Medical, Legal, and Ethical Issues PDF

CHAPTER 3 Medical, Legal, and Ethical Issues Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 3) Preparatory...

CHAPTER 3 Medical, Legal, and Ethical Issues Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 3) Preparatory Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Applies fundamental knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical issues to the provision of emergency care. National EMS Education Standard Competencies (2 of 3) Medical/Legal and Ethics Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Consent/refusal of care  Confidentiality  Advance directives  Tort and criminal actions  Evidence preservation  Statutory responsibilities National EMS Education Standard Competencies (3 of 3) Medical/Legal and Ethics (cont’d) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mandatory reporting  Ethical principles/moral obligations  End-of-life issues Introduction  A basic principle of emergency care is to do no further harm. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A health care provider usually avoids legal exposure if he or she acts:  In good faith  According to an appropriate standard of care Consent (1 of 2)  Consent is permission to render care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A person must give consent for treatment.  If the patient is conscious and rational, he or she has a legal right to refuse care. Consent (2 of 2)  Foundation of consent is decision-making capacity. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Can understand information provided  Can make informed choice regarding medical care  Patient autonomy is the right of the patient to make decisions about his or her health. Expressed Consent  The patient acknowledges he or she wants you to provide care or transport. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  To be valid, the patient must provide informed consent.  You have explained the treatment, risks, and benefits to the patient. Implied Consent (1 of 2)  Applies to patients who are  Unconscious Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Otherwise incapable of making an informed decision FIGURE 3-1 When a serious threat to life exists and the patient is unconscious or otherwise unable to give consent, the law assumes that the patient would give consent to care © Genaro and Molina/Los transport Angeles to the hospital. Times/Getty Images Implied Consent (2 of 2)  Should never be used unless there is a threat to life or limb. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Principle of implied consent is known as the emergency doctrine.  Try to get consent from a spouse or relative. Involuntary Consent  Applies to patients who are: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Mentally ill  In behavioral crisis  Developmentally delayed  Obtain consent from guardian or conservator.  Not always possible, so understand local provisions Minors and Consent (1 of 2)  Parent or legal guardian gives consent. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  In some states, a minor can give consent.  Emancipated minors (married, armed services, parents)  Teachers and school officials may act in place of parents. Minors and Consent (2 of 2)  If true emergency exists, and no consent is available: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Treat the patient.  Consent is implied. FIGURE 3-2 The law requires that a parent or a legal guardian give consent for treatment or transport of a minor. However, you must never © Jones withhold & Bartlett life-saving Learning. Courtesy of MIEMSS care. Forcible Restraint (1 of 2)  Sometimes necessary with combative patient Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Legally permissible  Consult medical control  May require law enforcement Forcible Restraint (2 of 2)  Once applied do not remove restraints en route unless they pose a risk to the patient. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Consider calling ALS backup to provide chemical pharmacological restraint. The Right to Refuse Treatment (1 of 4)  Conscious, alert adults with decision-making capacity: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Have the right to refuse treatment  Can withdraw from treatment at any time, even if the result is death or serious injury  Calls involving refusal are frequently litigated.  Involve online medical control and document this consultation. The Right to Refuse Treatment (2 of 4)  Assess the patient’s ability to make an informed decision:  Ask and repeat questions. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assess the patient’s answers.  Observe the patient’s behavior.  If the patient appears confused or delusional, you cannot assume that the decision to refuse is an informed refusal. The Right to Refuse Treatment (3 of 4)  Providing treatment is a much more defensible position than failing to treat a patient. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Do not endanger yourself.  Use the assistance of law enforcement. The Right to Refuse Treatment (4 of 4)  Before you leave a scene where a patient, parent, or caregiver has refused care: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Encourage the individual again to allow care.  Ask the individual to sign a refusal of care form.  A witness is valuable in these situations.  Document all refusals. Confidentiality (1 of 4)  Confidential information includes:  Patient history Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assessment findings  Treatment provided  Information generally cannot be disclosed except:  If the patient signs a release  If a legal subpoena is presented  If it is needed by billing personnel Confidentiality (2 of 4)  Health Insurance Portability and Accountability Act of 1996 (HIPAA) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Contains a section on patient privacy  Strengthens privacy laws  Safeguards patient confidentiality  Considers information to be protected health information (PHI) Confidentiality (3 of 4)  Failure to abide by the provisions of HIPAA laws can result in civil and/or criminal action. