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Transcript
Chapter 3
Legal and
Ethical Issues
and Documentation
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
3-1
Objectives
3-2
The Legal System
3-3
Branches of Government
• Legislative
• Executive
• Judicial
3-4
Government
Legislative Branch
• Made up of Congress
and government
agencies
• Law made by this
branch of
government is called
statutory or
legislative law.
3-5
Government
Executive Branch
• President of the United
States is the head of the
executive branch
• This branch includes:
– Vice President
– Cabinet members
– State governors
– State and federal
administrative agencies
3-6
Government
Executive Branch
• Administrative agency
– A governmental body responsible for
implementing and enforcing a particular
law passed by the legislature
– Rules and regulations made by the
executive branch are called
administrative law.
3-7
Government
Judicial Branch
• Court system
• Courts hear cases that
challenge or require
explanation of the law
• Federal courts
• State courts
3-8
Government
Judicial Branch
• Court levels
– Trial courts
– Appellate courts
– Supreme courts
3-9
Lawsuit
• Plaintiff
• Defendant
• Statute of limitations
3-10
Criminal Law
• Area of law in which the federal,
state, or local government
prosecutes individuals on behalf
of society for violating laws
designed to safeguard society
• Punishable by fine, imprisonment,
or both
3-11
Civil Law
• A branch of law that deals with
complaints by individuals or
organizations against a defendant for an
illegal act or wrongdoing (tort)
3-12
Steps in a Lawsuit
• Incident occurs
• Investigation is conducted by plaintiff's
representative
• Complaint is filed in court and served on
defendant
• Complaint is answered by defendant
3-13
Steps in a Lawsuit
• Discovery occurs
• Depositions (oral) or interrogatives (written)
are taken
• Documents are gathered
– Patient records
– Prehospital care reports
3-14
Steps in a Lawsuit
• Pre-trial conference
– Narrows the issues to be decided during
the trial
– Attempt to persuade the attorneys to settle
their case
– Most cases are settled during this period
3-15
Steps in a Lawsuit
• Trial is conducted
• Decision is handed down by judge or jury
– Decision may be appealed
3-16
Scope of Practice
• The emergency care and skills an EMT is
legally allowed and expected to perform
when necessary
• Also called the scope of care
3-17
Scope of Practice
• May be modified by using standing orders
and protocols
3-18
Standard of Care
• You are expected to
provide the same
standard of care in an
emergency as another
EMT with similar
training and
experience in similar
circumstances
3-19
Emergency Medical Technician Skills
• Patient assessment
• Insertion of oral and nasal
airways
• Assisting patients in taking
their own prescribed
mediations
• Upper airway suctioning
• Giving specific over-thecounter medications
• Bag-mask (BM) ventilation
• External hemorrhage control
• Supplemental oxygen
therapy
• Bandaging wounds
• Cardiopulmonary
resuscitation (CPR)
• Splinting
• Automated external
defibrillation (AED)
• Pulse oximetry
• Using a tourniquet
• Assisting in childbirth
• Assisting in lifting and
moving patients
• Mechanical patient restraint
3-20
Medical Oversight
• Your legal right to function
as an EMT depends on
medical oversight
– Physician must oversee
your training and practice
3-21
EMT: Legal Duties
• Provide for the well-being of the patient by giving
emergency medical care as outlined in the scope of
practice
• Provide the same standard of care as another EMT
with similar training and experience in similar
circumstances
• Before providing emergency care, make telephone
or radio contact with your medical oversight
authority (if required to do so)
• Follow standing orders and protocols approved by
medical oversight or the local EMS system
• Follow instructions received from medical oversight
3-22
Ethics
• Principles of right and wrong, good and bad,
and the consequences of human actions
– In other words, what a person ought to do
3-23
Ethical Responsibilities
• Treat all patients with respect
• Give each patient the best care you are
capable of providing
– Practice and master your skills
– Take advantage of continuing education
(CE) and refresher programs
– Look for areas in which you can improve
3-24
Ethical Responsibilities
• Be honest and accurate in your written and
verbal communication
• Respect your patient’s right to privacy
– Protected health information (PHI)
3-25
Ethical Responsibilities
• Have respect for and work cooperatively with
other emergency care professionals
3-26
Competence
• The patient’s ability to
understand the questions you
ask him and understand the
result of the decisions he
makes about his care
3-27
Competence
• Legal competence
• Mental competence
