Medical Decisions and Capacity
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Questions and Answers

What is a 4th party caller in EMS?

  • Someone who is with the patient and intimately familiar with their condition/situation
  • A healthcare professional requesting EMS services
  • A single caller passerby
  • Someone who is not on the scene and does not know the patient (correct)

    • What is the main purpose of EMS700?

  • To reduce hospital stays
  • To help EMS providers with higher acuity patients (correct)
  • To improve patient care protocols
  • To address staffing shortages

    • What is an example of interconnected professional entities?

  • Police department requesting EMS
  • A medical monitoring company
  • A hospital emergency department
  • All of the above (correct)

    • What is a challenge facing the healthcare system?

    <p>Staffing shortages</p> Signup and view all the answers

    What is the goal of the ROSC Checklist?

    <p>To improve patient outcomes</p> Signup and view all the answers

    What is a benefit of alternative destination options?

    <p>Reduced hospital overcrowding</p> Signup and view all the answers

    What is the goal of achieving ROSC in patients?

    <p>To discharge patients neurologically intact</p> Signup and view all the answers

    What is the purpose of the ROSC Checklist?

    <p>To verify and complete tasks after achieving ROSC</p> Signup and view all the answers

    How can behavioral health patient transport be facilitated?

    <p>By using interconnected professional entities</p> Signup and view all the answers

    What is an important aspect of patient care protocols?

    <p>Prioritizing patient care</p> Signup and view all the answers

    When should an EMS clinician transport a patient to a hospital where they were previously admitted?

    <p>If the patient has had a hospital admission within the last 30 days</p> Signup and view all the answers

    What is the purpose of repatriation in EMS?

    <p>To return patients to their original hospital for continuity of care</p> Signup and view all the answers

    What is a key principle of hospital transport procedures?

    <p>Coordinating care with hospital staff</p> Signup and view all the answers

    What is a key consideration for transporting behavioral health patients?

    <p>Transporting patients in police custody</p> Signup and view all the answers

    What is an essential aspect of patient care protocols?

    <p>Honor reasonable requests from patients</p> Signup and view all the answers

    What is the purpose of the alternative destination options?

    <p>To enable patients to make informed decisions about their care</p> Signup and view all the answers

    What is the purpose of proofreading in an ePCR narrative?

    <p>All of the above</p> Signup and view all the answers

    What happens as soon as an ePCR is posted?

    <p>It uploads to the patient's electronic health record</p> Signup and view all the answers

    What is the purpose of documenting 'GOOD INTENT' in an ePCR narrative?

    <p>It is indefensible and provides no information</p> Signup and view all the answers

    What is a possible outcome for a DNR-B Montgomery Hospice patient?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of the LAMS scale?

    <p>To assess stroke severity</p> Signup and view all the answers

    What is a key principle of transporting a patient with a chief complaint?

    <p>Ensure patient receives all appropriate medical assessments and treatments</p> Signup and view all the answers

    What is a hospital that can receive stroke patients?

    <p>All of the above</p> Signup and view all the answers

    Why is it important to document patient care in an ePCR narrative?

    <p>To defend what you did or did not do in court</p> Signup and view all the answers

    What is the purpose of the 5-minute Lineup Drill?

    <p>To train EMS personnel</p> Signup and view all the answers

    What determines an individual's medical decision capacity?

    <p>Their ability to understand and make informed decisions</p> Signup and view all the answers

    Why is it important to collaborate with Hospice Staff when identifying a DNR-B Montgomery Hospice patient?

    <p>To facilitate Hospice Visit scheduling</p> Signup and view all the answers

    What should be considered when determining whether to resuscitate a patient?

    <p>The patient's expressed wishes, if any</p> Signup and view all the answers

    What is the purpose of establishing a floor of care?

    <p>To determine the level of care required for a patient</p> Signup and view all the answers

    What should be obtained for a patient who does not want resuscitation?

    <p>A verbal DNR via medical consult</p> Signup and view all the answers

    Why is it important to consider a patient's autonomy in EMS care?

    <p>To respect a patient's right to make decisions about their care</p> Signup and view all the answers

    What is a crucial aspect of end-of-life care in EMS?

    <p>Respecting a patient's advanced directives</p> Signup and view all the answers

    What is the significance of the unit officer's role in cardiac arrest situations?

    <p>To designate a team leader for pit crew CPR</p> Signup and view all the answers

    Why is it important to prioritize one call at a time in EMS?

    <p>To facilitate good medicine and prioritize patient needs</p> Signup and view all the answers

    What should be considered when determining the most appropriate resources for a patient?

    <p>The patient's medical history and condition</p> Signup and view all the answers

    What is the primary reason for obtaining a verbal DNR?

    <p>To balance the duty to act with respect for patient and family wishes</p> Signup and view all the answers

    What is a key principle in identifying a patient in EMS?

    <p>The patient is anyone encountered by EMS with an actual or potential injury or medical problem</p> Signup and view all the answers

    What is the primary consideration when making resuscitation decisions in EMS?

    <p>The patient's autonomy and advance directives</p> Signup and view all the answers

    Who can be considered a 2nd party caller in EMS?

