Medical Decisions and Capacity

Medical Decisions and Capacity

• Individuals with medical decision capacity have the right to refuse medical treatment and transportation.
• Maryland protocol lists five conditions under which people are incapable of making medical decisions.

Emergency Petition

• An individual being Emergency Petitioned cannot refuse treatment and must remain in police custody.
• They can be transported to a hospital-based emergency department via a patrol car or by EMS, accompanied by police.

Repatriation

• To return a patient to a medical facility that provided previous treatment.
• This helps with treatment expediency, coordination of care, consistency of care, and improved patient outcomes.

High-Risk Refusals

• Remember, an individual being Emergency Petitioned cannot refuse treatment.
• If a patient has had a hospital admission within the last 30 days, the EMS clinician should transport (repatriate) the patient to that hospital.

ROSC Checklist

• A list of things to verify and do after achieving ROSC, but before moving the patient.
• The ROSC Checklist will be placed on each LUCAS device by EMS Logistics.

ePCR Narrative

• Reflects only things relating to the patient and care provided.
• Accuracy matters, including times, procedures, medications, and proofreading.

Writing a Good Report

• Document what you did and found on scene.
• A "good intent" is indefensible and provides no information.

DNR-B Patients

• A new option for assisting patients with palliative care.
• Collaborate with Hospice Staff when identifying a DNR-B Montgomery Hospice patient.

Stroke Patients

• Must go to a Thrombectomy Capable Primary Stroke Center or Comprehensive Stroke Center.
• Possible destinations include Shady Grove Medical Center, Suburban Hospital, and Washington Hospital Center.

LAMS (LOS ANGELES MOTOR SCALE)

• Facial Droop, Arm Drift, and Grip Strength are used to assess stroke patients.
• A LAMS score of 4 or 5 is indicative of Large Vessel Occlusion (LVO).

Patient Care

• Be a patient with a chief complaint (including undifferentiated agitation).
• Receive all appropriate medical assessments and treatments.

Interacting with Law Enforcement

• Do not allow police to dictate treatment or transport decisions.
• Ensure patient assessments and care are not compromised.

EMIHS 5-Minute Lineup Drill

• A checklist for EMS providers, including patient care and transportation.

EMS Five Minute Drills

• A list of important topics, including Calling Party Differentiation, EMS700, ePCR, Good Intent, and more.

What is a 4th Party Caller?

• Someone who is not with the patient and does not have intimate knowledge of the patient's condition/situation.

Operational Doctrine Statement

• Consistency in decision-making is crucial, and officers must ensure patients receive the necessary resources in the most appropriate manner.
• The unit officer has a designated role in cardiac arrests that cannot be filled if they are acting as an ALS provider.

Patient Wishes and DNR

• Ensure the patient receives the resources they need while respecting their wishes.
• Establish the floor of care using the SPASM mnemonic.
• Gather evidence of the patient's wishes, including talking to the family and reviewing the living will.
• Obtain a verbal DNR through the normal medical consult process.

Patient Definition

• A patient is anyone encountered by EMS with an actual or potential injury or medical problem.
• This includes 1st party callers, 2nd party callers, and those with a Power of Attorney who calls 911.

ePCR Narrative

• The ePCR narrative should reflect only things related to the patient and care provided.
• Accuracy matters, including times, procedures, medications, and proofreading.

Good Documentation

• Writing "good intent" is indefensible and provides no information.
• Document what you did and found on the scene to defend your actions.

DNR-B Patients

• DNR-B patients have a new option for assisting patients with palliative care.
• Collaborate with Hospice Staff when identifying a DNR-B Montgomery Hospice patient.

Stroke Centers

• Patients must be transported to a Thrombectomy Capable Primary Stroke Center or Comprehensive Stroke Center, including:
  • Shady Grove Medical Center
  • Suburban Hospital
  • Washington Hospital Center
  • Georgetown University Hospital
  • George Washington University Hospital

LAMS (LOS ANGELES MOTOR SCALE)

• LAMS assesses facial droop, arm drift, and grip strength.
• A LAMS score of 4 or 5 indicates large vessel occlusion (LVO).

Patient Care and Transport

• Be a patient with a chief complaint, transporting to a medical facility.
• Receive all appropriate medical assessments and treatments.
• Be accompanied by a law enforcement officer in the transport unit.
• Do not allow police to dictate treatment or transport decisions.

EMIHS 5-minute Lineup Drill

• People in police custody who are not being Emergency Petitioned have specific considerations.
• Medical decision capacity determines an individual's autonomy in making medical decisions.

Patient's Rights and Capacity

• Individuals with medical capacity have the right to refuse medical treatment and transportation.
• Maryland protocol lists five conditions under which people are incapable of making medical decisions.

High-Risk Refusals

• An individual being Emergency Petitioned cannot refuse and must remain in police custody.
• They can be transported to a hospital-based emergency department via a patrol car or by EMS when accompanied by police.

Repatriation

• To return a patient to a medical facility that provided previous treatment.
• Coordination of care, treatment expediency, consistency of care, and improved patient outcomes are the goals of repatriation.

General Patient Care

• For Priority 2 or 3 patients, if they have had a hospital admission within the last 30 days, the EMS clinician should transport (repatriate) the patient to that hospital.

ROSC Checklist

• A list of things to verify and do after ROSC (Return of Spontaneous Circulation) is achieved before moving the patient.

EMS Documentation

• The ePCR narrative reflects only things relating to the patient and care provided.
• Accuracy matters, including times, procedures, medications, and proofreading.

DNR-B Patients

• A new option for assisting patients with palliative care, collaborating with Hospice Staff.
• Possible outcomes include transport directly to the Casey House, telehealth visit, scheduling of a Hospice Visit, or transport to the ED.

Stroke Centers

• Patients must be taken to a Thrombectomy Capable Primary Stroke Center or Comprehensive Stroke Center.

LAMS (LOS ANGELES MOTOR SCALE)

• Facial Droop, Arm Drift, Grip Strength assessment for stroke patients.

Patient Encounters

• Be a patient-centered clinician, transporting to a medical facility, receiving all appropriate medical assessments and treatments.
• Do not allow police to dictate treatment or transport decisions.

EMIHS 5-minute Lineup Drill

• People in police custody (who are not being Emergency Petitioned) have the right to make medical decisions.

Medical Decision-Making Capacity

• Obtaining a verbal DNR can happen at any point, including after resuscitation has begun.
• Balancing duty to act with respect for patient and family wishes.