EMT Ch. 4 Test

You respond to the report of an unconscious female patient. You can acquire important medical information about the patient through which of the following? A) Medical identification device B) Driver's license C) Medical history identifier D) On-call Medical Director

Explanation: A) CORRECT. A patient may wear a medical identification device to alert EMTs and other health care professionals that she has a particular medical condition. B) INCORRECT. A driver's license will not have any medical information on it. C) INCORRECT. There is no common, immediately accessible medical information resource called a medical history identifier. D) INCORRECT. An on-call Medical Director is a physician who provides verbal direction to EMS personnel specific to medical care; the Medical Director would not have access to information about a specific patient. Page Ref: 91

You are treating an elderly male patient in the back of your ambulance. En route, the patient becomes unresponsive. Upon arrival, the ED nurse asks you several questions about his condition. What should you do? A) You should answer her questions because you may legally share the patient's medical condition with other pertinent health care providers. B) You should not disclose the information to the nurse because it is protected confidential information and the patient did not sign a release authorizing you to discuss his condition. C) You should not disclose the information because HIPAA laws only allow you to provide the information to the emergency department physician. D) You should disclose the information, as it is not protected by law.

Explanation: A) CORRECT. A patient's medical records and condition may be legally shared with any health care professional that will have a role in the patient's care or in quality improvement. B) INCORRECT. There is no need for the patient to sign a release before medical records or information is shared with health care providers who will be caring for him. C) INCORRECT. HIPAA does not prevent information from being shared with any medical professional who is involved in caring for the patient, not just physicians. D) INCORRECT. The patient's information is protected by law, but it should be disclosed in this situation to others who will be caring for the patient. Page Ref: 90

In which of the following situations should an EMT withhold resuscitative measures from a patient in cardiac arrest? A) The patient's caregiver presents a DNR order signed by the patient and his physician. B) The EMT's religious beliefs permit withholding resuscitation, and the caregiver presents documentation of the patient's wishes. C) Family members request that nothing be done. D) All of the above

Explanation: A) CORRECT. A properly signed Do Not Resuscitate (DNR) order is a legal directive to withhold defined resuscitative efforts. B) INCORRECT. An EMT's personal convictions should never be a factor in the decision to begin or withhold resuscitative measures. C) INCORRECT. The wishes of family members alone should not influence the decision to begin or withhold resuscitation. D) INCORRECT. Not all of the answers provided are correct. Page Ref: 83

You respond to a middle school for a 12-year-old male patient who has been hit by a car. You get consent to treat the patient from the school principal. What concept allows the principal to speak for the parents? A) In loco parentis B) Informed consent C) Res ipsa loquitur D) Healthcare proxy

Explanation: A) CORRECT. Care may be given to a minor without direct consent from a parent or guardian if authorized by a child care provider or school authority who is acting in loco parentis (in place of the parent). B) INCORRECT. Informed consent means that a patient must understand the risks associated with the treatment they will receive; it does not apply to a school official allowing care for a minor student. C) INCORRECT. The legal term res ipsa loquitur is associated with breach of duty lawsuits and does not apply to this scenario. D) INCORRECT. A healthcare proxy is a person who is legally assigned to make medical decisions on behalf of a specific person should that person be unable to decide on their own care; it rarely applies to consent in the prehospital setting and would not apply to this situation. Page Ref: 81

Your patient is a 45-year-old man who is suffering from chest pain. Upon arrival, the patient is pale, sweaty, and seems short of breath. The patient is angry with his daughter for calling 911. He says that he had some spicy sausage for breakfast and has indigestion. Which of the following is an appropriate means of getting the patient the care he needs? A) Try to find out why the patient does not want to go to the hospital. B) Call the patient's neighbors and tell them that you have been called to the patient's house but he is now refusing care. C) Inform the patient that if he does not agree to treatment, you will have to take him against his will because he has a potentially life-threatening problem. D) Tell the patient that his chest pain is most likely caused by his diet, have him take an antacid, and go to bed.