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The general public is often permitted by law to record identifying and protected patient information and images. Confidentiality (4 of 4)  Social media  Avoid agency logos, uniforms, vehicles, or other markings associated with your Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com agency while off duty.  Conduct yourself professionally on and off duty.  Free speech does not mean that everyone has a right to say anything under any circumstances and without repercussions. Advance Directives (1 of 5)  An advance directive specifies treatment should the patient become unconscious or unable to make decisions. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A do not resuscitate (DNR) order is an advance directive that gives permission not to resuscitate.  “Do not resuscitate” does not mean “do not treat.” Advance Directives (2 of 5)  Other names for advance directives: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Living will  Health care directive  DNR orders must meet the following requirements:  Statement of the patient’s medical problem(s)  Signature of the patient or legal guardian  Signature of physician or health care provider  Not expired Advance Directives (3 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 3-4 A. An example of a wallet-sized DNR order. © Jones & Bartlett Learning. Advance Directives (4 of 5)  Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Explicitly describe acceptable interventions for the patient  Must be signed by an authorized medical provider  Contact medical control for guidance. Advance Directives (5 of 5)  Some patients may have named surrogates to make decisions for them. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Durable powers of attorney for health care  Also known as health care proxies  Due to the growing number of hospice home health programs, you may face this situation. Physical Signs of Death (1 of 4)  A physician determines the cause of death. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Presumptive signs of death:  Unresponsiveness to painful stimuli  Lack of a carotid pulse or heartbeat  Absence of breath sounds  No deep tendon or corneal reflexes Physical Signs of Death (2 of 4)  Presumptive signs of death (cont’d): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Absence of eye movement  No systolic blood pressure  Profound cyanosis  Lowered or decreased body temperature Physical Signs of Death (3 of 4)  Definitive signs of death:  A body in parts (decapitation) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Dependent lividity (blood settling) FIGURE 3-5 Dependent lividity is an obvious sign of death caused by discoloration of the body from pooling of the blood to the lower parts © Americanof theofbody. Academy Orthopaedic Surgeons. Physical Signs of Death (4 of 4)  Definitive signs of death (cont’d): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Rigor mortis (stiffening)  Occurs between 2–12 hours after death  Algor mortis  Cooling of the body until it matches the ambient environment  Putrefaction (decomposition)  Occurs between 40–96 hours after death Medical Examiner Cases (1 of 2)  Involvement depends on nature/scene of death. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Examiner notified in cases of:  Dead on arrival (DOA)/dead on scene (DOS)  Death without previous medical care  Suicide  Violent death  Poisoning, known or suspected Medical Examiner Cases (2 of 2)  Examiner notified in cases of (cont’d):  Death from accidents Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Suspicion of a criminal act  Infant and child deaths Special Situations (1 of 4)  Organ donors Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Expressed a wish to donate their organs  Evidenced by information on:  Organ donor card and/or  Driver’s license  Your priority is to save the patient’s life.  Remember that organs need oxygen. Special Situations (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 3-7 The patient may be carrying a donor card or driver’s license indicating that he or she wishes to be anof the U.S. Department of Health and Human Services. Courtesy organ donor. Special Situations (3 of 4)  Medical identification insignia Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Bracelet, necklace, keychain, or card indicating:  DNR order  Allergies  Diabetes, epilepsy, or other serious condition  Some patients wear a medical bracelet with a USB flash drive. Special Situations (4 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 3-8 The patient may be carrying a medical identification card or wearing a bracelet or necklace that indicates important medical information and possible DNR orders. In the case of MedicAlert, the EMS provider can obtain stored patient history information © Lucas from the Oleniuk/Contributor/Toronto MedicAlert Star/Getty Images Foundation. Scope of Practice (1 of 2)  Outlines the care you are able to provide Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Usually defined by state law  Medical director further defines by developing:  Protocols  Standing orders Scope of Practice (2 of 2)  Carrying out procedures outside scope of practice may be considered: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Negligence  Criminal offense Standards of Care (1 of 3)  Manner in which you must act or behave  You must be concerned about the safety and Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com welfare of others. FIGURE 3-9 Act or behave toward others in a way that shows your concern about their safety and welfare. © Jones & Bartlett Learning. Courtesy of MIEMSS. Standards of Care (2 of 3)  Standards of care are established by: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Local custom  Law  Statutes, ordinances, administrative regulation, or case law  Professional or institutional standards  Example: AHA CPR guidelines  Textbooks  Example: NHTSA Standards of Care (3 of 3)  Standards of care established by (cont’d): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Standards imposed by states  Medical Practices Act  Certification  Licensure  Credentialing Duty to Act  Individual’s responsibility to provide patient care Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Duty to act applies:  Once your ambulance responds to a call  Once treatment is begun Negligence (1 of 3)  Failure to provide same care that person with similar training would provide in same or similar situation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Negligence (2 of 3)  All four of the following elements must be present for negligence to apply: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Duty  Breach of duty  Damages  Causation Negligence (3 of 3)  Res ipsa loquitur Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The cause of the injury was in the control of the EMT, generally does not occur unless there is negligence.  