1. You arrive at the site of a single-vehicle MVA. A man in his 80s was driving, his wife in the passenger seat. You assess the man as emergent and requiring transport. The man seems unconcerned about himself but keeps asking about his wife, who is dead. What do you tell him?
In this case, EMT professionals are not required to tell the truth, unlike physicians, the NAEMTs EMT Code of Ethics has no such requirement. Taking this into consideration, the procedure taken by the EMT professional, telling him his wife was receiving the best possible care and that they had to concentrate on him was appropriate.
2. An elderly man collapses in front of a local coffee house. While he is being assessed for a probable myocardial infarction, a woman runs up and says she’s the man’s caregiver, though she’s not a family member. She has no documentation proving her claim. She demands to know the patient’s condition
In the above scenario, a physician would be forbidden from giving any medical information to this woman. Medical information can be given only to a legally appointed or recognized decision-maker. A family member calling a hospital to see if a loved one is a patient cannot even be told if that person is in the hospital without that person’s prior written permission.
An EMS provider in the above case would be under similar legal restrictions. A copy of the privacy policies could be given to the woman, and you could request contact information for the nearest family member, but no medical information can be shared until the alleged caregiver can prove she’s the patient’s legal representative
3. A patient with early Alzheimer’s has fallen and requires assessment and potential treatment. Sometimes the patient appears lucid, but more often he does not.
Assessment of competence and capacity to make decisions would normally be the way to proceed in this case, however, in emergency situations this seems unnecessary and time consuming, therefore, implied consent would be assumed in this case, meaning in this case consent will neither be informed nor explicit. The patient should be examined and transported in case of serious injury.
4. A 58-year-old female is having difficulty breathing. After a lifetime of smoking, she figures her time is up and she probably has lung cancer. She indicates she does not want chemotherapy or other cancer treatments, but instead is ready to die. The immediate problem is difficulty getting a good oxygen sat.
If it were a physician, there would be time to indicate the risks and evaluate the situation, have several meetings with the patient and reach a conclusion finally. In the case of EMTs the consent conversation tends to be short if there is any regarding her shortness of breath, as establishing an airway would be their priority.
5. A 67-year-old male patient’s home healthcare provider calls in alarm because her patient has fallen unconscious. He was just discharged from the hospital last week. The home provider has the patient’s advance directive and a copy of a DNR order from his hospitalization. However, there is no prehospital advance directive (out-of-hospital DNR).
42 states have some form of out-of-hospital DNR order, sometimes called a prehospital advance directive (PHAD). Although it is beyond the scope of an EMS provider’s practice to withhold treatment, in reality, EMS providers sometimes do withhold resuscitation without a PHAD or medical director’s order. In the above case, an EMS provider would be required to initiate resuscitation and transport.
6. You are off duty, driving home on the freeway when you find traffic completely stopped. You see just ahead of you that an accident has occurred, and at least one person appears to have gone through his windshield. A person is running through the stopped traffic asking if anyone can provide medical care.
At work or on personal time, a physician must respond to patients in a medical emergency. EMS providers cannot choose whom to treat, the same way that a patient cannot choose which EMT treats them. However, EMT professionals aren’t legally required to intervene and provide care unless in Vermont or Minnesota.
7. A patient is bleeding out after a motor vehicle accident. Like most ambulances, the responding EMS providers do not stock human blood. The standard protocol is to give patients saline to increase fluid volume and to transport immediately. However, this community is participating in a research trial for a new artificial blood substitute. The patient has lost consciousness, and no one is around who can give consent for his participation.
Following the Common Rule, informed consent would be required in this case. However, informed consent in these situations can be difficult of impossible to obtain. Thus, the Department of Health and Human Services and Food and Drug Administration wrote 45 CFR Part 46, which permits research in emergency settings when the patient’s life is in jeopardy and informed consent cannot be obtained.