Explanation: A) CORRECT. If the cause of the refusal can be determined, The EMT may be able to develop a strategy to persuade the patient to accept care and transportation to the hospital. The best tact for this is to clearly inform the patient of the potential for a serious medical condition, and the implications of refusing care. B) INCORRECT. This would violate the patient's confidentiality, create the potential for conflict, and likely not be effective anyway. C) INCORRECT. An EMT who takes — or even threatens to take — a competent adult patient against his will could be violating numerous laws. D) INCORRECT. This would not be consistent with the standard of care expected of an EMT; advising this patient against medical evaluation would not be appropriate. Page Ref: 81-82

In which of the following situations is it legal to share information about treatment you provided to a patient? A) The triage nurse at the emergency department asks about the care you provided to the patient. B) The patient gives verbal consent to release information to a friend. C) The patient's lawyer requests the information over the phone. D) You are asked by a coworker who knows the patient.

Explanation: A) CORRECT. It is legal to share patient information with the staff who will be caring for her at the hospital. B) INCORRECT. Verbal consent from a patient is legally not sufficient for an EMT to release information to a friend. C) INCORRECT. It is not legal to share patient information over the phone without a signed release from the patient. D) INCORRECT. Sharing patient information with an EMS coworker who is not involved in caring for the patient is illegal. Page Ref: 90

While documenting a call, you add a false statement that was made about a local doctor. This could constitute which of the following? A) Libel B) Slander C) Degradation of character D) HIPAA violation

Explanation: A) CORRECT. Making a written statement that could injure another person's reputation is known as libel. B) INCORRECT. Slander is making a verbal statement that damages another person's reputation. C) INCORRECT. False statements will generally not degrade a person's character, just perhaps their reputation. D) INCORRECT. HIPAA relates to the management and sharing of confidential patient information, not statements written in emergency call documentation. Page Ref: 91

Which of the following requires training, policies, and procedures related to storing, accessing, and sharing patient information? A) HIPAA B) HIAPA C) EMTALA D) COBRA

Explanation: A) CORRECT. The Health Insurance Portability and Accountability Act (HIPAA) regulates the record-keeping, storage, access, and discussion of patient information; specifying both training and policies and procedures. B) INCORRECT. There is no patient information regulation referred to by the term HIAPA. C) INCORRECT. The Emergency Medical Treatment and Labor Act (EMTALA) relates to access to medical care regardless of the ability to pay, not the management of patient information. D) INCORRECT. COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act, pertains to the continuation of medical insurance after leaving employment; it does not regulate the management of patient information. Page Ref: 90-91

Which of the following refers to the set of regulations that defines the legal actions expected and limitations placed on the EMT? A) Scope of practice B) Legal standards of practice C) Protocols and standing orders D) Professional standards

Explanation: A) CORRECT. The collective set of regulations and ethical considerations that defines the extent and limitations of an EMT's job is known as a scope of practice. B) INCORRECT. The term legal standards of practice does not refer to the expectations and limitations placed on an EMT. C) INCORRECT. Protocols and standing orders guide specific medical interventions, not the entirety of an EMT's legal and ethical responsibilities. D) INCORRECT. Although there are professional standards for EMTs, this is not what the collective set of regulations is called. Page Ref: 79-80

The EMT's obligation to provide care to a patient either as a formal or ethical responsibility is known as which of the following? A) Legal responsibility B) Scope of practice C) Duty to act D) Standard of care

Explanation: A) INCORRECT. Although in certain situations an EMT has a legal responsibility to provide care, this term is not generally used to describe that obligation. B) INCORRECT. The types of medical interventions that an EMT is authorized to perform is defined in the scope of practice, not the obligation to carry them out. C) CORRECT. A duty to act is the obligation that an EMT has in certain situations to provide emergency care to a patient. D) INCORRECT. The care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation is known as the standard of care; it refers to the quality of care provided, not specifically the responsibility to do so. Page Ref: 89

While treating a patient involved in a shooting at the patient's vacation home, which of the following actions may interfere with the investigation of a crime scene? A) Moving the patient B) Using the bathroom C) Using the patient's phone D) All of the above

