EMT Ch. 3: Medical, Legal, & Ethical Issues STUDY SET
Factors for negligence case to be successful (4 must be present)
1. Duty 2. Breach of Duty 3. Real or perceived damages 4. Causation
Which of the following general statements regarding consent is correct? A. A patient can consent to transport but can legally refuse to be treated B. Expressed consent is valid only if given in writing by a family member C. All patients older than 18 years can legally refuse treatment or transport D. Patients who are intoxicated are generally allowed to refuse treatment
A patient can consent to transport but can legally refuse to be treated
To help protect patients, EMS agencies are required to have: A. An anonymous reporting system B. Online access to patient records C. Public forums with their medical director D. A privacy officer to answer questions
A privacy officer to answer questions
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 an underlying condition and feel strongly that he should go to the hospital. Which of the following statements regarding the situation is correct? A. A mentally competent adult can withdraw his or her consent to treatment at any time. B. Because of your suspicions, the best approach is to transport him to the hospital C. Any patient who refuses EMS treatment must legally sign a patient refusal form D. Once the patient is in the ambulance, he cannot legally refuse EMS treatment
A. A mentally competent adult can withdraw his or her consent to treatment at any time.
In many states, a minor may be treated as an adult for the purpose of consenting to or refusing medical treatment if the minor: A. Is self supporting and lives by him or herself B. Possesses a valid drivers license C. Has a poor relationship with his or her parents D. Is mentally competent and able to refuse
A. Is self supporting and lives by him or herself
When caring for a 65-year-old male with respiratory distress, you place him in a comfortable position but do not apply oxygen. The patient's condition continues to deteriorate and he develops cardiac arrest and dies at the hospital. This scenario is an example of: A. Negligence B. Battery C. Abandonment D. Assault
A. Negligence
Gross negligence requires ___________. A. a willful or reckless disregard for the standard of care B. an action considered excessive by the public C. a duty to act D. negligent actions by at least two providers
A. a willful or reckless disregard for the standard of care
There are varying degrees of DNR orders, expressed through a variety of detailed instructions that may be part of the order, such as A. allowing for CPR only if cardiac or respiratory arrest was observed. B. allowing comfort care measures such as intravenous feeding. C. disallowing the use of long-term life-support measures. D. specifying only five minutes of artificial respiration will be attempted.
A. allowing for CPR only if cardiac or respiratory arrest was observed.
At a crime scene, the EMT-B should A. avoid disturbing any evidence at the scene unless emergency care requires. B. immediately remove the patient from the scene. C. move all obstacles from around the patient to make more room to work. D. search the house for clues to the cause of the crime.
A. avoid disturbing any evidence at the scene unless emergency care requires.
When you inform the adult patient of a procedure you are about to perform and its associated risks, you are looking for A. expressed consent. B. negligence. C. implied consent. D. applied consent.
A. expressed consent.
A patient successfully sued your EMS employer and was awarded compensatory and punitive damages. This means the agency was likely found guilty of ___________. A. gross negligence B. simple negligence C. a felony D. procedural misconduct
A. gross negligence
If an action or procedure that was performed on a patient is not recorded on the written report: A. it was not performed in the eyes of the law. B. it can be qualified by the EMT in charge. C. it cannot be used in establishing negligence. D. it was performed haphazardly by the EMT.
A. it was not performed in the eyes of the law.
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: A. provide treatment up to your level of training and transport the child at once. B. recognize that you cannot begin treatment without expressed parental consent. C. transport the child to the closest hospital and let the staff there provide any treatment. D. administer oxygen only until you receive parental consent for further treatment.
A. provide treatment up to your level of training and transport the child at once.
Leaving a patient after care has been initiated without assuring the patient has been turned over to someone with equal or greater medical training
Abandonment
A written order given by the physician based upon a decision by a patient prior to his/her demise
Advance directive
During your monthly internal quality improvement (QI) meeting, you review several patient care reports (PCRs) with staff of your EMS system. You identify the patients name, age, and sex and then discuss the treatment provided by the EMTs in the field. By taking this approach to the QI process, you: A. Are in violation of HIPAA because you did not remove the PHI from the PCR beforehand B. Accepted appropriately but must have each EMT sign a waiver stating that he or she will not discuss the cases with others C. Violated the patients privacy because you should have discussed the info only with the EMTs involved D. Adequately safeguarded the patients PHI because the cases were discussed internally
Are in violation of HIPAA because you did not remove the PHI from the PCR beforehand
A patient regains consciousness en route from his office to the emergency department. The patient tells you that he feels fine and does not want to go to the hospital. Under these circumstances you should: A. have the patient sign a refusal form and return him to his office B. Assess whether the patient's mental condition is impaired C. Request that the police place the patient under protective custody D. Document the patient's request but continue to transport him
Assess whether the patient's mental condition is impaired
Which of the following is considered confidential?