• Medical/situational competence
3-28
Incompetence
• An adult is generally considered
incompetent if she:
– Has an altered mental status
– Is under the influence of drugs or alcohol,
including legal or prescription drugs
– Has a serious illness or injury that affects her
ability to make an informed decision about her
care
– Has been declared legally incompetent related
to a known mental disorder
3-29
Consent
• Consent = permission
• You must have consent
before assessing or
treating a patient
• Any competent patient
has the right to make up
his own mind
concerning his care
3-30
Expressed Consent
• Patient gives specific authorization for care
and transport
– Must be obtained from every responsive,
mentally competent adult before
providing care
– Patient must be of legal age and
competent to give consent
3-31
Expressed Consent
• To obtain expressed consent:
– Identify yourself and your level of
medical training
– Explain all treatments and
procedures to the patient
– Identify the benefits of each
treatment or procedure
– Identify the risks of each
treatment or procedure
3-32
Expressed Consent
• Use words and phrases the patient can
understand
– Do not use confusing medical terms
3-33
Expressed Consent
• A competent adult can withdraw consent at
any time during care and transport
3-34
Implied Consent
• Consent is assumed from a patient requiring
emergency care who is mentally, physically,
or emotionally unable to provide expressed
consent
– Effective only until the patient no longer
requires emergency care or regains
competence to make decisions
3-35
Implied Consent (1 of 2)
• Applies to patients who are
– Unconscious
– Otherwise incapable of making informed
decision
Source: © Dan Myers
Implied Consent (2 of 2)
• Should never be used unless there is a
threat to life or limb.
• Principle of implied consent is known as the
emergency doctrine.
• Good to get consent from a spouse or
relative.
Consent: Implied
Consent implied for unconscious patient
Based on the assumption the patient
would consent if conscious
Special Situations
• Children and mentally
incompetent adults must
have a parent or
guardian give consent
for treatment
• If a life-threatening
emergency exists, treat
under implied consent
3-39
Medical Identification Devices
Alert EMT to patient’s medical
condition, such as:
– Heart condition
– Diabetes
– Allergies
– Epilepsy
– Other information
Medical Identifications Devices
(Front)
Medical Identification Devices (Back)
Involuntary Consent
• Applies to patients who are:
– Mentally ill
– In behavioral crisis
– Developmentally delayed
• Obtain consent from guardian
– Not always possible, so understand local
provisions
Involuntary Transportation
• Patient considered threat to self or others
• Court order
• Usually requires decision by mental health
professional or police officer
• If patient restrained, must not risk legal
liability
Refusals
• If a patient refuses treatment or transport,
you must inform her of the following:
– Nature of her illness or injury
– Treatment that needs to be performed
– Benefits of that treatment
– Risks of not providing that treatment
– Any alternatives to treatment
– Dangers of refusing treatment (including
transport)
3-45
Refusals
• Do not make a decision on
your own not to treat or
transport a patient.
• Consult with medical direction
or leave this decision to
advanced medical personnel
on the scene.
3-46
Examples of High-Risk Refusals
•
•
•
•
•
•
•
•
•
•
Abdominal pain
Chest pain
Severe electrical shock
Foreign body ingestion
Poisoning
Pregnancy-related
complaints
Water-related incidents
Falls >20 feet
Vehicle rollovers
Head injury
• High-speed auto
crashes
• Auto-pedestrian or
auto-bicycle injury with
significant (>5 mph)
impact
• Pedestrian thrown or
run over
• Motorcycle crash >20
mph or with separation
of the rider from bike
• Pediatric patient with a
vague medical
complaint
3-47
Refusal Documentation
•
•
•
•
•
•
•
•
•
•
Patient’s name, age, and chief complaint
Patient’s medical history
Two complete sets of vital signs
Patient’s mental status (including orientation)
Patient’s behavior and cooperation
Patient’s ability to follow instructions/commands
Physical examination findings
Patient’s reason for refusing treatment and/or
transport
Patient agrees to call 911 if the condition recurs,
becomes worse, or if he/she changes their mind
Patient’s signature
3-48
The Right to Refuse Treatment (1 of 2)
• Conscious, alert adults with decisionmaking capacity:
– Have the right to refuse treatment
– Can withdraw from treatment at any time
– Even if the result is death or serious
injury
• Places burden on EMT to clarify need for
treatment
The Right to Refuse Treatment (2 of 2)
• Before you leave a scene where a patient,
parent, or caregiver has refused care:
– Encourage them again to allow care.
