiopulmonary resuscitation upon the presentation of:
- An original or completed copy of DH Form 1896, Florida Do Not Resuscitate Order Form
- A Do Not Resuscitate Order patient identification device
The Do Not Resuscitate Order Form shall be printed on yellow paper and have the words “DO NOT RESUSCITATE ORDER” printed in black and displayed across the top of the form
The shade of yellow does not have to be an exact duplicate
The patient identification device is a miniature version of DH Form 1896
Use of the patient identification device is voluntary and is intended to provide a convenient and portable DNRO which travels with the patient

Crime Scene Determination

Do NOT go through the victim’s personal effects, clean the body, or cover the body with a sheet or other material (if expired).
Do NOT move, take, or handle any object at the scene or litter the crime scene with medical equipment, dressings, bandages, or other supplies.
If resuscitation efforts are deemed necessary, transfer the victim from the scene to the vehicle expeditiously and stabilize the victim in the vehicle, when possible.
If the patient relates any information relating to the crime while in transit to the medical facility, inform law enforcement personnel at once.

Helicopter Safety

The standard dispatch for an Air Rescue assignment should be one (1) engine company and one (1) rescue
The need for additional units should be dictated by the incident circumstances
Dispatchers should not take it upon themselves to modify this assignment
The only personnel who can modify the assignment are Uniformed Fire Department Officers
Air Rescue response may be necessary in the following circumstances:
- Level 1 trauma patient with a ground transport time of greater than twenty (20) minutes to an appropriate trauma facility
- Level 2 trauma patient with a ground transport time of greater than thirty (30) minutes to an appropriate trauma facility
- The patient is located in an area inaccessible by ground
- Extrication of a trauma patient is anticipated to exceed fifteen (15) minutes
- Severe cardiac crisis, severe pulmonary crisis, stroke, drowning, or life threatening pediatric illness with a transport time of greater than twenty (20) minutes to an appropriate medical facility
- Dive emergencies

Mass Casualty Incident

The Transport Officer reports to the Incident Commander or the Medical Branch
The Transport Officer is responsible for the coordination of victims and maintenance of records relating to victim identification, injuries, mode of transportation, and destination
- Radio designation “Transport”
- Assign a Documentation Aide with a radio to assist with paperwork and communications
- Assign a Medical Communication Coordinator to establish continuous contact with Medical Control (Medcom or MRCC)
- Establish a victim loading area
- Advise Staging of the location and direction of travel
- Consider requesting law enforcement assistance for ensuring the security of the loading area
- Arrange for the transport of victims from the treatment area
- Maintain a Hospital Transportation Log
- Keep a piece of the triage tag for future documentation
- Communicate with the Landing Zone (LZ)/Heli-spot Officer and relay the number of victims to be transported by air
The Medical Communications Coordinator reports to the Transport Officer and is responsible for maintaining communication with Medical Control to assure proper victim transport information and destination
- Radio designation “Communication”
- Establish communication with Medical Control (Medcom or MRCC1)
- Advise Medical Control of the overall situation and the number and categories of victims
- Document this information on the Hospital Capability Worksheet
- Coordinate with the Transport Officer the designation of a location for victim loading and the best route to the area
- Maintain a reserve of at least two transport vehicles
The Incident Commander will coordinate the gathering of all pertinent documentation at the completion of the incident
A Post-Incident Analysis (PIA) will be completed

MCI Kits

Each responder vehicle should carry the following MCI kit:
- One (1) pediatric face mask
- Colored ribbons (Red, Yellow, Green & Black) either rolls or ribbons
- Trauma Tourniquets (2)
- Hemostatic Dressing (2)
- Chest Decompression Needles(2)
- Chest Seals (2)
- Fifty (50) triage tags
- Pencils/grease pencils and pens
- Additional tourniquets, hemostatic dressing, chest seals & chest decompression needles (10)
- The following MCI FOGs, logs, and associated paperwork for each officer:
  - MCI Transportation Log
  - MCI Triage Tag Log
  - Hospital Capability Worksheet
  - Mass Casualty Incident Command Log
  - Haz-Mat/Special Services/Technical Rescue Log
  - Incident Command System Worksheet
  - Mass Casualty Incident Command Log
  - Incident Report—MCI

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Description

This quiz covers the essential protocols and criteria for patients, particularly those with diabetes, to refuse treatment and transport. It emphasizes the conditions that must be met for a patient to sign a refusal form, as well as the necessary documentation and procedures to follow in such cases. Understanding these guidelines is crucial for medical professionals in the field.