Explanation: A) INCORRECT. Although potentially necessary, moving the patient will most likely interfere with the crime scene investigation, but this is not the only consideration. B) INCORRECT. EMT's going anywhere in the home and moving or touching anything at the scene can interfere with the investigation, but this is not the only consideration. C) INCORRECT. Touching and dialing the patient's phone can ruin potential evidence, but this is not the only consideration. D) CORRECT. All of the answers provided could interfere with a crime scene investigation. Page Ref: 94

Which of the following is the EMT's primary responsibility at a secured crime scene? A) Identifying any potential suspects encountered at the scene B) Providing patient care C) Taking notes that may be needed during court testimony D) Preserving evidence

Explanation: A) INCORRECT. Although the EMT should remain observant while on scene, his first priority is not identifying potential suspects. B) CORRECT. Once police have made the scene safe, the EMT's priority at a crime scene is to provide patient care. C) INCORRECT. Everything should be documented appropriately, but taking notes in anticipation of court testimony would not be the EMT's primary responsibility. D) INCORRECT. Sometimes rendering needed patient care is more important than preserving evidence; although the EMT should avoid disturbing evidence whenever possible. Page Ref: 93-94

An off-duty EMT is driving down the road when she sees a major vehicle accident. There are no Emergency Medical Responders on the scene yet. There are only Good Samaritans. The EMT is late for a doctor's appointment so she decides that she will not stop and help. The driver of the vehicle dies before help arrives. One of the Good Samaritans notices her EMT license plates and writes them down as she passes by. The Good Samaritan is angry that the EMT did not stop and help and tries to get the EMT fired for not helping. Which of the following statements is true? A) The EMT is negligent for not stopping and helping. B) The EMT is negligent because the patient died. C) The EMT is not negligent because she had a doctor's appointment. D) The EMT is not negligent because she did not have a duty to act.

Explanation: A) INCORRECT. Even though a good argument can be made that the EMT had a moral duty to stop and help the patient, she did not have a legal duty to act; therefore, negligence does not apply. B) INCORRECT. Death of a patient does not by itself constitute negligence. C) INCORRECT. A doctor's appointment does not necessarily relieve an EMT from her legal duty to act. D) CORRECT. An EMT who is not on-duty generally will not have a duty to act, therefore negligence cannot be proven. Page Ref: 88

Which of the following statements is true concerning protection by Good Samaritan laws? A) A Good Samaritan law allows an EMT to exceed the scope of practice, if necessary, when providing emergency care off-duty. B) An EMT is expected to act as a lay person when providing emergency care off-duty. C) The purpose of Good Samaritan laws is to protect people who are trying to help in an emergency. D) An EMT cannot be sued for negligence if the state in which he works has a Good Samaritan law.

Explanation: A) INCORRECT. Good Samaritan laws would not cover an EMT who performs interventions that are not part of her normal scope of practice, whether on- or off-duty. B) INCORRECT. An EMT is always expected to provide the standard of care for which they are trained. C) CORRECT. Good Samaritan laws have been developed in all states to provide immunity to individuals trying to help people in emergencies. D) INCORRECT. The same rules of negligence apply, even with Good Samaritan laws. Page Ref: 89-90

Your patient is a 10-year-old boy who suffered a possible fractured arm while rollerblading at a friend's house. Which of the following is the BEST way to obtain consent for treatment? A) Act on implied consent. B) Get consent from the patient's 15-year-old sister, who is at the scene. C) Call the patient's mother at work. D) Allow the patient to consent as an emancipated minor.

Explanation: A) INCORRECT. Implied consent applies to unconscious patients and minors when a parent or guardian cannot be contacted. B) INCORRECT. Another minor, even when related, cannot legally provide consent. C) CORRECT. Since the injury is not life-threatening, it would be appropriate to take the time to contact a parent or guardian to seek approval for care. D) INCORRECT. A 10-year-old minor would most likely not be emancipated; consent would have to be obtained to treat him. Page Ref: 81

Which of the following is NOT required to prove a claim of negligence against an EMT? A) The EMT had a duty to act. B) Proximate causation existed. C) The EMT failed to act according to the standard of care. D) The patient was in fear of bodily harm at the time of the incident.