– Ask them to sign a refusal of care form.
– Document all refusals.
– A witness is valuable in these situations.
Refusal of Care
• Patient may refuse care or transport
– Legally able to consent
– Mentally competent and oriented
– Fully informed of risks
– Sign release form
• Despite all precautions, EMT may still be
held liable
If in Doubt About Refusal
•
•
•
•
•
•
Discuss decision with patient
Ensure patient understands risks
Consult medical direction
Ask to contact family member
Contact law enforcement
Listen to patient to determine why refusing
care
Pertinent Legal Documents
3-53
Durable Power of Attorney
• Document that allows a patient to
appoint a person or organization to
handle affairs while they are
unavailable or if they are unable to
make decisions for themselves.
• The person or organization appointed
is referred to as an "Attorney-in-Fact"
or "Agent."
3-54
Durable Power of Attorney
Two main types
1.Power of Attorney for Health Care
Purposes
– Allows the Agent to make health care
decisions on the patient’s behalf if they
are unconscious, mentally incompetent,
or otherwise unable to make such
decisions.
– Is void if the patient is mentally able to
make their own decisions.
3-55
2. Power of Attorney for General
Purposes
– Authorizes the Agent to act on the
patient’s behalf in a variety of different
situations (finances, investments,
buying/selling property, managing a
business, etc.)
– Usually used to allow the agent to handle
affairs during a period of time when the
patient is physically or mentally unable to
do so themselves.
3-56
Guardianship
• A legal relationship in which the Court gives
a person (the guardian) the power to make
personal and health care related decisions
for another (the ward).
• A family member or friend may initiate the
proceeding by filing a petition in the county
where the individual resides.
• A medical examination by a licensed
physician is necessary to establish the
mental capacity of the individual.
3-57
Guardianship
• If the judge finds that the person does not
have the necessary mental capacity to care
for his or her personal needs, the judge will
appoint a guardian to make personal
decisions for the individual.
• Unless limited by the court, the guardian has
the same rights, powers and duties over his
ward as parents have over their minor
children.
• The guardian is required to report to the
court on an annual basis.
3-58
Organ Donation
An organ donor is a patient who has
completed a legal document that
allows for donation of organs in the
event of his death.
A patient’s driver’s license may also
indicate that the patient wishes to
donate organs upon his death.
EMT Role in Organ Donation
Organ donor patients are treated
the same as other patients.
Identify potential donors.
Notify medical direction.
Provide care to maintain vital
organs.
Organ Donor
Form
Advance Directives and
Do Not Resuscitate (DNR) Orders
3-62
Advance Directives
• Any competent patient can refuse
resuscitation
• Advance directive
– Legal document that specifies a person’s
healthcare wishes when she becomes
unable to make decisions for herself
3-63
Advance Directives
• If you arrive on the scene to find a patient is not
breathing and has no pulse and an advance directive
is present:
– Make sure the form clearly identifies the person to
whom the DNR applies
– Make sure the patient is the person referred to in
the document
– Make sure that the document you are viewing is of
the correct type approved by your state and local
authorities
– If the document is valid, follow the instructions
outlined in the document
3-64
Do Not Resuscitate (DNR) Orders
• Different types of DNR orders exist
– May specify that the patient does not want
CPR or a shock to the heart
– May want (and expect) oxygen and/or
medications to be given
– Alternately, may specifically state the
patient does not wish any resuscitative
measures
3-65
Advance Directive
• Some states recognize
only a specific form of
advance directive for EMS
personnel
• An individual may wear an
identifying bracelet on the
wrist or ankle
3-66
Comfort Care
• Providing comfort care means giving care to
ease the symptoms of an illness or injury.
• Comfort care includes
– Emotional support
– Suctioning the airway
– Giving oxygen
– Controlling bleeding
– Splinting
– Positioning the patient for comfort.
