Chapter 4: Medicolegal and Ethical Issues

Question 1

In a medical liability suit involving a paramedic, the plaintiff:
A) must prove that the paramedic broke an established law.
B) is the paramedic and is generally represented by a lawyer.
C) usually seeks compensation for the injury he or she sustained.
D) must convince 6 of 12 jurors to agree with his or her position.

Answer 1

C) usually seeks compensation for the injury he or she sustained.

Question 2

What is the main legal risk of providing a tiered-response EMS system?
A) Ambulance crashes at intersections as ALS and BLS providers simultaneously respond to the scene
B) Exposure to liability if the BLS crew makes an improper determination that a patient does not need ALS care
C) Lengthy response times for the BLS crew if ALS providers wait too long before determining that they need help
D) Premature canceling of a BLS crew by an on-scene paramedic who performs an improper assessment of the patient

Answer 2

B) Exposure to liability if the BLS crew makes an improper determination that a patient does not need ALS care

Question 3

According to the qualified immunity doctrine, the paramedic can be held liable only if:
A) he or she volunteers as a paramedic and receive no remuneration for his or her medical services.
B) the medical care that he or she provided was not consistent with what a physician would have provided.
C) he or she was not employed by a governmental entity at the time an incident or violation occurred.
D) the plaintiff proves that the paramedic violated a clearly established law about which he or she should have known.

Answer 3

D) the plaintiff proves that the paramedic violated a clearly established law about which he or she should have known.

Question 4

While on duty, a paramedic unit stops at the scene of a traffic accident to which it has not been dispatched. During the course of providing patient care, one of the paramedics purposely manipulates the patient’s neck to elicit a painful response. This paramedic:
A) is protected by the Good Samaritan law because he was not officially dispatched to the scene of the accident.
B) is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed.
C) is not protected by the Good Samaritan law but provided treatment that is consistent with the accepted standard of care.
D) cared for the patient in a manner consistent with his scope of practice and is not liable for the patient’s injury or injuries.

Answer 4

B) is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed.

Question 5

Documenting a false statement that injures a person’s good name or reputation constitutes:
A) libel and defamation.
B) assault and battery.
C) slander and defamation.
D) gross negligence.

Answer 5

A) libel and defamation.

Question 6

Which of the following is an example of slander?
A) Asking a family member if the patient uses drugs
B) Telling the receiving facility that a patient is drunk
C) Asking a patient if he or she is under psychiatric care
D) Documenting that you noted the possible smell of alcohol

Answer 6

B) Telling the receiving facility that a patient is drunk

Question 7

While caring for a conscious and alert 49-year-old man with a suspected myocardial infarction, you start an IV before obtaining the patient’s consent. This action constitutes:
A) appropriate care.
B) assault.
C) battery.
D) gross negligence.

Answer 7

C) battery.

Question 8

Assault on a patient occurs when the EMS provider:
A) defames a patient’s character in his or her report.
B) touches another person without obtaining consent.
C) carries out a harmful physical act against a patient.
D) instills the fear of immediate bodily harm in a patient.

Answer 8

D) instills the fear of immediate bodily harm in a patient.

Question 9

Which of the following scenarios MOST accurately depicts abandonment?
A) A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day.
B) While en route to the hospital with a patient experiencing chest pressure, you encounter a major motor vehicle accident, call the dispatcher to request assistance, and proceed to the hospital with your patient.
C) During a mass-casualty incident involving a building collapse, a paramedic triages a patient as being low priority and instructs an EMT to observe the patient and inform the paramedic if the patient’s condition deteriorates.
D) A mentally competent adult with shortness of breath adamantly refuses to be transported to the hospital via EMS, so you arrange for a friend or family member to stay with the patient and call 9-1-1 if it becomes necessary.

Answer 9

A) A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day.

Question 10

Abandonment occurs when:
A) a patient is released and did not require further medical care.
B) an emergency nurse takes a verbal report from a paramedic.
C) care of a patient was terminated without his or her consent.
D) a patient refuses care and subsequently dies of his condition.