Explanation: A) INCORRECT. In order to find an EMT negligent, a duty to act must have existed. B) INCORRECT. Proximate causation, or the concept that damages to the patient resulted from the actions or inaction of an EMT, must be proven. C) INCORRECT. An EMT must fail to act in accordance with the standard of care for negligence to occur. D) CORRECT. There is no need for the patient to have feared bodily harm in order for negligence to have occurred. Page Ref: 88

Which of the following situations BEST illustrates the act of abandonment by the EMT? A) The EMT resuscitates a patient who has a DNR order signed by his physician. B) An EMT transports a patient to the emergency department, leaves the patient in the waiting room, but does not advise the ED staff. C) An EMT begins care of a patient, then turns the patient over to a paramedic. D) An EMT who is off-duty sees a motor vehicle collision with probable injuries but does not stop to help.

Explanation: A) INCORRECT. Resuscitating a patient in spite of a DNR would not be considered abandonment. B) CORRECT. Transporting a patient to a hospital and then leaving prior to properly turning over the patient's care to the staff would be considered abandonment. C) INCORRECT. Turning patient care over to a medical provider with a higher level of training is common and not abandonment. D) INCORRECT. In order for abandonment to occur, care must first be initiated by the EMT. Page Ref: 89

Which of the following refers to the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation? A) Scope of practice B) Standard of practice C) Protocols and standing orders D) Professional standards

Explanation: A) INCORRECT. Scope of practice is the collective set of regulations and ethical considerations that defines the extent and limitations of an EMT's job. B) CORRECT. The term standards of practice refers to the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation. C) INCORRECT. Protocols and standing orders guide specific medical interventions, not the entirety of an EMT's legal and ethical responsibilities. D) INCORRECT. Although there are professional standards for EMTs, this is not what the collective set of regulations is called. Page Ref: 80

Sharing information about a patient's medical history with your neighbor after you hear a call on a radio scanner would constitute which of the following? A) Slander B) Violation of patient privacy C) Breach of confidentiality D) Libel

Explanation: A) INCORRECT. Slander is making a statement that damages another person's reputation; sharing a patient's medical history would not be slanderous. B) INCORRECT. Although this type of disclosure is sharing private information about a patient, this is not the term used. C) CORRECT. Any information that an EMT obtains about a patient's condition, history, or treatment is considered confidential; a signed patient release is required before the information can be shared. D) INCORRECT. A false written statement that damages another person's reputation is known as libel. Page Ref: 90-91

The administration of oxygen and the application of spinal immobilization is part of which of the following for the EMT? A) Duty to act B) Standard of care C) Scope of practice D) None of the above

Explanation: A) INCORRECT. Specific elements of patient care are not defined by a duty to act, just the responsibility to provide care in certain situations. B) INCORRECT. Standard of care is usually defined as the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation; it does not define the specific interventions. C) CORRECT. The authorization to administer oxygen or immobilize a patient with suspected spinal injury could fall within an EMT's scope of practice. D) INCORRECT. One of the answers provided is correct. Page Ref: 79-80

Which of the following incidents is the EMT legally required to report to law enforcement? A) You suspect the wife of the patient you are treating for chest pain has been smoking marijuana. B) Your patient is an 18-year-old college student who has been consuming large amounts of alcohol at a fraternity party. C) 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. D) Your patient has facial and head injuries and states that her husband beat her with a telephone receiver.

Explanation: A) INCORRECT. Suspected previous drug use by a bystander at the scene of a medical emergency is not relevant and the EMT would not be required to report it. B) INCORRECT. Alcohol consumption by a patient is not generally a reportable event. C) INCORRECT. There is no requirement to submit a report to law enforcement just because a minor patient's parents are at work. D) CORRECT. Many states require EMTs and other health care professionals to report suspected child, elder, or domestic abuse to law enforcement. Page Ref: 94-95

Two EMTs respond to the scene of a syncopal episode. They evaluate a 50-year-old male patient who passed out and cut his upper lip. The EMTs examine the patient and his vital signs are normal. The EMTs talk the patient out of an expensive ambulance ride and suggest he will save money by driving himself to the urgent care clinic for stitches for his lip rather than waiting all night in the emergency department as a nonemergency patient. The patient signs the EMS refusal form. The patient decides to see his own doctor the next morning but dies at his house from sudden cardiac arrest an hour later. Which of the following statements is true? A) The EMTs are not negligent because the patient signed the refusal form. B) The EMTs are negligent because the patient died. C) The EMTs are negligent because there was proximate causation. D) The EMTs are not negligent because the EMTs have no control over the patient's medical condition.