3-67
Physician Orders for
Life-Sustaining Treatment (POLST)
• POLST programs exist in some states
• POLST form
– Summarizes advance directives
– Does not replace an advance directive
– Is not conditional on losing decisionmaking capacity
3-68
Advance Directive
• Obtain consent from the patient as long
as he is able to make decisions about
his healthcare
3-69
Assault and Battery
• Assault
– Threatening, attempting, or
causing a fear of offensive
physical contact with a
patient or other individual
• Battery
– Unlawful touching of another
person without consent
3-70
Duty to Act
• May be a formal, contractual duty or an
implied duty
• A legal duty to act may not exist, but a moral
or an ethical duty to act may exist
3-71
Abandonment
• Terminating patient care
without making sure that
care will continue at the
same level or higher
3-72
Negligence
•
Negligence
– Deviation from the accepted standard of care,
resulting in further injury to the patient
•
Four elements must be present to prove negligence:
1. There was a duty to act
2. The healthcare professional breached that duty
3. Injury and/or damages (physical or
psychological) were inflicted
4. The actions of the healthcare professional
caused the injury and/or damage (proximate
cause)
3-73
Breach of Duty
• Performing skills or treatments outside your
scope of care can lead to a breach of duty
• A breach of duty may be proved if you failed
to act or you acted inappropriately
3-74
Damages
• Damages occur if
the patient is
injured, either
physically or
psychologically, by
your breach of duty
3-75
Proximate Cause
• Proximate cause is established when:
– Your action or inaction was the cause
of or contributed to the patient's injury
– You could reasonably foresee that
your action or inaction would result in
the damage
3-76
Protection Against Negligence Claims
• Maintain a professional attitude and conduct
• Provide skills and treatments within your scope of
care
• Maintain mastery of your skills
• Participate in CE and refresher programs
• Follow instructions provided by medical oversight
authority
• Follow standing orders or protocols
• Provide patients with a consistently high standard of
care
• Make sure your documentation is thorough and
accurate
3-77
Good Samaritan Laws and Immunity
(1 of 2)
• If you reasonably help another person, you
will not be held liable for error/omission
• Good Samaritan actions 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 is conduct that
constitutes willful or reckless disregard.
• There is another group of laws that grants
immunity from liability to official providers.
– Laws vary; always consult with the
medical director.
Confidentiality
• Health Insurance Portability and
Accountability Act (HIPAA)
– Provides patients with control over their
health information
– Sets boundaries on use and release of
medical records
– Ensures the security of personal health
information
– Establishes accountability for medical
record use and release
3-80
Confidentiality
• Protected health information (PHI) is
information that:
– Relates to an individual’s physical or
mental health, treatment, or payment
– Identifies the individual or gives a
reasonable basis to believe that the
individual can be identified
– Is transmitted or maintained in any format
3-81
Confidentiality
• You must keep confidential:
– Any medical history given to you in a
patient interview
– Any findings you may discover during
your patient assessment
– Any care that you provide
3-82
Confidentiality
• Situations in which patient consent/authorization to
the release of PHI is not required:
– When you are required by law to provide this
information
– For public health activities, such as injury/disease
control and prevention
– When the patient is a victims of abuse, neglect, or
domestic violence
– For judicial and administrative proceedings
– For specific law enforcement purposes
– To avoid a serious threat to health or safety
3-83
Confidentiality
• You may discuss your patient’s medical
condition, the treatment you gave, and the
patient’s health information with others
involved in the medical care of the patient.