Answer 10

C) care of a patient was terminated without his or her consent.

Question 11

You deliver a 61-year-old man with abdominal pain to a busy emergency department. A staff nurse instructs you to take the patient to the triage area where he will be tended to later. She further tells you that after you leave a copy of your patient care report with the clerk, you are free to leave. You should:
A) do as the nurse instructs you and thoroughly document the incident to ensure you are not accused of abandonment.
B) leave the patient in the triage area, give your patient care report to the clerk and tell the clerk to keep an eye on the patient.
C) advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient.
D) transfer the patient to a gurney in a highly visible area, advise the nurse of what you did, and give the nurse a copy of your patient care report.

Answer 11

C) advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient.

Question 12

Which of the following general statements regarding medical law is correct?
A) Medical providers with fewer than 5 years of experience are at highest risk of being sued.
B) A poor patient outcome typically means that the medical provider was grossly negligent.
C) The patient or survivor must prove all elements of negligence before a lawsuit will be successful.
D) A medical liability lawsuit will only be successful if the patient’s outcome was unfavorable.

Answer 12

C) The patient or survivor must prove all elements of negligence before a lawsuit will be successful.

Question 13

Which of the following is NOT a required element needed to prove negligence?
A) The paramedic committed a breach of duty.
B) The patient’s condition was life-threatening.
C) The paramedic or EMS system had a duty to act.
D) An act of omission was the cause of the patient’s injury.

Answer 13

B) The patient’s condition was life-threatening.

Question 14

Which of the following statements regarding the harm element of a negligence lawsuit is MOST correct?
A) The burden of proof for establishing harm rests with the defendant.
B) Serious injury must have occurred in order for harm to be established.
C) A loss of earning capacity is a form of harm that the patient may claim.
D) Loss of income is the most common form of harm proven in a lawsuit.

Answer 14

C) A loss of earning capacity is a form of harm that the patient may claim.

Question 15

Prior to administering nitroglycerin to a patient with chest pain, the patient denies the use of erectile dysfunction (ED) drugs when asked, even though he took an ED drug a few hours earlier. After being given the nitroglycerin, the patient experiences severe hypotension and almost dies. Which of the following could the paramedic use as a potential defense if the patient attempts to sue?
A) Patient incompetence
B) Contributory negligence
C) Plausible deniability
D) Qualified immunity

Answer 15

B) Contributory negligence

Question 16

Informed consent involves:
A) carefully explaining the potential ramifications of refusing emergency medical treatment.
B) ensuring that a patient understands the potential risks involved in performing a particular procedure.
C) a patient verbally expressing his or her wishes for you to proceed with emergency medical treatment.
D) explaining the rationale for an invasive procedure to a patient after you have already performed it.

Answer 16

B) ensuring that a patient understands the potential risks involved in performing a particular procedure.

Question 17

A patient who rolls up his or her sleeve so that you can take his or her blood pressure has given you __________ consent.
A) implied
B) informed
C) rational
D) expressed

Answer 17

A) implied

Question 18

Implied consent is based on the premise that a patient:
A) would consent to care because of the seriousness of his or her injury.
B) will die unless emergency medical treatment is provided immediately.
C) is of legal age and is able to make rational decisions regarding his or her care.
D) would refuse any emergency medical care if he or she were unconscious.

Answer 18

A) would consent to care because of the seriousness of his or her injury.

Question 19

Because minors have no legal status:
A) they can neither consent to nor refuse medical care.
B) you must obtain consent from both parents before treating.
C) they must always be treated under the law of implied consent.
D) you must obtain a court order before you can legally treat them.

Answer 19

A) they can neither consent to nor refuse medical care.

Question 20

If a conscious patient with decision-making capacity refuses care for a potentially life-threatening condition:
A) you must begin lifesaving treatment at once.
B) he or she cannot be treated without a court order.
C) implied consent will allow you to treat the patient.
D) medical direction can overrule the patient’s decision.

Answer 20

B) he or she cannot be treated without a court order; involuntary consent.

