General Guidelines

Adult patients are ____ years and older

12

Geriatric patients are ___ years and older

65

What age range considered pediatric

Less than 12

Age range considered neonate

Less than a month

Age range considered newborn

Less than 48 hours

What is CURV used for and what does it stand for?

To determine DMC

1. Can the patient communicate a decision?

2. Does the patient understand the risks/benefits/alternatives/consequences of the decision?

3. Can the patient give a logical reason for not wanting to go?

4. Does the patient’s decisions seem in line with their values; i.e., similar to how they’ve been responding to questions so far?

True or false: a provider is able to override a patient’s DMC if the provider feels like the patient is making a bad decision

False. If a patient has DMC, they have the right to “make a bad decision”

True or false: if a provider smells alcohol on an adult patient’s breath, that means that the patient is likely drunk and so does not have DMC.

False. Possible intoxication on its own does not remove DMC.

You are dispatched to a 16 year old patient seeking treatment for depression. Her father is present and states that he does not want her to be transported. Who has DMC?

Patients 15 years or older can seek treatment for mental health without parental consent. So in this case, the 16 year old has DMC and you can transport regardless of her father’s wishes.

What must you document in the case of a refusal?

• PCR required for any minor with a complaint/injury

• EMS assistance offered and declined

• Risks of refusal explained to patient

• Patient understands risks of refusal

• Patient reminded to call back if they need us

• Name of base contact physician authorizing refusal of care if applicable

• Signed refusal of care if possible

Examples of signs of life in a patient?

• Spontaneous movement

• Breathing

• Pulse

• Reactive pupils

• Cardiac activity on ultrasound

Exceptions to the typical guidelines for field pronouncements?

• Hypothermic arrest

• Drowning with hypothermia and submersion < 60 min

• Lightning strike and electrocution

• Avalanche victim

• Pregnant patient >= 20 weeks

What constitutes a nonviable birth?

• < 22 weeks

• Fused fingers in unknown gestational age

• No signs of life in presence of:

  • Decomposition

  • Missing major part of head and/or brain

• Always contact base

You are performing chest compressions on your patient. You suddenly see an abrupt rise in ETCO2 by 40 mmHg and it is sustained. What does this mean?

ROSC