3-84
Medical Identification Insignia
• Used to alert others of a particular medical
condition that the patient has
– May be a bracelet, a necklace, or an ID
card
3-85
Medical Identification Devices
Safe Haven Laws
• Allow person to drop an infant or child at any
fire, police, or EMS station
• States have different guidelines for ages of
children included
• Protect children who may otherwise be
abandoned or harmed by parents unwilling
or unable to care for them
Crime Scenes
• A crime scene is the responsibility of law
enforcement personnel
• As an EMT, your responsibilities are to:
– Ensure your own safety
– Provide care for the patient
3-88
Crime Scenes
• Responsibilities of medical personnel:
– Protect potential evidence
– Leave holes in clothing from bullet or stab
wounds intact, if possible
– Do not disturb any item at the scene
unless emergency care requires it
– Observe and document anything unusual
3-89
Crime Scenes
• Location where crime
was committed or
anywhere evidence
may be found
• Once police have made
scene safe, EMT’s
priority is patient care
• Know what evidence is
• Take steps to preserve
evidence
Examples of Evidence
•
•
•
•
Condition of scene
Patient
Fingerprints and footprints
Microscopic evidence
Evidence Preservation
•
•
•
•
Remember what you touch
Minimize impact on scene
Work with police
If patient transported on your stretcher,
stretcher sheet may be valuable source of
evidence
• Document thoroughly
Special Reporting Requirements
• Child abuse
• Elder abuse
• Spousal abuse
• Infectious disease exposure
3-93
Mandatory
Reporting Guidelines
•
•
•
•
•
Child, elderly, or domestic abuse
Sexual assault
Stab/gunshot wounds
Animal attacks
Check local laws and protocols
Mass Casualty Incidents
3-95
Organ Donation
• Organ donor
– A person who has signed a legal
document to donate his organs in the
event of his death
• Your responsibilities:
– Provide any necessary emergency care
– Notify EMS or hospital personnel that the
patient is a potential organ donor when
you transfer patient care
3-96
Documentation
3-97
Prehospital Care Report (PCR)
The prehospital care report may also be
called the:
– Patient care report
– Run report
– Encounter form
– EMS form
– Run sheet
– Trip sheet
– Incident report
– Ambulance report
3-98
Uses of the Prehospital Care Report
• Medical uses
• Continuity of care
• Legal document
• Administrative uses
• Educational and research uses
• Quality management
3-99
Characteristics of
Good Documentation
3-100
Complete
• “If it is not written down, it was not done.”
• “If it was not done, do not write it down.”
3-101
Clear and Concise
•
Your report should be clear and to the
point.
•
Include enough detail so that you will be
able to recall the events that occurred long
after they happened.
3-102
Objective
•
Document facts
– Facts should be supported by what you
see, hear, feel, and smell.
– Assessment findings such as vital signs,
audible wheezing, guarding,
restlessness, contusions, etc.
– Observations of the surroundings such
as during an MVC or suicide attempt.
3-103
Subjective
• Document
– The patient’s response to treatment. Such as “I’m
breathing better now.”
– The patient’s own description of their complaint.
Such as “I’m having a hard time catching my
breath.”
– The patient’s own description of their pain. Such
as “It feels like an elephant is sitting on my
chest.”
– The patient’s abnormal behavioral response. Such
as “I just want to die.”
3-104
Timely
3-105
Accurate
3-106
Legible
•
Write neatly
– Some interpret a sloppy report as a
reflection of sloppy care.
•
Print if necessary.
•
When completing a paper report, use a
ballpoint pen with black or blue
waterproof ink.
3-107
Documentation “Red Flags”
• It is incomplete
• It is inaccurate
• It is vague
• It is illegible
• Opinions are
included
• It has been altered
• Labeling is used
• The report is
missing
• It is late
3-108
Elements of the Prehospital Care Report
• Administrative Information
– Time incident reported to 9-1-1
– Time unit notified
– Time of arrival at patient
– Time unit left scene
– Time of arrival at destination
– Time of transfer of care
3-109
Elements of the Prehospital Care Report
• Patient Information
– Chief complaint
– Mechanism of injury or nature of illness
– Level of consciousness
– Breathing rate and effort
– Heart rate
– Skin perfusion (capillary refill) for patients
younger than 6 years old
– Skin color and temperature
– Systolic blood pressure for patients older
than 3 years old
3-110
Administrative or Dispatch
Information Section
3-111
Patient and Scene Information
3-112
Patient Assessment Section
3-113
Documentation
General Guidelines
3-114
General Guidelines
• Document important observations about the
scene.
• Document events in chronological order.
• Document pertinent positives and pertinent
negatives.
• Use abbreviations only if they are standard
and approved by your EMS system.
3-115
General Guidelines
• Documentation of sensitive information
• Document the emergency care delivered.