    <p>A witness to the patient's symptoms or signs of illness</p> Signup and view all the answers

    What is the primary purpose of complying with patient wishes for care in EMS?

    <p>To identify and comply with the patient's wishes for their care</p> Signup and view all the answers

    What is the primary benefit of respecting patient autonomy in EMS?

    <p>It allows patients to make informed decisions about their care</p> Signup and view all the answers

    What is the primary focus of the ePCR narrative?

    <p>Patient care and medical treatments</p> Signup and view all the answers

    Why is it important to proofread the ePCR narrative?

    <p>To provide a clear and accurate record of patient care</p> Signup and view all the answers

    What is the purpose of the 'GOOD INTENT' document?

    <p>To provide no information and is indefensible</p> Signup and view all the answers

    What should be done when identifying a DNR-B Montgomery Hospice patient?

    <p>Call the Montgomery Hospice number and collaborate with Hospice Staff</p> Signup and view all the answers

    What is the purpose of the LAMS scale?

    <p>To determine the severity of a patient's stroke</p> Signup and view all the answers

    What is a key principle of transporting a patient with a chief complaint?

    <p>Receive all appropriate medical assessments and treatments</p> Signup and view all the answers

    What determines an individual's medical decision capacity?

    <p>Their ability to make informed decisions about their care</p> Signup and view all the answers

    Why is it important to document patient care in an ePCR narrative?

    <p>To provide a clear and accurate record of patient care</p> Signup and view all the answers

    What is the purpose of the 5-minute Lineup Drill?

    <p>To facilitate transport of patients in police custody</p> Signup and view all the answers

    What is a benefit of alternative destination options for patients?

    <p>Increasing patient satisfaction and autonomy</p> Signup and view all the answers

    What is the primary consideration when determining the transportation of a patient who has been hospitalized within the last 30 days?

    <p>The hospital where the patient was previously admitted</p> Signup and view all the answers

    Under what circumstances can an individual's right to refuse medical treatment be overridden?

    <p>If the individual is being Emergency Petitioned</p> Signup and view all the answers

    What is the primary goal of the ROSC Checklist?

    <p>To increase the number of patients discharged from the hospital neurologically intact</p> Signup and view all the answers

    What is the purpose of repatriation in EMS?

    <p>To transport patients to a hospital that provided previous treatment</p> Signup and view all the answers

    What is a key principle of transporting patients with advanced directives?

    <p>Respecting the patient's autonomy in making medical decisions</p> Signup and view all the answers

    What is the primary benefit of respecting patient autonomy in EMS?

    <p>Enhancing the dignity and quality of life of patients</p> Signup and view all the answers

    What is the primary purpose of the 5-minute Lineup Drill?

    <p>To verify and complete tasks after achieving ROSC</p> Signup and view all the answers

    What determines an individual's medical decision capacity?

    <p>The Maryland protocol's five conditions</p> Signup and view all the answers

    What is the primary purpose of obtaining a verbal DNR?

    <p>To respect patient autonomy and wishes</p> Signup and view all the answers

    What is the primary consideration when making resuscitation decisions in EMS?

    <p>The patient's wishes for care</p> Signup and view all the answers

    What determines an individual's ability to make medical decisions in EMS?

    <p>Their ability to communicate effectively</p> Signup and view all the answers

    What is the primary focus of end-of-life care in EMS?

    <p>Providing comfort care and pain management</p> Signup and view all the answers

    What is the primary purpose of complying with patient wishes for care in EMS?

    <p>To respect patient autonomy and wishes</p> Signup and view all the answers

    Who can request EMS for a patient?

    <p>A healthcare professional or family member</p> Signup and view all the answers

    What is the primary purpose of documenting care in an ePCR narrative?

    <p>To provide a clear record of patient care for future reference</p> Signup and view all the answers

    What is a key consideration when transporting a patient with a chief complaint?

    <p>The patient's advanced directives</p> Signup and view all the answers

    What is the primary focus of end-of-life care in EMS?

    <p>Respecting the patient's autonomy and wishes</p> Signup and view all the answers

    What determines an individual's medical decision capacity?

    <p>Their ability to understand and communicate their wishes</p> Signup and view all the answers

    What is the purpose of the LAMS scale?

    <p>To assess the severity of stroke symptoms</p> Signup and view all the answers

    Why is it important to collaborate with Hospice Staff when identifying a DNR-B Montgomery Hospice patient?

    <p>To prioritize the patient's autonomy and wishes</p> Signup and view all the answers

    What is a possible outcome for a DNR-B Montgomery Hospice patient?

    <p>Telehealth visit with Hospice Staff</p> Signup and view all the answers

    What is the purpose of the 5-minute Lineup Drill?

    <p>To simulate real-world emergency scenarios</p> Signup and view all the answers

    Why is it important to proofread an ePCR narrative?

    <p>To provide a clear record of patient care</p> Signup and view all the answers

    What happens as soon as an ePCR is posted?

    <p>It uploads to the patient's electronic health record</p> Signup and view all the answers

    Study Notes

    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.

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    Related Documents

    EMS 5-Minute Drills PDF

    Description

    This quiz covers medical decision-making capacity, refusal of treatment, and emergency petitions. It also discusses the Maryland protocol and the procedures for emergency petitions.

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