Chapter 4 | Medical, Legal, and Ethical Issues

Question 1

Define:

patient consent

Answer 1

expressed or implied permission from patient to assess/treat/transport

Question 2

Fill in the blank:

Minors [ARE/AREN’T] permitted to provide consent for treatment.

Answer 2

Minors aren’t permitted to provide consent for treatment.

Question 3

Explain:

obtaining patient consent for children

(and exceptions)

Answer 3

seek consent from parent or legal guardian

(except in loco parentis, emancipated minors, or major life threats)

Question 4

Explain:

obtaining patient consent for mentally incompetent adults

Answer 4

state and local laws and protocols permit transport of such patients under implied consent

Question 5

Define:

involuntary transport

Answer 5

court-ordered patient transport when patient is considered threat to self or others

Question 6

List:

requirements for a patient to refuse care

4 points

Answer 6

• legally able to consent
• mentally competent and oriented
• fully informed of risks
• signed release form

Question 7

Fill in the blank:

Despite all precautions for refusal of care, the [BLANK] may still be [BLANK].

Answer 7

Despite all precautions for refusal of care, the EMT may still be held liable.

Question 8

List:

reccomended actions when feeling doubtful about patient’s refusal of care

6 points

Answer 8

• 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

Question 9

List:

special considerations when obtaining a patient’s refusal of care

4 points (what to tell them, what you need, what you should do right after)

Answer 9

• have witnesses to refusal
• inform patient to call 911 if mind changed
• have friend/relative remain with patient
• document everything

Question 10

Define:

advance directives

Answer 10

legal document expressing patient’s wishes if unable to speak for self

Question 11

List:

examples of advance directives

3 points

Answer 11

• do-not-resuscitate order (DNR)
• living will
• health care proxy

Question 12

Fill in the blank:

Advance directives [DO/DON’T] prevent the EMT from providing comfort measures.

Answer 12

Advance directives do not prevent the EMT from providing comfort measures.

Question 13

Define:

scope of practice

Answer 13

regulations and ethical considerations that define extent or limits of job duties

Question 14

Fill in the blank:

Scope of practice is determined by [BLANK], [BLANK], and [BLANK].

Answer 14

Scope of practice is determined by laws, statutes, and protocols.

Question 15

Define:

standard of care

Answer 15

care expected from EMT with similar training for patient in a similar situation

Question 16

Explain:

difference between scope of practice and standard of care

Answer 16

• scope of practice: what you can do
• standard of care: how you should do it

Question 17

Define:

duty to act

Answer 17

obligation to provide care

(applies when EMT is on duty and no risk to safety)

Question 18

Define:

res ipsa loquitur

(latin legal term)

Answer 18

occurrence of accident itself implies negligence

Question 19

Define:

abandonment

Answer 19

discontinuance of care without proper patient transfer to medical personnel of equal/greater training

Question 20

Define:

good samaritan laws

Answer 20

laws which grant immunity from liability for people acting in good faith within level of training

Question 21

Describe:

“privacy rule” of the Health Insurance Portability and Accountability Act (HIPAA)

Answer 21

statute that defines information on patient’s history, condition, treatment as confidential

does not apply to other health care personnel as part of continuing care

Question 22

Define:

organ donor

Answer 22

person with completed legal document allowing donation of organs and tissues in event of death

Question 23

List:

ways to identify organ donors

3 points

Answer 23

• family members
• donor card
• drivers license

Question 24

Answer:

What do you do when you learn that a patient is an organ donor?

Answer 24

Receiving hospital and/or medical direction should be advised (per protocol).

Question 25

Define:

safe haven laws

Answer 25

laws which allow people to drop an infant/child at any fire, police, or EMS station without repercussions

Question 26

Define:

crime scene

Answer 26

location where crime was committed

anywhere evidence may be found

Question 27

List:

examples of crime scene evidence

4 points

Answer 27

• condition of scene
• patient
• fingerprints/footprints
• microscopic evidence

Question 28

List:

ways to preserve evidence on scene

5 points

Answer 28

• remember what you touch
• minimize impact on scene
• work with police
• preserve stretcher sheet (if used)
• document thoroughly

Question 29

List:

criteria of mandatory reporting guidelines

4 points (different types of incidents)

Answer 29

• child/elderly/domestic abuse
• sexual assault
• stab/gunshot wound
• animal attacks

Question 30

Fill in the blank:

Involuntary transport of a patient requires a [BLANK].