– Time of each intervention
– Who performed the skill
– Patient’s response
3-116
General Guidelines
• Document orders from medical direction.
• Document changes in the patient’s condition.
• Do not intentionally leave spaces blank.
– Use “N/A” if information does not apply
3-117
Confidentiality
3-118
Confidentiality
• The PCR and the information
on it are considered
confidential.
– Patient confidentiality laws
(HIPAA)
• Distribute copies of the form
per local and state protocol
and procedures.
3-119
Falsification
• Falsification of information
on the PCR may:
– Lead to suspension or
revocation of
certification/license
– Lead to other legal action
– Harm the patient
3-120
Error Correction
3-121
Documentation Formats
3-122
SOAP
• Subjective findings
• Objective findings
• Assessment
• Plan
3-123
CHART
•
•
•
•
•
Chief complaint
History
Assessment
Rx (Treatment)
Transport
3-124
Narrative
• Short story in chronological order
– Assessment findings
– Pertinent historical information
– Treatment
– Patient responses
– Transport data
3-125
Questions?
3-126
Review Questions
1. Define scope of practice, negligence,
duty to act, abandonment, and
confidentiality.
2. List several steps that must be taken
when a patient refuses care or
transportation.
3. List several types of evidence and ways
you may act to preserve it at a crime
scene.
Street Scenes
Was it appropriate not to include the
information that the patient has AIDS
during the radio report to the hospital?
What is the obligation of these EMTs
concerning the confidentiality of patient
information?
(cont.)
Street Scenes
Would you have handled the transfer of
information differently?
Would it be appropriate to tell all the
hospital staff so they would know to take
infection precautions?
(cont.)
Street Scenes
Should the information that this patient
has AIDS be shared with other EMS
providers in case they get a call for this
patient?
(cont.)
Street Scenes
What are the principles for confidentiality
that EMTs should always maintain?
Chapter Review
Chapter Review
• Medical, legal, ethical issues part of every
EMS call.
• Morals are how a person expresses beliefs
of right and wrong.
• Consent may be expressed or implied
continued
Chapter Review
• If a competent patient refuses care or
transport, you should make every effort to
persuade him, but you cannot force him to
accept care or go to the hospital.
• Negligence is failing to act properly when
you have a duty to act.
continued
Chapter Review
• Abandonment is leaving a patient after you
have initiated care and before you have
transferred the patient to a person with equal
or higher training.
Remember
• EMTs must use good judgment and decisionmaking skills when dealing with patient
consent and refusal.
• Avoiding negligence implies using good
judgment; critical thinking is an essential
component for avoiding liability.
continued
Remember
• EMTs hold responsibility for patients’
protected health information; exercising care
when dealing with this information is a legal
and ethical obligation.
Questions to Consider
• Define scope of practice, negligence, duty to
act, abandonment, and confidentiality.
• What steps must you take when a patient
refuses care or transportation?
• What types of evidence may be found at a
crime scene? How should you act to
preserve evidence?
Critical Thinking
• You respond to a motor vehicle crash and
find a seriously injured patient. He has no
pulse and you are about to begin CPR when
someone says, “Don’t do that! He’s got
cancer and a DNR!” No one has the DNR at
the scene. Do you start CPR and transport
the patient?
Summary (1 of 8)
• Consent is generally required from a
conscious adult before care can be started.
• Never withhold lifesaving care unless a valid
DNR order is present.
Summary (2 of 8)
• A parent or legal guardian must give
consent for treatment or transport of a
minor.
• Conscious, alert adults have the right to
refuse treatment or withdraw from
treatment.
Summary (3 of 8)
• Patient communication is confidential.
• Advance directives, living wills, or health
care directives are often used when a
patient becomes comatose.
• There are both definitive and presumptive
signs of death.
Summary (4 of 8)
• A donor card or driver’s license indicates
consent to organ donation.
• Standard of care is established in many
ways.
• When your ambulance responds to a call or
treatment is begun, you have a legal duty to
act.
Summary (5 of 8)
• Negligence is based on duty, breach of duty,
damages, and causation.
• Abandonment is termination of care without
the patient’s consent or provisions for
transfer of care.
• Assault is unlawfully placing a person in
fear of immediate bodily harm.