Assessment findings, A patients mental condition, A patients medical history
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: A. Wait for the backup ambulance while your partner performs CPR B. Begin two-rescuer CPR and apply the AED as soon as possible C. Advise your partner that you cannot provide care to this patient D. Obtain permission from med control to not attempt resuscitation
B. Begin two-rescuer CPR and apply the AED as soon as possible
Where would you MOST likely find info regarding a patients wishes to be an organ donor? A. Voter registration card B. Drivers license C. Insurance card D. Social security card
B. Drivers license
Which of the following types of consent allows treatment of a patient who is unconscious or mentally incapacitated? A. Actual B. Implied C. Informed D. Expressed
B. Implied
Forcing a competent adult patient to go to the hospital against his will may result in ________ charges against the EMT-Basic. A. abandonment B. assault and battery C. implied consent D. negligence
B. assault and battery
Acting in such a way as to make another person fear immediate bodily harm is called: A. libel. B. assault. C. battery. D. negligence.
B. assault.
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: A. require personnel to transport all patients to the closest hospital. B. be reasonable and realistic to avoid overburdening EMS personnel. C. demand that all personnel consistently exceed the standard of care. D. expect personnel to function beyond their scope of practice if needed.
B. be reasonable and realistic to avoid overburdening EMS personnel.
For a do not resuscitate (DNR) order to be valid, it must: A. be dated within the previous 24 months. B. clearly state the patient's medical problem. C. be updated a minimum of every 6 months. D. be signed by the local justice of the peace.
B. clearly state the patient's medical problem.
Commonly required reporting situations include all of the following except A. child and elderly abuse. B. crimes in public places. C. sexual assault. D. domestic abuse.
B. crimes in public places.
Legislation that governs the skill and medical interventions that may be performed by an EMT-B is A. uniform throughout the country. B. different from state to state. C. uniform for regions within a state. D. governed by the U.S. Department of Transportation.
B. different from state to state.
If an EMT-B with a duty to act fails to provide the standard of care, and if this failure causes harm or injury to the patient, the EMT-B may be accused of A. breach of promise. B. negligence. C. abandonment. D. assault.
B. negligence.
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: A. call the district attorney's office and explain the details of the case. B. notify the director of your EMS system and obtain legal counsel. C. attach an official addendum to the original patient care report. D. contact the patient's family attempt to resolve the matter with them.
B. notify the director of your EMS system and obtain legal counsel.
You are dispatched to the residence of a person who frequently calls 9-1-1 for nonemergency care. You should: A. defer the call to a local private ambulance company. B. respond under the assumption that an acute emergency exists. C. ask the dispatcher to send law enforcement before you respond. D. refuse the call, but thoroughly document the patient's circumstances.
B. respond under the assumption that an acute emergency exists.
The collective set of regulations and ethical considerations governing the EMT-B is called A. duty to act. B. scope of practice. C. advance directives. D. Good Samaritan laws.
B. scope of practice.
Credentialing refers to: A. the process by which an institution is evaluated and recognized. B. the process by which the qualifications to practice are determined. C. the process by which the state grants permission to practice. D. the list of standards available in an EMS textbook.
B. the process by which the qualifications to practice are determined.
In a hospital, long-term life-support and "comfort care" measures would consist of intravenous feeding and A. routine inoculations. B. the use of a respirator. C. infection control by the health care providers. D. hourly patient documentation.
B. the use of a respirator.
When treating a critical patient who has an organ donor card, the EMT-Basic should A. transport without delay and document a DNR. B. treat the patient the same as any other patient and inform the ED physician. C. withhold oxygen therapy from the patient to keep the organ hypoxic. D. All of the above.
B. treat the patient the same as any other patient and inform the ED physician.
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: A. use your authority under the implied consent law. B. try to persuade the mother that treatment is needed. C. ask the mother to sign a refusal form and then leave. D. tell the mother that her refusal is a form of child abuse.