Answer 30

Involuntary transport of a patient requires a court order.

Question 31

Define:

negligence

Answer 31

failure to act (or act correctly)

Question 32

List:

3 criteria to determine negligence

Answer 32

• EMT had duty to act
• breach of duty (EMT failure to provide standard of care)
• proximate causation (patient suffered harm because EMT action/inaction)

Question 33

Define:

breach of duty

Answer 33

EMT failure to provide standard of care

Question 34

Define:

proximate causation

Answer 34

harm suffered by patient due to EMT negligence

Question 35

Fill in the blank:

Res ipsa loquitur is a legal concept important in [BLANK] cases.

Answer 35

Res ipsa loquitur is a legal concept important in negligence cases.

Question 36

Answer:

Your patient has facial and head injuries and states that her husband beat her with a telephone receiver.

Do you have to report this incident?

Answer 36

probably

Question 37

Answer:

Your patient is an 18-year-old college student who has been consuming large amounts of alcohol at a fraternity party.

Do you have to report this incident?

Answer 37

probably not

Question 38

Answer:

You suspect the wife of the patient you are treating for chest pain has been smoking marijuana.

Do you have to report this incident?

Answer 38

probably not

Question 39

Answer:

Your patient is a 12-year-old male who fell from his bicycle, breaking his left arm, and tells you his parents are at work.

Do you have to report this incident?

Answer 39

probably not

Question 40

Define:

in loco parentis

Answer 40

in the place of a parent (with reference to other adult responsible for children)

(e.g. school nurse can make decisions for child)

Question 41

Choose:

You are called to a local residence for a distraught adult female complaining of a bloody nose and mouth from an accidental household fall. As you approach the home, a man comes out, closing the door behind him. He tells you that “everything is fine”, advising you to “just leave before you make things worse.”

What is the correct course of action in this case?

A. Tell him you must get a refusal from the apparent victim of the injury

B. Tell him to get out of the way before you have him arrested

C. Return to the unit and clear the call as no patient found

D. Return to the unit and advise dispatch and supervisor of the circumstances

Answer 41

D

Never cause a confrontation on scene with a bystander or even a patient. It is best in this situation to return to the safety of the unit (leave the immediate area if it will calm the situation) and advise dispatch and your supervisor of the situation at hand.

Question 42

Choose:

Which of the following situations must be reported by an emergency medical services provider to local law enforcement?

A. Trauma caused by animals/pets

B. Drug overdoses

C. Accidental injuries to a minor

D. Motor vehicle accident

Answer 42

A

In most states and regions, all EMS personnel have a duty to act and report incidents of ANY animal bites either from a wild animal or a domestic pet. This is due to risk to the public and the potential for fatal disease (rabies). Normally, it is to the local sheriff’s department.

Question 43

Choose:

You are on scene with a patient in cardiac arrest. You turn the AED on and attach the pads to the patient. When the AED begins to analyze the patient’s cardiac rhythm, it signals “low battery” and then shuts off. The patient subsequently dies.

Which of the following statements regarding this scenario is most correct?

A. The manufacturer of the AED will be held liable for negligence.

B. The crew member that checked off the truck may be held liable for negligence.

C. Most errors associated with the AED involve charging failure.

D. You and your partner may be held liable for negligence.

Answer 43

D

The most common errors that occur with the AED are the result of operator error (not equipment failure), usually because no one made sure that the batteries were fully charged when checking the ambulance at the start of the shift. Most jurisdictions have equipment readiness checklists that EMS providers are responsible for at the beginning of their shifts, making those individuals potentially legally responsible for the individual’s death.