Medical, Legal, and Ethical Issues

The process by which an individual, institution, or program is evaluated and recognized as meeting certain predetermined standards to ensure safe and ethical patient care.

Certification

The process by which a competent authority, usually the state, grants permission to practice a job, trade, or profession.

Licensure

An established process to determine the qualifications necessary to be allowed to practice a particular profession or to function as an organization.

Credentialing

How a reasonably prudent person with similar training and experience would act under similar circumstances, with similar equipment, and in the same or similar place.

Standard of care

Once your ambulance is dispatched to an emergency, you have an obligation to respond. What is this called?

Duty to act

You arrive at the scene of a call to find an elderly man complaining of chest pain. You introduce yourself and ask permission to examine him. He nods and extends his arm. Which type of consent is this?

Expressed content

While evaluating a noncritical patient in the field, you received a call from dispatch about a serious four-car accident. You inform the patient whom you are treating that he should have someone take him to his doctor to get checked out; you then leave to attend to the more seriously injured people. This is an example of:

abandonment

What is the best way to care for your patient once he tells you he does not want to go to the hospital?

Encourage the patient to call 9-1-1 again if his condition worsens

The right of a patient to make decisions concerning his or her health is called:

patient autonomy.

_____ is an obvious sign of death, which is caused by discoloration of the body from pooling of the blood to the lower parts of the body.

Dependent lividity

You belong to a small volunteer EMS company and are treating a patient with chest pain. You believe that the administration of aspirin is indicated. You ask the patient if he is allergic to aspirin and he says no. Shortly after you administer the aspirin, the patient develops signs and symptoms of a severe allergic reaction. Later in the hospital, the doctor advises you that the patient’s medical history shows that the patient has an allergy to aspirin. The patient later sues you. Which of the following is your best defense strategy?

Gross negligence

Which of the following gives surrogates the right to make decisions for patients regarding their health care in the event that the patient is incapacitated and unable to make such decisions?

Durable power of attorney for health care

You have responded to a vehicle accident call. Initially, the male patient allows you to splint his broken arm and complete a primary assessment. However, he rescinds consent during transport and demands to be let out of the ambulance. If you refuse, which of the following might you be charged with?

False imprisonment

During your monthly internal quality improvement (QI) meeting, you review several patient care reports (PCRs) with the staff of your EMS system. You identify the patient's name, age, and sex, and then discuss the treatment that was provided by the EMTs in the field. By taking this approach to the QI process, you:

are in violation of HIPAA because you did not remove the PHI from the PCR beforehand.

Acting in such a way as to make another person fear immediate bodily harm is called:

assault.

The EMT's scope of practice within his or her local response area is defined by the:

medical director

While transporting a stable patient with chest pain to the hospital, you come across a major motor vehicle crash involving several critically injured patients. You should:

continue transporting your patient and notify the dispatcher of the crash.

You are treating a man who was assaulted and has a closed-head injury. The patient, who has slurred speech, becomes verbally abusive and tells you to leave him alone. You should:

proceed with treatment and utilize law enforcement for assistance if necessary.

In which of the following circumstances can the EMT legally release confidential patient information?

The patient is competent and signs a release form

You and your partner are the first to arrive at a potential crime scene with a critically injured patient involved. The scene is safe. Your first priority is to:

provide immediate patient care.

You have been tasked by your medical director with assisting in the development of your EMS agency's institutional standards. When developing these standards, it is important to:

be reasonable and realistic to avoid overburdening EMS personnel.

Which of the following general statements regarding consent is correct?

A patient can consent to transport but can legally refuse treatment.

Shortly after you load your patient, a 50-year-old man with abdominal pain, into the ambulance, he tells you that he changed his mind and does not want to go to the hospital. The patient is conscious and alert and has no signs of mental incapacitation. You are suspicious that the man has a significant underlying condition and feel strongly that he should go to the hospital. Which of the following statements regarding this situation is correct?

A mentally competent adult can withdraw his or her consent to treat at any time

Which of the following situations requires you to notify the appropriate authorities?

Attempted suicide

Putrefaction is defined as:

decomposition of the body's tissues.

Two EMTs witnessed a call in which a coworker gave adequate medical care but ignored the patient's emotional needs. The coworker was deliberately rude solely because the patient was thought to be infected with the human immunodeficiency virus (HIV). The EMTs ignored the coworker's treatment of this patient and took no steps to prevent this behavior from happening again. This lack of action on the part of the two EMTs is considered:

legal but unethical.

Which of the following statements regarding Good Samaritan laws is correct?

Such laws will not protect the EMT in cases of gross negligence.

You are dispatched to the residence of a person who frequently calls 911 for nonemergency care. You should:

ask the dispatcher to send law enforcement before you respond.

An EMT would most likely be held liable for abandonment if he or she:

did not make provisions for continued care of an injured patient.

You respond to the home of a 59-year-old man who is unconscious with slow, shallow breathing and a weak pulse. The family states that the patient has terminal brain cancer and does not wish to be resuscitated. They further state that there is a DNR order for this patient, but they are unable to locate it. You should:

begin treatment and contact medical control as needed.

Maintaining the chain of evidence at the scene of a crime should include:

not cutting through holes in clothing that were caused by weapons.

You are dispatched to an office building for a 49-year-old male with chest pain. When you arrive at the scene, you find the patient to be conscious and alert but in obvious pain. He tells you that he did not call 911; a coworker did. He further states that he does not want to be treated or transported to the hospital. You should:

ensure that he is aware of the risks of refusing medical care.

You arrive at the scene of a motor vehicle-versus-pedestrian accident. The patient, a 13-year-old male, is unconscious and has multiple injuries. As you are treating the child, a law enforcement officer advises you that the child's parents will be at the scene in approximately 15 minutes. What should you do?

Transport the child immediately and have the parents meet you at the hospital.

To minimize the risk of litigation, the EMT should:

provide competent care that meets current standards.

You suspect that a pregnant 16-year-old girl has a broken leg after she was hit by a car. You explain that you plan to splint her leg, and she agrees to treatment. Which of the following types of consent describes her agreement?

Minor's

When you and your partner arrive at the residence of a man in cardiac arrest, you immediately recognize the patient as the drunk driver who killed your brother several years earlier. A backup ambulance is en route to the scene. You should:

begin two-rescuer CPR and apply the AED as soon as possible.

You are dispatched to an apartment complex to respond to a shooting. Law enforcement personnel are present and have the suspect in custody. You find the patient lying in a narrow space between the couch and coffee table of his small apartment. He is semiconscious and has a large gunshot wound to his chest. You should:

quickly move the coffee table so you can access and treat the patient.

You receive a subpoena to testify in court regarding a case that occurred two years ago in which you and your partner did not attempt resuscitation of a cardiac arrest patient. Upon receiving the subpoena, you should:

notify the director of your EMS system and obtain legal counsel.

As an EMT, the performance of your duties will be compared to that of:

another EMT.

You suspect that a 6-year-old girl has broken her leg after falling from a swing at a playground. Shortly after you arrive, the child's mother appears and refuses to allow you to continue treatment. You should:

try to persuade the mother that treatment is needed.

You are dispatched to a middle school for a 16-year-old female experiencing an asthma attack. She is conscious and alert but in severe respiratory distress. The school nurse informs you that she has tried several times to contact the patient's parents but has not been successful. You should:

provide treatment up to your level of training and transport the child at once.