Explanation: A) INCORRECT. The fact that the patient signed the refusal form does not relieve the EMT of his duty to perform the standard of care. B) INCORRECT. Just because a patient dies does not mean the EMT is negligent. C) CORRECT. This scenario meets the definition of negligence because the EMTs had a duty to take the patient to the hospital and warn him of the risks and benefits of not being transported. EMTs should never talk a patient out of going to the ED for an evaluation. This is a breach of the standard of care. As a result of that breach, the proximal cause was that the patient did not get evaluated by a physician and died from his condition. Had the EMTs transported him to the hospital, it is highly unlikely that he would have died. D) INCORRECT. Although the EMTs have no control over a patient's medical condition, they do have control over how it is treated. Page Ref: 88

You are providing care to a 54-year-old male patient complaining of chest pain. The patient asks to speak to you privately. He tells you he is taking Cialis® for erectile dysfunction and his wife does not know he is taking it. He does not want his wife to find out. As you are putting the EMS bags back in the ambulance, the wife corners you and insists that you tell her what her husband said. What should you do? A) You should tell her. As his spouse, she is legally entitled to know his medical information. B) You should not tell her. There is no reason to humiliate your patient by disclosing his embarrassing condition. C) You should tell her. He may be having an affair without her knowledge and she needs to be tested for sexually transmitted diseases. D) You should not tell her. By law, your conversation with your patient is confidential.

Explanation: A) INCORRECT. The law does not allow people to receive confidential patient information solely because they are family members. B) INCORRECT. Revealing the information will be humiliating to the patient; however, the greater consequence of revealing the patient's confidential information is the legal repercussions of breaking federal law, including significant monetary fines and even possible imprisonment. C) INCORRECT. Disclosing this type of information is in no way appropriate for an EMT. D) CORRECT. By law, your patient's medical condition is confidential. Only health care providers directly involved in patient care or quality improvement are privy to such information. Page Ref: 90-91

You are on the scene with a 72-year-old male patient with chest pain. The patient is complaining of shortness of breath but also refuses to go to the hospital, even after multiple attempts urging him to go. Which of the following should you do next? A) Stay with the patient until he loses consciousness. B) Fully inform the patient about his situation and the implications of refusing care. C) Inform the patient that he is having a "heart attack" and must be taken to the hospital for evaluation. D) Contact medical direction for orders to restrain the patient.

Explanation: A) INCORRECT. The patient may not lose consciousness and simply standing by waiting for it is a disservice to the patient and the rest of the community that the EMT serves. B) CORRECT. Although competent adult patients generally have the right to refuse care, it is the EMT's responsibility to fully inform the patient of the situation and the potential consequences of refusing care. C) INCORRECT. It is inappropriate for EMT's to provide diagnoses to patients. D) INCORRECT. A competent adult patient should never be restrained and forced to receive treatment; a physician should never order it. Page Ref: 82-83

You arrive on the scene of a 55-year-old male patient. The patient's wife called 911 because he is having chest pains. The patient is very angry with his wife for calling 911 because he states he only has heartburn and adamantly refuses any treatment or transport. After signing the patient refusal form, the patient collapses and goes into sudden cardiac arrest. The wife is crying uncontrollably and begging you to do something. What should you do? A) Respect his legal right to not have any treatment, regardless of how much the wife begs you to help. B) Explain to the wife that her husband signed a legal document refusing care, and if you intervened to help him now, you would be breaking the law. C) Provide emergency care for the patient only if his wife signs a document stating they will not sue the EMS service. D) Provide emergency care under implied consent.

