SOP 90-91

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Questions and Answers

According to the policy, what is the primary role of St. Johns County Fire Rescue?

To provide emergency medical treatment but not necessarily transport patients

To provide emergency medical treatment and transport for all EMS calls (correct)

To determine the best course of action based on the patient's condition

To assess the need for transport and provide treatment only if necessary

What is the relationship between the actions of EMTs and Paramedics in the field and the Fire Rescue Medical Director (MD)?

The MD has no legal responsibility for the actions of EMTs and Paramedics

The MD is solely responsible for the actions of EMTs and Paramedics

The actions of EMTs and Paramedics are considered the delegated practice of the MD (correct)

The actions of EMTs and Paramedics are independent of the MD's authority

If an EMT or Paramedic makes a decision based on poor judgment, who bears the liability?

The liability is shared between the EMT/Paramedic and the Medical Director

The EMT or Paramedic bears the liability for their own poor judgment (correct)

The Fire Rescue Medical Director bears the liability

The EMT or Paramedic bears no liability

According to the policy, what should guide the decisions made by Fire Rescue personnel regarding treatment and transport?

The directive of the Fire Rescue Medical Director, Florida Administrative Code, and Florida Statutes Signup and view all the answers

Who is ultimately responsible for decisions made by Fire Rescue, such as not treating or not transporting a patient?

The Engineer/Officers on the scene Signup and view all the answers

What is the expectation of citizens who call for emergency medical services from the Fire Rescue Department?

That the Department will help them through their crisis situation Signup and view all the answers

Informed Consent requires the patient to:

Understand the nature and risks of procedures Signup and view all the answers

What is Implied Consent for emergency treatment?

Consent inferred for unconscious patients Signup and view all the answers

What must Fire Rescue personnel ensure before a patient refuses treatment?

The risks and options are understood Signup and view all the answers

When can emergency treatment be undertaken under implied consent?

When no one is available to provide consent Signup and view all the answers

In scenarios where a minor does not require transport, who can they be released to?

Any adult capable of taking custody approved by the parent/guardian Signup and view all the answers

What does the term 'Treat/Transport' refer to?

Making a decision based on patient's best interest and following procedures Signup and view all the answers

'No Treatment' decision is usually made by:

The patient themselves Signup and view all the answers

'No Transport' decision can be made by:

'No Transport' can be decided by either the patient or provider Signup and view all the answers

'No Patient' decision is made by:

'No Patient' decisions are made solely by providers Signup and view all the answers

'Consent Refusal' implies that:

'Consent Refusal' indicates the patient cannot be treated without further steps Signup and view all the answers

What is the purpose of this policy?

To establish procedures for Do Not Resuscitate Order (DNRO) and Deceased on Arrival (DOA) responses. Signup and view all the answers

Who does this policy apply to?

Patients of all ages, including victims of SIDS. Signup and view all the answers

What is the role of EMS personnel when dealing with a dying patient?

To communicate effectively with the patient's family and handle the patient with compassion. Signup and view all the answers

What is the purpose of the Florida-Do Not Resuscitate Order (FL-DNRO) form?

To identify people who wish to be resuscitated in the event of respiratory or cardiac arrest. Signup and view all the answers

What are the requirements for a valid FL-DNRO form?

All of the above. Signup and view all the answers

What should Fire Rescue personnel do if they have any question about the validity of a completed FL-DNRO form?

Initiate life-saving techniques, including CPR, if appropriate. Signup and view all the answers

What does the presentation of a valid FL-DNRO form mean for Fire Rescue personnel?

Both A and B. Signup and view all the answers

How can a FL-DNRO form be revoked?

By the patient, the patient's health care surrogate or proxy, or a court-appointed guardian, in writing, by physical destruction, by failure to present it, or by orally expressing a contrary intent. Signup and view all the answers

What is the purpose of the Patient Identification Device mentioned in the policy?

To provide a convenient and portable version of the FL-DNRO form that travels with the patient. Signup and view all the answers

What should Fire Rescue personnel do if a patient does not have a valid FL-DNRO form or other DNRO documentation?

Initiate life-saving techniques, including CPR, if appropriate. Signup and view all the answers

What is the primary purpose of the text?