B. try to persuade the mother that treatment is needed.
Subjecting a patient to unwanted care and transport can be considered this in a court of law
Battery
You respond to the home of a 59 year old man who is unconscious, has slow, shallow breathing; and has 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: A. Transport the patient without providing any treatment B. Honor the patients wishes and withhold all treatment C. Decide on further action once the DNR order is produced D. Begin treatment and contact med control as needed
Begin treatment and contact med control as needed
Not providing the standard of care
Breach of duty
As an EMT, the performance of your duties will be compared to that of: A. A paramedic supervisor B. The general public C. Another EMT D. The medical director
C. Another EMT
You arrive at the scene of an apparent death. When evaluating the patient, which of the following is a definitive sign of death? A. Absence of a pulse B. Profound cyanosis C. Dependent lividity D. Absent breath sounds
C. Dependent lividity
To minimize the risk of litigation, the EMT should: A. Utilize at least 4 personnel when moving a patient B. Always transport patients to the hospital of their choice C. Provide competent care that meets current standards D. Use universal precautions with every patient encounter
C. Provide competent care that meets current standards
Which of the following is an action you should not take if a patient refuses care? A. Leave phone stickers with emergency numbers. B. Recommend that a relative call the family physician to report the incident. C. Tell the patient to call his family physician if the problem reoccurs. D. Call a relative or neighbor who can stay with the patient.
C. Tell the patient to call his family physician if the problem reoccurs.
Termination of care of the patient without assuring the continuation of care at the same level or higher is called A. liability infraction. B. battery. C. abandonment. D. breach of duty.
C. abandonment.
Which of the following is not a type of consent required for any treatment or action by an EMT-B? A. child and mentally incompetent adult B. implied C. applied D. expressed
C. applied
You are caring for a patient with pancreatic cancer. The patient is emaciated and only responds to loud verbal stimulus with the occasional moan. He offers no other response. The family tells you that there is no DNR but they do provide you with a Physician Order for Life Sustaining Treatment (POLST), which provides medical orders and is signed by the patient's physician. As you review the documentation, your partner reports that the patient has stopped breathing and has no carotid pulse. You should: A. follow the interventions as listed on the POLST. B. ignore the POLST and resuscitate the patient as per your existing protocols. C. contact medical control for guidance. D. transport the patient immediately with supportive care only.
C. contact medical control for guidance.
An EMT would MOST likely be held liable for abandonment if he or she: A. refused to care for a violent patient who is armed with a knife. B. remained at the hospital for 30 minutes to give a patient report. C. did not make provisions for continued care of an injured patient. D. terminated care of a competent adult patient at his or her request.
C. did not make provisions for continued care of an injured patient.
When the EMT-B makes the physical/emotional needs of the patient a priority, this is considered a(n) of the EMT-B. A. advance directive B. protocol C. ethical responsibility D. legal responsibility
C. ethical responsibility
Consent which is based on the assumption that an unconscious patient would approve the EMT-B's life-saving interventions is called A. expressed. B. negligence. C. implied consent. D. applied consent.
C. implied consent.
All of the following are considered to be protected health information (PHI), EXCEPT: A. patient history. B. treatment rendered. C. location of the call. D. assessment findings.
C. location of the call.
Your record of a patient's refusal of medical aid or transport should include all of the following except A. informing the patient of the risks and consequences of refusal. B. documenting the steps you took. C. signing of the form by the Medical Director. D. obtaining a "release" form with the patient's witnessed signature.
C. signing of the form by the Medical Director.
The manner in which the EMT must act or behave when caring for a patient is called the: A. EMT oath. B: code of ethics. C. standard of care. D. scope of practice.