Question 21

If a patient has a potentially life-threatening illness or injury and there is any doubt as to his or her decision-making capacity, the paramedic should:
A) treat and transport, even if it is against the patient’s will.
B) obtain a court order and then begin emergency treatment.
C) have the patient arrested and placed in protective custody.
D) obtain consent from a family member to treat the patient.

Answer 21

A) treat and transport, even if it is against the patient’s will.

Question 22

A patient’s wife called 9-1-1 because the patient was complaining of a severe headache and nausea. The patient is conscious and alert, but obviously upset that his wife called 9-1-1 without consulting with him first. As you present the blood pressure cuff, the patient folds his arms and turns away from you. From this patient’s actions, you should conclude that:
A) he is not mentally competent.
B) you do not have consent to treat him.
C) consent to treat this patient is implied.
D) he will only consent to EMS transport.

Answer 22

B) you do not have consent to treat him.

Question 23

A 39-year-old man with severe dehydration requires IV fluid therapy to treat his condition. The patient is conscious, alert, and oriented to person, place, time, and event. You should:
A) ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy.
B) tell the patient that you are going to start an IV on him in order to replenish his body with lost fluid and electrolytes.
C) start the IV to quickly restore his body fluid balance and then explain to the patient why you started the IV line.
D) establish the IV line based on the law of implied consent, because his condition has impaired his decision-making capacity.

Answer 23

A) ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy.

Question 24

You arrive at the scene of a motor-vehicle-versus-pedestrian accident. The patient is a 12-year-old girl who was struck by a car while riding her bike. She is conscious but combative. She has a large hematoma on her leg and several hematomas to her forehead. As a police officer attempts to contact the child’s parents, you should:
A) provide supportive care only but do not transport the child until the parents arrive and give consent.
B) closely monitor the child’s condition and begin emergency treatment after obtaining consent from both parents.
C) assume that her parents would consent to emergency treatment and initiate the appropriate care for the child.
D) withhold all emergency care until you have obtained consent from at least one of her parents via telephone.

Answer 24

C) assume that her parents would consent to emergency treatment and initiate the appropriate care for the child.

Question 25

A person wishes to be an organ donor. He or she must:
A) have a documented terminal illness.
B) be at least 21 years of age in most states.
C) have this delineated on his or her driver’s license.
D) have witnessed informed consent, usually in writing.

Answer 25

D) have witnessed informed consent, usually in writing.

Question 26

If a mortally injured patient’s wishes regarding organ donation are not known:
A) Consent should be obtained from a family member.
B) it should be assumed that the patient would consent.
C) a physician can legally authorize donation of organs.
D) a court order is required to initiate the procurement process.

Answer 26

A) Consent should be obtained from a family member.

Question 27

Conducting EMS research studies on critically ill or injured patients without their informed consent is:
A) inappropriate.
B) ethically acceptable.
C) a true ethical dilemma.
D) legal under the law of implied consent.

Answer 27

C) a true ethical dilemma.

Question 28

You are caring for a 66-year-old man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating “Just let me die with dignity!” You should:
A) tell him that the oxygen is crucial in preventing him from experiencing cardiac arrest.
B) respect the patient’s wishes and ask him if he wants to be transported to the hospital.
C) contact medical control and request permission to treat without the patient’s consent.
D) recognize that patients with terminal illnesses do not have decision-making capacity.

Answer 28

B) respect the patient’s wishes and ask him if he wants to be transported to the hospital.

Question 29

You arrive at the scene of a major motor vehicle crash. The patient, a 29-year-old man, is in cardiac arrest from a severe head injury and has been receiving bystander CPR for approximately 10 minutes. A law enforcement official advises you that the patient’s driver’s license identifies him as an organ donor. You should:
A) recognize that none of the patient’s vital organs are appropriate for donation and ask the bystanders to stop CPR.
B) continue to attempt resuscitation of the patient because his liver, kidneys, and heart are likely viable for harvesting.
C) begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting.
D) continue basic life support only until law enforcement can notify a family member of the patient and obtain consent for organ donation.

Answer 29

C) begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting.