Explanation: A) INCORRECT. The refusal form only indicated that the patient did not want treatment for his chest pain, which was his legal right; the subsequent cardiac arrest is considered a separate medical condition. B) INCORRECT. EMTs would not face criminal charges for caring for an unresponsive patient who previously refused care. C) INCORRECT. Treatment for a life-threatening condition should never be withheld pending release of liability documentation. D) CORRECT. Once the patient becomes unresponsive and is unable to make an informed decision regarding his care, implied consent takes over. Page Ref: 81

Which of the following information may be important to law enforcement officers investigating a crime scene? A) What route you took when responding to the scene B) How you gained access to the scene C) Your opinion of what happened before you arrived on-scene D) Your experience as an EMT

Explanation: A) INCORRECT. The route taken by the EMS responders to arrive at the scene of a crime would most likely not be important to law enforcement. B) CORRECT. The police will want to know the condition of the scene upon EMS arrival and everything moved or touched, including entry doors. C) INCORRECT. An EMT's opinion of what occurred at the scene prior to her arrival would generally not be beneficial or welcome. D) INCORRECT. Background information about the EMT would not be considered important. Page Ref: 93-94

If the EMT is in doubt as to whether a patient in cardiac arrest should be resuscitated, which of the following is the best decision? A) Have the patient's family put their wishes in writing. B) Withhold resuscitative measures. C) Consult with the patient's physician. D) Begin resuscitative measures.

Explanation: A) INCORRECT. The wishes of family members alone should not influence the decision to begin or withhold resuscitation. B) INCORRECT. Resuscitative measures should never be withheld when there is doubt about the patient's wishes. C) INCORRECT. Due to the time-sensitive nature of a cardiac arrest, it wouldn't be in the patient's best interest to take the time to try to reach the physician before beginning care. D) CORRECT. It's always best to err on the side of providing care. Page Ref: 88

Your patient is a 40-year-old known diabetic who was found unconscious at work by a coworker. What type of consent allows you to treat this patient? A) Consent for treatment of minor emergencies B) Consent for mentally incompetent adults C) Expressed consent D) Implied consent

Explanation: A) INCORRECT. There is no specific consent defined that is based on the severity of the situation; just if medical care is needed or not. B) INCORRECT. There is no specific classification for consent involving mentally incompetent adults. Implied consent would need to be given in this type of situation. C) INCORRECT. An unconscious patient cannot give expressed consent. D) CORRECT. Implied consent is assumed when a patient is unconscious or otherwise incapacitated. Page Ref: 81

Which type of consent must be used by the EMT when seeking to treat a mentally competent adult? A) Unconditional consent B) Expressed consent C) Conscious consent D) Implied consent

Explanation: A) INCORRECT. There is not a type of consent for medical care that is unconditional. B) CORRECT. Expressed consent, which must be obtained from all patients who are physically and mentally able to give it, can only be given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being. C) INCORRECT. Conscious consent is not a recognized type of authorization to provide emergency medical care. D) INCORRECT. Implied consent is used in the case of an unconscious patient (or one who may be physically or mentally incapacitated but in need of emergency care); in these situations consent is assumed. Page Ref: 81

You respond to a bus accident with multiple patients. As you arrive at the scene, you are approached by a local politician who states that his wife has been involved. He tells you that if you will take care of her first, he will ensure that you get the promotion you are up for. This becomes what type of decision for you as an EMT? A) Legal B) Financial C) Medical D) Ethical

Explanation: A) INCORRECT. There may be no specific law that applies in this situation; as long as all patients get appropriate care, it may be perfectly legal to treat the politician's wife first. B) INCORRECT. Although the promise of a promotion may create the opportunity for financial benefit in the future, this decision is not a financial one. C) INCORRECT. The decision to treat one patient instead of another for the promise of personal gain for the responding EMT is not a medical decision. D) CORRECT. Ethical decisions are ones where the EMT must choose between doing what is right and what might be wrong or self-serving; many ethical decisions are not clinical in nature and can have legal ramifications. Page Ref: 89