C. standard of care.
The obligation not to reveal information obtained about :i patient except to other health care professionals involved in the patient's care, or under subpoena, or in a court of law
Confidentiality
You are called to attend an elderly patient with an extensive medical history who is now in cardiac arrest. The patient's family tells you that the patient has a DNR order. There is no paperwork available but the patient does have a MedicAlert bracelet indicating Do Not Resuscitate. You should: A. Initiate resuscitation in the absence of paperwork B. Transport with minimal care C. Confirm the patients identity and honor the DNR order D. Confirm the patients identity and then confirm the DNR by calling the MedicAlert Foundation number on the bracelet
Confirm the patients identity and then confirm the DNR by calling the MedicAlert Foundation number on the bracelet
Permission from the patient to treat him/her
Consent
In which of the following situations does a legal duty to act clearly exist? A. The EMT witnesses a vehicle crash while off duty B. A bystander encounters a victim who is not breathing C. The EMT hears of a cardiac arrest after his or her shift ends D. A call is received 15 minutes prior to shift change
D. A call is received 15 minutes prior to shift change
Which of the following patients has decision-making capacity and can legally refuse emergency medical treatment? A. A confused young male who says he is the president B. A man who is staggering and states that he had 3 beers C. A diabetic woman who has slurred speech and is not aware of the date D. A conscious and alert woman with severe abdominal pain
D. A conscious and alert woman with severe abdominal pain
The EMT-B should not discuss information about a patient outside of relaying pertinent information to the physician at the Emergency Department. Information considered confidential includes A. patient history gained through interview. B. assessment findings. C. treatment rendered. D. All of the above.
D. All of the above.
Putrefaction is defined as: A. Blood settling to the lowest point of the body B. Profound cyanosis to the trunk and face C. Separation of the torso from the rest of the body D. Decomposition of the body's tissues
D. Decomposition of the body's tissues
Which of the following most accurately defines negligence? A. Transport of a mentally incompetent patient against his or her will B. Providing care that is consistent with care provided by other EMTS C. Transferring patient care to a provider with a lower level of training D. Deviation from the standard of care that may result in further injury
D. Deviation from the standard of care that may result in further injury
Which type of consent is involved when a 39-year-old mentally competent female with a severe headache asks you to take her to the hospital? A. Formal B. Informed C. Implied D. Expressed
D. Expressed
In the eyes of the courts, an incomplete or untidy patient care form indicates: A. A potential falsification of the patient care form B. Thorough documentation was not required C. The EMT was too busy providing patient care to fill out the form D. Inadequate patient care was administered
D. Inadequate patient care was administered
The EMTs scope of practice within his or her local response area is defined by the: A. State EMS office B. Local health district C. EMS supervisor D. Medical director
D. Medical director
Maintaining the chain of evidence at the scene of a crime should include: A. Quickly moving any weapons out of the patient's sight B. Placing the patient in a private area until the police arrive C. Making brief notes at the scene and then completing them later D. Not cutting through holes in clothing that were caused by weapons
D. Not cutting through holes in clothing that were caused by weapons
What is forcible restraint permitted? A. Only if law enforcement personnel have witnessed threatening behavior B. Anytime that the EMT feels threatened C. Only if consent to restrain is given by a family member D. When the patient poses a significant threat to self or others
D. When the patient poses a significant threat to self or others
Another name for a DNR order is A. deviated nervous response. B. duty not to react. C. refusal of treatment. D. advance directive.
D. advance directive.
presumptive signs of death would not be adequate in cases of sudden death due to: A. severe trauma B. cardiac arrest C. acute poisoning D. hypothermia
D. hypothermia
Medical identification insignia that indicate serious patient medical conditions come in the form of all of the following except A. bracelets. B. necklaces. C. cards. D. patches.
D. patches.
The EMT-B can release confidential patient information in all of the following circumstances except A. to inform other health care professionals who need to know information to continue care. B. to report incidents required by state law, such as rape or abuse. C. to comply with a legal subpoena. D. to protect the other victims of a motor vehicle collision.
D. to protect the other victims of a motor vehicle collision.
A legal document, usually signed by the patient and his/her physician, to "do not resuscitate"
DNR order
An obligation to provide emergency care to a patient
Duty to act
Your responsibility to provide patient care is called?
Duty to act
Which of the following components are needed to prove negligence?
Duty to act, breach of duty, injury/damages, and causation
Which of the following components are needed to prove negligence? A. Breach of duty, injury/damages, abandonment, and causation B. Duty to act, abandonment, breach of duty, and causation C. Abandonment, breach of duty, damages, and causation D. Duty to act, breach of duty, injury/damages, and causation
Duty to act, breach of duty, injury/damages, and causation
Child who is married or of a specific age who, in certain states, can make his/her own legal decisions
Emancipated minor
When performing his or her duties, the EMT is generally expected to: A. Contact med control on every EMS call B. Function above his or her scope of practice C. Exercise reasonable care and act prudently D. Consistently exceed the standard of care
Exercise reasonable care and act prudently
Permission given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being
Expressed consent
Upon arrival at the scene, your partner began assessing vital signs without talking to the patient. This demonstrates?
