Patients have the right to refuse resuscitative efforts. In general, refusal requires written orders from a physician. Review your own state and local legislation/protocols relative to DNR
orders and advance directives. When in doubt or when written orders are not present, the First Responder should begin resuscitation efforts.
Competent adult patients have the right to refuse emergency
medical care. The First Responder should not make an independent decision
regarding the refusal of care.The patient may withdraw from emergency medical care at any time. For example, an unresponsive patient regains responsiveness and refuses transport to the hospital. Refusals must be made by mentally competent adults following the
rules of expressed consent.
The patient must be informed of and fully understand all the
risks and consequences associated with refusal of emergency medical care. When in doubt, err in favor of providing care. The First Responder must ensure that additional EMS resources
will evaluate the patient.
While awaiting arrival of additional EMS resources the First
- Try again to persuade patients to accept care.
- Determine whether patients are able to make rational,
informed decisions; in other words, they are not under the influence of alcohol or other drugs or the effects of the injury or illness.
- Inform them why they should accept care and what may happen to them if they do not.
- Consult medical oversight as directed by local protocol.
- Consider assistance of law enforcement.
- Report any assessment findings and emergency medical care provided.
Assault & Battery - unlawfully touching a patient without consent and providing emergency medical care when a competent patient does
not consent to the emergency medical care. (However, no universal definition of assault and battery exists for EMS personnel.)
Abandonment - terminating care of the patient without insuring
that care will continue at the same level or higher.
Negligence - deviation from the accepted standard of care resulting in further
injury to patients.
- Duty to Act
- A contractual or legal obligation must exist.
- Formal - As part of First Responder's occupation, they are required to render emergency medical care.
- Patient calls for assistance and the dispatcher confirms that help is being sent.
- The First Responders are dispatched as part of the EMS response.
- Emergency medical care is initiated for patients.
- "Legal" duty to act varies according to state law where there are moral and ethical considerations.
- Specific state regulations regarding duty to act will guide your decisions.
- Duty to act appropriately means following guidelines for standards of care and acting as another prudent individual would in that situation.
- Breach of the duty means failure to act or failure to act appropriately.
- Actions or lack of actions of the First Responder caused the physical or psychological injury/damage.
Confidential information includes:
- Patient history gained through interview.
- Assessment findings.
- Emergency medical care rendered.
Releasing confidential information:
- Requires a written release form signed by the patient. Do not release any patient information on request, unless authorized in writing.
- Does not require a release form when:
- Other health care providers need to know information to continue care.
- State law requires reporting incidents (examples: rape, abuse or gun shot wounds).
- Subpoena is issued.
Medical Identification Insignia bracelet, necklace, or card indicates a medical condition of the patient, such as allergies, diabetes, epilepsy.
- Dispatch should notify police personnel.
- Emergency medical care of the patient is the First Responder's priority.
- Do not disturb any item at the scene unless emergency medical care requires it.
- Observe and document anything unusual at the scene.
- If possible, do not cut through holes in clothing from gunshot wounds or stabbing.
- Fundamental medical documentation:
- System/local requirements for documentation.
- State requirements for documentation.
- Special reporting situations are established by state regulations or statutes and may vary from
state to state.
- Commonly required reporting situations
- Wounds sustained or potentially sustained by violent crime
- Sexual assault
- Infectious disease exposure
Legal and ethical issues are present in every aspect of
patient care. Decisions to treat or not treat a patient, to release or not release
information, to report or not report an incident all require a knowledge of current state
and local legislation, policy, and protocol. Up-to-date knowledge of the
current legal interpretation of issues such as negligence, battery,
confidentiality, consent, and refusal of emergency medical care is essential for the First