To provide guidelines for determining the appropriate destination facility for patient transport Signup and view all the answers

Which of the following is NOT a factor that can determine the destination facility?

Patient's insurance coverage Signup and view all the answers

What is the primary reason Fire Rescue may deny a patient's or physician's requested destination facility?

All of the above Signup and view all the answers

What is the primary purpose of having patients or families sign a waiver of liability when requesting transport to a stand-alone emergency department?

To ensure the patient understands the limitations of the stand-alone facility Signup and view all the answers

When is Fire Rescue permitted to transport a critical patient to a stand-alone emergency department, even if it is not the recommended destination?

When the stand-alone emergency department is the closest facility Signup and view all the answers

What is the role of law enforcement in patient transport?

Law enforcement has no authority to dictate patient destination unless the patient is in their custody Signup and view all the answers

Which of the following conditions would NOT be appropriate for transport to a stand-alone emergency department, according to the text?

Cardiac chest pain Signup and view all the answers

What is the primary responsibility of E.D. staff according to the text?

To coordinate with crews to effect the transfer of patients as quickly as possible Signup and view all the answers

What is the primary factor that Fire Rescue considers when a patient or family requests transport to a stand-alone emergency department against their recommendation?

The patient's medical condition and potential needs Signup and view all the answers

Which of the following is NOT a type of destination facility determination mentioned in the text?

Hospital administration decision Signup and view all the answers

What criteria must a DNRO document include for Fire-Rescue personnel to honor it?

A statement instructing not to resuscitate, patient's full name, physician's signature, two witnesses' signatures Signup and view all the answers

In the case of an unquestionably non-resuscitatable medical patient, what confirmed condition is necessary in 2 leads to waive the need for asystole confirmation?

Lividity, decay/decomposition, or rigor mortis Signup and view all the answers

Under what circumstances may a traumatic cardiac arrest patient be presumed deceased without initiating resuscitation?

Severed trunk or decapitation Signup and view all the answers

What action should be taken if a patient is pronounced DOA and not under Hospice care with no valid DNRO form?

Left where they were found for investigation by law enforcement Signup and view all the answers

In what scenario will resuscitative efforts be continued in the transport unit and transport initiated to the chosen destination?

If the patient has been removed from the scene for resuscitative efforts Signup and view all the answers

Why might some healthcare providers call 911 even when dealing with patients enrolled in hospice care?

To protect themselves from liability Signup and view all the answers

What should personnel do after determining a DOA at the scene if no signs of trauma or foul play are present?

Consult with the patient's family Signup and view all the answers

According to the policy, when resuscitation efforts are stopped, what should personnel NOT do?

Remove any disposable medical equipment/materials from the victim's body Signup and view all the answers

What is one of the primary reasons for the policy regarding death with dignity?

To respect the patient's family Signup and view all the answers

If resuscitation efforts are stopped, and the patient has been removed from the scene to a transport unit, what should personnel do?

Continue resuscitation efforts in the transport unit and transport to the closest emergency department Signup and view all the answers

When a death has occurred, what responsibility do Fire Rescue personnel have towards the patient's family?

They should provide a calm and tactfully compassionate explanation of why certain actions are or are not being taken Signup and view all the answers

In the event of unquestionable death criteria, what should personnel NOT do to the victim?

Remove any disposable medical equipment from the victim's body Signup and view all the answers

Which of the following statements is NOT supported by the policy?

Law enforcement officers should be prioritized over the family's concerns Signup and view all the answers

What is considered 'treatment' in the context of EMS calls?

Patient assessment Signup and view all the answers

In which scenario can Fire Rescue make a decision that no transport is required without it being documented as patient refusal?

After thoroughly evaluating the patient and reasons for the call Signup and view all the answers

What action is necessary if a patient refuses all care or definitive treatment by Fire Rescue?

Completing a Patient Refusal Form Signup and view all the answers

Under what conditions can a patient make the decision not to be transported?

When they are fully informed of Fire Rescue assessment findings Signup and view all the answers

When does a 'no transport' decision require a Patient Refusal Form to be completed?

When Fire Rescue determines no transport is needed Signup and view all the answers

What must be documented when a decision is made not to transport a patient?

Full patient assessment with vital signs Signup and view all the answers

Under what conditions can a 'no patient' disposition occur?