Summary (6 of 8)
• Battery is unlawfully touching a person,
which includes providing emergency care
without consent.
• Good Samaritan laws protect persons who
stop to render aid.
Summary (7 of 8)
• Records and reports are important,
particularly if a case goes to court.
• You should know the special reporting
requirements for abuse of children, the
elderly, and others; injuries related to
crimes; drug-related injuries; and childbirth.
Summary (8 of 8)
• You must meet legal and ethical
responsibilities while caring for the
patient’s physical and emotional needs.
• As an EMT, a number of situations might
cause you to end up in court.
Review
1. You arrive at the scene of an elderly lady
complaining of chest pain. In assessing her,
she holds her arm out for you to take her
blood pressure. This is an example of:
A. implied consent.
B. informed consent.
C. expressed consent.
D. emergency consent.
Review
Answer: C
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 of 2)
1. You arrive at the scene of an elderly lady
complaining of chest pain. In assessing her, she
holds her arm out for you to take her blood
pressure. This is an example of:
A. implied consent.
Rationale: Implied consent is limited to lifethreatening 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.
Review (2 of 2)
1. You arrive at the scene of an elderly lady
complaining of chest pain. In assessing her, she
holds her arm out for you to take her blood
pressure. This is an example of:
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.
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 EMR is transferred patient care from
an AEMT.
Review
Answer: D
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 (1 of 2)
2. Which of the following is an example of
abandonment?
A. An EMT leaves the scene after a competent adult
has refused care.
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.
Review (2 of 2)
2. Which of the following is an example of
abandonment?
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 EMR is transferred patient care from an AEMT.
Rationale: Correct answer
Review
3. The unauthorized confinement of a person
is called:
A. assault.
B. battery.
C. false imprisonment.
D. slander.
Review
Answer: C
Rationale: False imprisonment is defined as
the confinement of a person without legal
authority or the person’s consent.
Review (1 of 2)
3. The unauthorized confinement of a person
is called:
A. assault.
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.
Review (2 of 2)
3. The unauthorized confinement of a person
is called:
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:
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 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:
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 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. only provide airway management until the parents
are contacted.
Review
Answer: A
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 (1 of 2)
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 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.
Review (2 of 2)
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 parents. You should:
C. continue with treatment only if authorized by
medical control.
Rationale: If a true emergency exists, then
consent is implied.
D. only provide airway management 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.
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
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 (1 of 2)
6. An advance directive is:
A. a set of specific guidelines that clearly defines the
different types of consent.
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.
Review (2 of 2)
6. An advance directive is:
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 defines the patient’s medical decisions.
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
B. A man who is staggering and states that
he only drank 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
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 a rationale decision;
therefore, you should provide care based on
the law of implied consent.
Review (1 of 2)
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
Rationale: You must assess whether this patient’s
mental condition is impaired.
B. A man who is staggering and states that he only
drank three beers
Rationale: You must assess whether this patient’s
mental condition is impaired.
Review (2 of 2)
7. Which of the following patients is competent and
can legally refuse EMS care?
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 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
Rationale: Unlawfully placing a person in fear
of immediate bodily harm (ie, having him
restrained) without his consent constitutes
assault. Unlawfully touching a person without
his or her consent constitutes battery.
Review (1 of 2)
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 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 care without
consent.
Review (2 of 2)
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 restrained if he does not give you consent.
Your actions in this case are an example of:
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:
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
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.
Rationale: This is a moral obligation to act and 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: This is a moral obligation to act, and not
a legal one.
Review
10. Which of the following statements about
records and reports is FALSE?
A. Legally, if it wasn't documented, it was not
performed
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
Rationale: One of your most important safeguards
against legal problems is a complete, accurate
report; if it wasn’t documented, it wasn’t done!
Furthermore, an incomplete or untidy patient care
report (PCR) suggests incomplete or inexpert
medical care. The PCR becomes a part of the
patient’s hospital medical record; even though
your treatment was provided outside the hospital,
the PCR ensures continuity of care in the hospital.
Review (1 of 2)
10. Which of the following statements about records
and reports is FALSE?
A. Legally, if it wasn't documented, it was not
performed
Rationale: True. If it was not written, 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.
Review (2 of 2)
10. Which of the following statements about records
and reports is FALSE?
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