Question 30

Patients with decision-making capacity:
A) cannot refuse EMS treatment and transport after they have given consent for it.
B) have the right to refuse all or part of the emergency medical care offered to them.
C) must agree to EMS transport if they give consent for emergency medical treatment.
D) cannot withdraw consent unless their conditions are deemed to be non-life-threatening.

Answer 30

B) have the right to refuse all or part of the emergency medical care offered to them.

Question 31

If a mentally competent adult refuses emergency medical treatment, your FIRST action should be to:
A) call medical control and seek further guidance.
B) determine if his or her condition is life-threatening.
C) assume the refusal is from fear and begin treatment.
D) try to determine why he or she is refusing treatment.

Answer 31

D) try to determine why he or she is refusing treatment.

Question 32

A 17-year-old woman presents with acute abdominal pain while at a party with her husband. You arrive at the scene, assess the patient, and advise her of the need for EMS treatment and transport. However, the patient, who is conscious and alert, refuses EMS treatment and transport and states that her husband will transport her in his car. You should:
A) advise her of the potential risks of refusing EMS treatment and transport.
B) begin treatment using implied consent, because she is under 18 years of age.
C) ensure that she has decision-making capacity and then obtain a signed refusal.
D) accept her refusal because the fact that she is married makes her emancipated.

Answer 32

A) advise her of the potential risks of refusing EMS treatment and transport.

Question 33

You are called to a community center for a 40-year-old woman who is “acting strange.” Upon your arrival, you assess the patient and determine that she is conscious, alert, and oriented to person, place, time, and event. She does not appear to be mentally impaired. Her oxygen saturation is 99% on room air and her blood glucose level is 112 mg/dL. The patient’s husband tells you that his wife has bipolar disorder and takes medication for it. The patient tells you that she is fine and does not want to go to the hospital. You should:
A) contact online medical control and request permission to transport the patient against her will because of her bipolar disorder.
B) recognize that this patient has decision-making capacity at the present time and that you cannot force her to go to the hospital.
C) transport the patient against her will, but only if it can be established that she has been noncompliant with her bipolar medication.
D) advise the patient that, because of her history of bipolar disorder, she does not have the legal capacity to refuse EMS treatment and transport.

Answer 33

B) recognize that this patient has decision-making capacity at the present time and that you cannot force her to go to the hospital.

Question 34

Patient autonomy is MOST accurately defined as the:
A) court’s support and upholding of the rights of a patient with regard to health care decisions.
B) patient’s right to direct his or her own care and to decide how end-of-life care should be provided.
C) inability of the patient to refuse medical treatment once he or she has given appropriate consent.
D) right of the patient to determine which medications the paramedic should administer for a given situation.

Answer 34

B) patient’s right to direct his or her own care and to decide how end-of-life care should be provided.

Question 35

You respond to a skilled nursing facility for a patient who is not breathing. When you arrive, you assess the patient, a 78-year-old man, and confirm apnea. However, the patient has a rapid carotid pulse. The charge nurse advises you that, according to the patient’s family, the patient is not to be resuscitated. You should:
A) not attempt any form of resuscitation and ask the charge nurse to notify the patient’s family immediately.
B) remain at the scene, begin artificial ventilations, but discontinue if the family arrives and presents a valid DNR order.
C) contact medical control and request authorization to provide palliative care only and transport the patient to the hospital.
D) maintain the patient’s airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

Answer 35

D) maintain the patient’s airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

Question 36

A DNR order is MOST accurately defined as a:
A) written order designed to tell health care providers when resuscitation is or is not appropriate.
B) legal document that is executed by the patient while he or she still has decision-making capacity.
C) written or oral directive that stipulates the care that a patient should receive at the end of his or her life.
D) legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients.

Answer 36

A) written order designed to tell health care providers when resuscitation is or is not appropriate.

Question 37

Although the technicalities of EMS DNR orders vary from state to state, they all:
A) are completely irrevocable by the patient’s immediate family members.
B) require the patient to wear a DNR insignia such as a bracelet or necklace.
C) are designed to tell EMS providers when resuscitation is or is not appropriate.
D) must be renewed every 5 years or they will expire and become null and void.