Failure to obtain consent
A series of laws, varying in each state, designed to provide immunity from liability to individuals trying to help in emergencies
Good Samaritan laws
You and your partner arrive at the scene of a major motor vehicle crash. The driver, a young male, is severely entrapped in his car. He has an open head injury and massive facial trauma. He is unresponsive, is not breathing, and does not have a palpable carotid pulse. You should: A. Have your partner check for a pulse to confirm that the patient is deceased B. Stop any active bleeding and advise dispatch to send a paramedic crew C. Ventilate the patient for 5 minutes and then stop if there is no response D. Request the fire department to extricate the patient so you can begin CPR
Have your partner check for a pulse to confirm that the patient is deceased
Permission to treat an unconscious patient until he/she becomes conscious
Implied consent
Which of the following statements about patient care report is correct? A. Patient care cannot be discredited based on poor documentation B. Incomplete reports are common and accepted in EMS C. It is difficult to prove actions were performed if they are not included on the report D. EMTs are not liable for any actions that are not accurately documented
It is difficult to prove actions were performed if they are not included on the report
Which of the following statements about the patient care report is correct?
It is difficult to prove actions were performed if they are not included on the report.
What is the best way to care for your patient once he tells you he does not want to go to the hospital?
Let him know how important it is that he accepts transport to the hospital
Being held legally responsible
Liability
As an EMT, the standards of emergency care are often partially based on: A. A consensus among paramedic supervisors B. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols
Locally accepted protocols
finding of failure to act properly in a situation in which there was a duty to act
Negligence
Which aspect of HIPAA MOST affects EMS personnel? A. Controlling insurance costs B. Ensuring access to insurance C. Preventing insurance fraud D. Protecting patient privacy
Protecting patient privacy
The care that an EMT is able to provide is most commonly defined as?
Scope of practice
The collective medical, legal, and ethical guidelines that govern the EMT-Basic
Scope of practice
Which of the following statements regarding Good Samaritan laws is correct? Such laws provide the EMT with absolute immunity from a lawsuit. Such laws guarantee that the EMT will not be held liable if he or she is sued. Such laws do not protect EMTs who are off duty. Such laws will not protect the EMT in cases of gross negligence.
Such laws will not protect the EMT in cases of gross negligence.
In which of the following circumstances can the EMT legally release confidential patient information?
The patient is competent and signs a release form
In which of the following circumstances can the EMT legally release confidential patient information? A. A media representative inquires about the patient B. The family requests a copy for insurance purposes C. The patient is competent and signs a release form D. A police officer requests a copy to place one file
The patient is competent and signs a release form
How the EMT is required to act or behave with a patient is called?
The standard of care
You arrive at the scene of a motor vehicle versus pedestrian accident. The patient is a 13 year old male, 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? A. Treat the child at the scene and wait for the parents to arrive and give consent B. Withhold treatment until the parents arrive and give you consent for the treatment C. Transport the child immediately and have the parents meet you at the hospital D. Begin transport at once and have the parents meet you en route to the hospital
Transport the child immediately and have the parents meet you at the hospital
A important safeguard against legal implication is?
Writing a complete and accurate run report.
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.
The process by which an individual, an institution, or a program is evaluated and recognized as meeting certain standards is called:
certification.
While transporting a woman with diabetes, you inadvertently give her oral glucose even though her blood glucose level was high. You reassess the patient and note that her condition did not change; she remained stable. You should:
contact medical control and notify them of the error.
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.
What are the presumptive signs of death that are obvious and clear even to non medical persons.
dependent lividity rigor mortis putrefaction
You and your partner arrive at the scene of a major motor vehicle crash. The driver, a young male, is severely entrapped in his car. He has an open head injury and massive facial trauma. He is unresponsive, is not breathing, and does not have a palpable carotid pulse. You should:
have your partner check for a pulse to confirm that the patient is deceased.
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 and ethical. legal but unethical. illegal but ethical. illegal and unethical.
legal but unethical.
When caring for a 65-year-old male with respiratory distress, you place him in a comfortable position but do not apply oxygen. The patient's condition continues to deteriorate and he develops cardiac arrest and dies at the hospital. This scenario is an example of:
negligence.
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: notify medical control for advice. provide immediate patient care. wait for law enforcement to arrive. determine why the patient was injured.
provide immediate patient care.
You are dispatched to an apartment complex for 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.
An important safeguard against legal implication is:
writing a complete and accurate run report.