At a scene where no EMS intervention was needed Signup and view all the answers

'Abandonment' in an EMS context refers to:

Leaving a patient without initiating care Signup and view all the answers

Study Notes

DNRO and DOA Policies

The policy establishes procedures for DNRO (Do Not Resuscitate Order) and DOA (Deceased on Arrival) responses, applying to patients of all ages, including SIDS victims.
The policy cannot address all possible contingencies, so personnel will attempt resuscitation according to procedures when in doubt.

Florida-DNRO Form

The Florida Department of Health's FL-DNRO form identifies people who do not wish to be resuscitated in the event of respiratory or cardiac arrest.
The form must be signed by the patient, physician, and witnesses, and meet specific criteria to be valid.

Honoring DNRO Forms

Fire Rescue personnel will honor a FL-DNRO form if it meets all the required criteria, including:
- Presented in its original form or a duplicated version on yellow paper.
- Signed by the patient, physician, and witnesses.
- Verified patient identification.
If the FL-DNRO form is valid, CPR should not be initiated, but comfort care measures and treatment for other medical conditions can still be performed.

Revoking a DNRO

A DNRO can be revoked at any time by the patient, healthcare surrogate, proxy, or court-appointed guardian.
Revocation can be in writing, by physical destruction, or by orally expressing a contrary intent.

DOA Medical-Unquestionable Death

For non-trauma patients, the following criteria must be met to confirm death:
- Unresponsive.
- Apneic.
- Pulseless without heart tones.
- Asystole confirmed in two leads (can be waived if signs of decomposition are present).
- Unresponsive pupils.
- No measurable blood pressure.
- Verified down time >30 minutes (except in drowning or hypothermia cases).

Trauma-Unquestionable Death

Traumatic cardiac arrest patients may be presumed deceased and resuscitation not initiated if they meet one of the following criteria:
- Open cranium with exposed brain tissue.
- Decapitation.
- Severed trunk.
- Pulseless and apneic with prolonged inaccessibility to care.

Post-DOA Procedures

If the patient is not under Hospice care and did not present a valid DNRO form, the body will be left at the scene for investigation by law enforcement.
Fire Rescue personnel will assist in respectful placement of the body and consult with the family regarding their wishes.### Death Criteria
In instances of unquestionable death, the victim's body will not be disturbed unless necessary to determine death.
After resuscitation efforts are stopped, disposable medical equipment will not be removed from the victim's body.

Resuscitation Efforts

If resuscitation efforts are stopped, they will be continued in a transport unit and initiated to the closest Emergency Department.
Personnel will notify law enforcement officers of any scene changes or critical observations before leaving the scene.

Family Interaction

Fire Rescue personnel should remember their responsibility to the patient's family when dealing with death.
They should provide a calm and compassionate explanation of what is happening, ensuring "death with dignity".
Respect for the patient's family is essential.

No Treatment

"No Treatment" dispositions only include patients who refuse all care or definitive treatment by Fire Rescue.
A patient assessment is considered treatment and will be properly documented in a patient care report.
Refusing treatment requires the completion of a Patient Refusal Form.

No Transport

Convincing a patient who requests transport that they do not need to go to the hospital is not acceptable or legal.
A "no transport" decision can be made by the patient (or family/legal decision maker) or Fire Rescue.
Patients can refuse transport if they are competent and fully informed of the assessment findings.
Fire Rescue can decide not to transport a patient after a complete assessment.

No Patient

A "no patient" disposition occurs when a patient cannot be found or when a scene requires no EMS intervention or assessment.
If the patient cannot be found, efforts to locate them must be documented on the ePCR.
Scenes that do not require EMS intervention or assessment require only response information documentation.

Abandonment

Fire Rescue personnel cannot leave a patient until another equally or more competent health professional assumes responsibility for care.
Exceptions include transporting a skilled nursing facility resident with Battalion Chief approval, or non-emergency transport with Battalion Chief approval.
Fire Rescue units must remain on scene with a patient until transport arrives.

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Description

This quiz covers the policy and direction concerning consent and transport decisions for St. Johns County Fire Rescue personnel responsible for making medical decisions. It also addresses the expectations of citizens who call for emergency medical services.