Negligence per se  The conduct of the person being sued is alleged to that occurred in clear violation of a statute.  Torts  Civil wrongs Abandonment  Unilateral termination of care by EMT without:  Patient’s consent Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Making provisions for continuing care  Abandonment may take place:  At the scene  In the emergency department  Always obtain a signature on your patient care record Assault and Battery, and Kidnapping (1 of 2)  Assault: unlawfully placing person in fear of immediate bodily harm Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Example: restraint  Battery: unlawfully touching a person  Example: providing care without consent Assault and Battery, and Kidnapping (2 of 2)  Kidnapping: seizing, confining, abducting, or carrying away by force Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Example: transport against will  False imprisonment: unauthorized confinement of a person Defamation  Communication of false information that damages reputation of a person Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Libel: written  Slander: spoken Good Samaritan Laws and Immunity (1 of 2)  If you reasonably help another person, you will not be held liable for errors or omissions. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Good Samaritan conditions to be met:  Good faith  Without expectation of compensation  Within scope of training  Did not act in grossly negligent manner Good Samaritan Laws and Immunity (2 of 2)  Gross negligence: conduct that constitutes willful or reckless disregard Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Immunity statutes apply to EMS systems that are considered governmental agencies.  Sovereign immunity: provides limitations on liability and immunity is not complete Records and Reports (1 of 2)  Compile a record of all incidents involving sick or injured patients. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Important safeguard against legal complications  Courts consider:  An action not recorded was not performed.  Incomplete or untidy reports is evidence of poor emergency medical care. Records and Reports (2 of 2)  National EMS Information System (NEMSIS) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Provides the ability to collect, store, and share standardized EMS data  Used to improve the speed and accuracy of data collection Special Mandatory Reporting Requirements (1 of 3)  Most states have a reporting obligation: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Abuse of children, older persons, and others  Injury during commission of a felony  Drug-related injuries  Childbirth Special Mandatory Reporting Requirements (2 of 3)  Most states have a reporting obligation (cont’d): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Attempted suicides  Dog bites  Communicable diseases  Assaults  Domestic violence Special Mandatory Reporting Requirements (3 of 3)  Most states have a reporting obligation (cont’d): Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Sexual assault or rape  Exposures to infectious disease  Transport of patients in restraints  Scene of a crime  The deceased Ethical Responsibilities (1 of 2)  Ethics: philosophy of right and wrong, moral duties, and ideal professional behavior Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Morality: code of conduct affecting character, conduct, and conscience  Bioethics: specifically addresses issues that arise in the practice of health care Ethical Responsibilities (2 of 2)  Require you to evaluate and apply ethical standards Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Your own  Those of the profession  Allow rules, laws, and policies to guide your decision making. The EMT in Court (1 of 6)  You can end up in court as:  A witness Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A defendant  Case can be civil or criminal. FIGURE 3-12 Court discussions will be based on your documentation. Make sure your documentation is thorough and accurate. © Brand X Pictures/Creatas. The EMT in Court (2 of 6)  Whenever called to testify, notify: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Your service director  Legal counsel  As witness:  Remain neutral.  Review run report before court. The EMT in Court (3 of 6)  As a defendant, an attorney is required. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Defenses may include:  Statute of limitations  Governmental immunity  Contributory negligence The EMT in Court (4 of 6)  Discovery allows both sides to obtain more information through: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Interrogatories  Written requests or questions  Depositions  Oral requests or questions The EMT in Court (5 of 6)  Most cases are settled following the discovery phase during the settlement phase. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If not settled, the case goes to trial.  Damages that may be awarded:  Compensatory damages  Punitive damages The EMT in Court (6 of 6)  Any EMT charged with a criminal offense should secure the services of a highly experienced criminal attorney immediately. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Review 1. You arrive at the scene of an older woman complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com is an example of: A. implied consent. B. informed consent. C. expressed consent. D. emergency consent. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Expressed consent (also called actual consent) is when the patient authorizes you to provide treatment and transport, either verbally or nonverbally. For example, a patient who holds out his or her arm to allow you take a blood pressure is nonverbally giving you expressed consent. Review 1. You arrive at the scene of an older woman complaining of chest pain. In assessing her, she holds her arm out for you to take her blood pressure. This Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com is an example of: A. implied consent. Rationale: Implied consent is limited to life-threatening emergencies and is appropriate when a person is unconscious and/or delusional. B. informed consent. Rationale: Informed consent is when the patient has been told of the specific risks, benefits, and alternative treatments. C. expressed consent. Rationale: Correct answer. It is also known as actual consent. D. emergency consent. Rationale: This does not exist as a form of consent. Review 2. Which of the following is an example of abandonment? A. An EMT leaves the scene after a competent adult has refused care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. An EMT transfers care of a patient to an emergency department nurse. C. An AEMT transfers care of a patient to a paramedic. D. An AEMT transfers care of a patient to an EMR. Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Abandonment occurs when patient care is terminated without the patient’s consent or when care is transferred to a provider of lesser training and level of certification. Review 2. Which of the following is an example of abandonment? A. An EMT leaves the scene after a competent adult has refused care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Mentally competent adults have the right to refuse treatment or withdraw from treatment at any time. B. An EMT transfers care of a patient to an emergency department nurse. Rationale: An EMT can transfer care to someone of equal or higher medical authority. C. An AEMT transfers care of a patient to a paramedic. Rationale: An AEMT can transfer care to someone of equal or higher medical authority. D. An AEMT transfers care of a patient to an EMR. Rationale: Correct answer Review 3. The unauthorized confinement of a person is called: A. assault. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. battery. C. false imprisonment. D. slander. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: False imprisonment is defined as the confinement of a person without legal authority or the person’s consent. Review 3. The unauthorized confinement of a person is called: A. assault. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Assault is unlawfully placing a person in fear of bodily harm. B. battery. Rationale: Battery is touching a person or providing care without consent. C. false imprisonment. Rationale: Correct answer. D. slander. Rationale: Slander is false and damaging information about a person that is communicated by the spoken word. Review 4. Failure of the EMT to provide the same care as another EMT with the same training is called: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. libel. B. slander. C. negligence. D. abandonment. Review Answer: C Rationale: An EMT could be held liable for negligence if he or she fails to provide Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the same care as another EMT with the same training would provide in the same situation. For example, if an EMT fails to give oxygen to a patient with shortness of breath (an intervention that is clearly indicated), he or she may be held liable for negligence. Review 4. Failure of the EMT to provide the same care as another EMT with the same training is called: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. libel. Rationale: Libel is making a false statement in a written form that injures a good person’s name. B. slander. Rationale: Slander is verbally making a false statement that injures a good person’s name. C. negligence. Rationale: Correct answer D. abandonment. Rationale: Abandonment is the abrupt termination of contact with a patient. Review 5. An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to contact the child’s Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com parents. You should: A. continue to treat the child and transport as soon as possible. B. cease all treatment until the child’s parents can be contacted. C. continue with treatment only if authorized by medical control. D. provide airway management only until the parents are contacted. Review Answer: A Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The child in this scenario is critically injured and requires immediate treatment and transport; waiting until his parents are contacted wastes time and increases his chance of a negative outcome. If you are unable to contact a minor’s parents or legal guardian, you should proceed with care based on the law of implied consent. Review 5. An 8-year-old boy was struck by a car, is unconscious, and is bleeding from the mouth. A police officer tells you that he is unable to Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com contact the child’s parents. You should: A. continue to treat the child and transport as soon as possible. Rationale: Correct answer B. cease all treatment until the child’s parents can be contacted. Rationale: If a true emergency exists, then consent is implied. C. continue with treatment only if authorized by medical control. Rationale: If a true emergency exists, then consent is implied. D. provide airway management only until the parents are contacted. Rationale: If a true emergency exists, then consent is implied. Review 6. An advance directive is: A. a set of specific guidelines that clearly defines the different types of consent. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. a formal list that defines by state law whether a patient has decision-making capacity. C. a written document that specifies the care you should provide if the patient is unable to make decisions. D. a verbal order given to you by a dying patient's family regarding whether treatment should be provided. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: An advance directive is a written document signed by the patient and a witness that specifies the medical care that should be provided if the patient loses decision-making capacity (ie, he or she is no longer deemed competent). Review 6. An advance directive is: A. a set of specific guidelines that clearly defines the different types of consent. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: An advance directive specifies the specific care a patient will receive and does not address any type of consent. B. a formal list that defines by state law whether a patient has decision-making capacity. Rationale: An advance directive document has already determined that a patient was competent to make decisions when the document was created and signed. C. a written document that specifies the care you should provide if the patient is unable to make decisions. Rationale: Correct answer D. a verbal order given to you by a dying patient's family regarding whether treatment should be provided. Rationale: An advance directive is a written order that identifies the patient’s medical decisions. Review 7. Which of the following patients is competent and can legally refuse EMS care? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. A confused young female who states that she is the president B. A man who is staggering and states that he drank only three beers C. A conscious and alert woman who is in severe pain from a broken leg D. A diabetic patient who has slurred speech and is not aware of the date Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: A patient who is of legal age (18 in most states), is conscious, and is alert to person, place, time, and event, likely has decision-making capacity and can legally refuse EMS care. However, patients who are confused, possibly intoxicated, or delusional are not capable of making rational decisions; therefore, you should provide care based on the law of implied consent. Review 7. Which of the following patients is competent and can legally refuse EMS care? A. A confused young female who states that she is the president Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: You must assess whether this patient’s mental condition is impaired. B. A man who is staggering and states that he drank only three beers Rationale: You must assess whether this patient’s mental condition is impaired. C. A conscious and alert woman who is in severe pain from a broken leg Rationale: Correct answer D. A diabetic patient who has slurred speech and is not aware of the date Rationale: You must assess whether this patient’s mental condition is impaired. Review 8. You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com restrained if he does not give you consent. Your actions in this case are an example of: A. assault. B. battery. C. negligence. D. abandonment. Review Answer: A Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Unlawfully placing a person in fear of immediate bodily harm (ie, having him restrained) without his consent constitutes assault. Review 8. You are treating a patient with an apparent emotional crisis. After the patient refuses treatment, you tell him that you will call the police and have him Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com restrained if he does not give you consent. Your actions in this case are an example of: A. assault. Rationale: Correct answer B. battery. Rationale: Battery is unlawfully touching a person. This includes giving care without consent. C. negligence. Rationale: Negligence is failure to provide the same care that a person with similar training would provide. D. abandonment. Rationale: Abandonment is the unilateral termination of care without the patient’s consent. Review 9. The EMT has a legal duty to act if he or she is: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. off duty and witnesses a major car accident. B. a volunteer, is on duty, and is dispatched on a call. C. paid for his or her services, but is not on duty. D. out of his or her jurisdiction and sees a man choking. Review Answer: B Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The EMT—paid or volunteer—has a legal duty to act if he or she is on duty and is dispatched on a call, regardless of the nature of the call. If the EMT is off duty and/or out of his or her jurisdiction, he or she has a moral obligation to act, but not necessarily a legal one. Review 9. The EMT has a legal duty to act if he or she is: A. off duty and witnesses a major car accident. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: There is a moral obligation to act, but not a legal one. B. a volunteer, is on duty, and is dispatched on a call. Rationale: Correct answer C. paid for his or her services, but is not on duty. Rationale: Whether paid or volunteer, the EMT must be on duty. D. out of his or her jurisdiction and sees a man choking. Rationale: There is a moral obligation to act, but not a legal one. Review 10. Which of the following statements about records and reports is FALSE? A. Legally, if it was not documented, it was not performed. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. A complete, accurate report is an important safeguard against legal problems. C. An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical care. D. Your patient care report does not become a part of the patient’s hospital record because your treatment was provided outside the hospital. Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The statement “Your patient care report does not become a part of the patient’s hospital record because your treatment was provided outside the hospital” is incorrect. Your patient care report does, in fact, become a permanent part of the patient’s hospital record. Review 10. Which of the following statements about records and reports is FALSE? A. Legally, if it was not documented, it was not performed. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: True. If it was not written down, then it was not performed. B. A complete, accurate report is an important safeguard against legal problems. Rationale: True. The most important safeguard against legal problems is a complete, accurate report. C. An incomplete or untidy patient care report is evidence of incomplete or inexpert emergency medical care. Rationale: True. An incomplete or untidy report equals incomplete or inexpert emergency care. D. Your patient care report does not become a part of the patient’s hospital record because your treatment was provided outside the hospital. Rationale: Correct answer