Answer 37

C) are designed to tell EMS providers when resuscitation is or is not appropriate.

Question 38

The husband of a terminally ill woman called 9-1-1 because he thinks his wife is about to die. The patient has a valid living will and an out-of-hospital DNR order. You should:
A) ask the husband why he called EMS if his wife is not to be resuscitated.
B) assume that the husband has revoked the DNR order and begin treatment.
C) contact medical control and request permission to provide emergency care.
D) treat the husband and his wife with respect and provide emotional support.

Answer 38

D) treat the husband and his wife with respect and provide emotional support.

Question 39

A 77-year-old man with end-stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apneic and pulseless. The daughter presents you with an out-of-hospital DNR order; however, the document expired 3 months ago. You should:
A) begin CPR only and contact medical control for further guidance.
B) realize that the patient cannot be resuscitated and notify the coroner.
C) begin full resuscitative efforts because the DNR order is no longer valid.
D) confirm that the order has expired before initiating any patient treatment.

Answer 39

A) begin CPR only and contact medical control for further guidance.

Question 40

Health care powers of attorney are also called “durable” powers of attorney because they:
A) must be in the patient’s possession at all times.
B) can only be revoked by the patient’s personal physician.
C) remain in effect once a patient loses decision-making capacity.
D) do not require anyone to make decisions on the patient’s behalf.

Answer 40

C) remain in effect once a patient loses decision-making capacity.

Question 41

When functioning at a crime scene, it is important for the paramedic to:
A) collect and safeguard any and all evidence.
B) carefully question witnesses as to what they saw.
C) use caution and not disturb the scene unnecessarily.
D) avoid performing patient care until cleared by the police.

Answer 41

C) use caution and not disturb the scene unnecessarily.

Question 42

You arrive at the scene of a shooting. The patient, a 19-year-old man, has a gunshot wound to the side of his head with a large amount of exposed brain matter. Further assessment reveals that the patient is apneic and pulseless. Law enforcement personnel advise you that the person who shot the patient is in their custody. You should:
A) begin resuscitative measures at once and contact the patient’s family to determine if he is an organ donor.
B) begin CPR immediately, cover the wound with a bulky dressing, and prepare to transport the patient.
C) avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene.
D) place plastic bags over the patient’s hands, apply a cardiac monitor to confirm asystole, and notify the coroner’s office.

Answer 42

C) avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene.

Question 43

While caring for an 80-year-old man with a possible fractured arm, you discover other injury patterns that are suggestive of abuse. The patient is conscious and alert. You should:
A) splint the patient’s arm, transport him to the hospital, and report your suspicions to the emergency department physician.
B) advise the patient that you suspect he has been abused and that you are required by law to report this to the authorities.
C) splint the patient’s arm and contact his family to determine if they are aware of the fact that he has been physically abused.
D) treat the patient’s injury appropriately and then obtain his consent to report your suspicions to the emergency department physician.

Answer 43

A) splint the patient’s arm, transport him to the hospital, and report your suspicions to the emergency department physician.

Question 44

You have been attempting resuscitation of a middle-aged woman for approximately 15 minutes; however, she has not responded to any of your treatment. There is no evidence of hypothermia or drug ingestion, and the cardiac monitor shows asystole. You should:
A) determine if she has an advance directive.
B) consider terminating your resuscitative efforts.
C) perform CPR only and try to contact her family.
D) pronounce the patient dead and call the coroner.

Answer 44

B) consider terminating your resuscitative efforts.

Question 45

During the attempted resuscitation of a 79-year-old man in cardiac arrest, a young man arrives at the scene and asks you to cease resuscitative efforts. He further tells you that the patient has entrusted him to make all of his medical decisions. You should:
A) continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions.
B) limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive.
C) cease all resuscitative efforts, contact medical control, and advise medical control that a surrogate decision maker is present and has requested you to stop.
D) advise the man that, because he does not have valid documentation that he is authorized to make decisions for the patient, you must continue resuscitation.

Answer 45

A) continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions.