Chapter 3 Medical Legal and Ethical Issues

Permission to treat an unconscious patient until he/she becomes conscious
Implied consent

A written order given by the physician based upon a decision by a patient prior to his/her demise
Advance directive

Being held legally responsible
Liability

An obligation to provide emergency care to a patient
Duty to act

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

Permission from the patient to treat him/her
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

The collective medical, legal, and ethical guidelines that govern the EMT-Basic
Scope of practice

Not providing the standard of care
Breach of duty

finding of failure to act properly in a situation in which there was a duty to act
Negligence

A legal document, usually signed by the patient and his/her physician, to “do not resuscitate”
DNR order

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

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

Child who is married or of a specific age who, in certain states, can make his/her own legal decisions
Emancipated minor

Subjecting a patient to unwanted care and transport can be considered this in a court of law
Battery

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.

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.

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

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Scope of Practice
A set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT’s job.
* A collective set of regulations, duties, and ethical considerations that define your role as an EMT

EMT is accountable to…
Patient, Medical Direction, State legislation

Consent
Receiving permission from the patient prior to treatment or action by the EMT

Three types of consent
1. Expressed/Informed/actual
2. Implied
3. Consent to treat minors or mentally incompetent patients

Expressed/Informed/Actual
The consent given by adults who are of legal and who are mentally competent to make a rational decision in regard to their medical well-being

Implied Consent
type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment

Children and Mentally Incompetent Adults
Children and mentally incompetent adults are not legally allowed to provide consent or refuse medical care and transportation

Liability
Being legally responsible

Emancipated Minor
A person under 18 years of age who is married, pregnant, a parent, a member of the armed forces, or financially independent and living away from home.

Refusing Care
You will find that some patients who require treatment and transportation to the hospital will refuse

Options for Patient Refusing Care
1. Utilize others to help
* Family members may help convince the patient
* Medical direction may assist
* Law enforcement may have legal options

Documenting Patient Refusal
1. Documentation is key to protection
* Note all physical findings
* Attempt to persuade patient to accept care
* Outline risks and consequences as explained

Assault and Battery
Unlawful touching a patient without consent can be considered battery

Providing care without consent

Three types of advance directives
1. Do not resuscitate order
2. Living will
3. Healthcare proxy

Do not resuscitate order
a legal document, usually signed by the patient and his physician, which states that the patient has a terminal illness and does not wish to prolong life through resuscitative efforts.

Advanced Directives
A DNR order; instructions written in advance of an event

Ethical Responsibilities
1. Make patient’s needs a priority
2. Maintain skills and knowledge
3. Critically review performance
4. Prepare honest reports

Negligence
Deviation from accepted standards of care recognized by law for the protection of others against the unreasonable risk of harm
* A finding of failure to act properly in a situation in which there was duty to act, that needed care as would reasonably be expected of the EMT was not provided, and that harm was caused to the patient as a result

Elements of Proving Negligence
1. Duty to act
2. Breach of that duty
3. Actual damages
4. Proximate cause

Duty to Act
an obligation to provide care to a patient
1. Formal duty: Contractual obligation between agency and municipality
2. Implied duty: call to 911; beginning care to patient

Duty to Act: Ethical/Moral
1. Off duty
2. Out of your EMS system but in an ambulance
3. Off duty but in uniform

Breach of Duty
An action or inaction that violates the standard of care expected from an EMT

Malfeasance
Performance of a wrongful or unlawful act by an EMT

Misfeasance
Performance of a legal act in a harmful or injurious manner

Nonfeasance
Failure to perform a required act or duty

Abandonment
Leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training

Actual damages
Refers to compensable physical, psychological, or financial harm

Proximate Cause
An action or inaction that immediately caused or worsened the damage

Good Samaritan Law
a law that provides immunity from liability for acts performed in good faith to assist at the scene of a medical emergency unless those acts constitute gross negligence

Confidential Information
Any information you obtain about a patient’s history, condition, or treatment is considered confidential and must not be shared with anyone else.

Exception to written release
1. Subpoena
2. Other healthcare personnel treating patient
3. Mandatory reporting
4. Insurance

HIPAA
Health Insurance Portability and Accountability Act mandates increased privacy of patient-specific medical information and its:
1. Record keeping
2. Storage
3. Access
4. Discussion

Medical Identification Devices
1. Alert EMT to patient’s medical condition, such as:
* Heart conditions
* Diabetes
* Allergies
* Epilepsy
* other information

Organ Donation
An organ donor is a patient who has completed a legal documentation that allows for donation of organs in the event of his death

EMT role is Organ Donation
1. organ donor patients are treated the sane as other patients
2. Identify potential donors
3. Notify medical direction
4. Provide care to maintain vital organs

Crime Scene
Defined as the location where a crime has been committed or any place that evidence relating to a crime may be found.

1. Do not enter the crime scene until it is safe
2. Patient care is the priority
3. Remain alert for evidence and try not to disturb it

Crime Scenes…
1. Be observant
2. Minimize your impact on the scene
3. Remember what you touch
4. Plan and communicate with the police

Special Crimes and Reporting
1. Abuse
2. Sexual assault
3. Gunshot wound
4. Infectious disease exposure
5. Restraint
6. MCI
7. Other unusual situations
8. Mandatory reporting laws vary from state to state

Emergency Medical Care
Immediate care, or treatment, that is often provided by an EMT.

Consent
Permission given by the patient to render care. If a person is conscious, rational, and capable of making informed decisions, he or she has a legal right to refuse care, even though ill or injured. Can be expressed (actual) or implied and can also apply to the care of a minor or a mentally incompetent patient.

Decision Making Capacity
The foundation of consent. The ability of a patient to understand the information you are providing to him or her, coupled with the ability to process that information and make an informed choice regarding medical care that is appropriate for him or her.

Patient Autonomy
The right of a patient to make decisions concerning his or her health.

Distinctions between “Competence” and “Decision Making Capacity”
“Competence” is generally regarded as a legal term and determinations regarding competence are typically made by a court of law.

“Decision Making Capacity” is the term more commonly used in health care to determine whether or not a person is capable of making health care decisions.

Factors to consider when determining a patient’s decision making capacity
– Intellectual capacity impaired by mental limitations or dementia?
– Of legal age? (18 years of age in most states)
– Impaired by alcohol/drugs/serious injury/illness?
– Appear to be experiencing significant pain?
– Any apparent hearing or visual problems?
– Language barrier present? Do you and your patient speak the same language?
– Appear to understand what you are saying? Does he or she ask rational questions that demonstrate an understanding of the information you are trying to share?

Types of consent
– Expressed consent
– Implied consent
– Involuntary consent

Expressed Consent
The type of consent given when the patient verbally or otherwise acknowledges that he or she wants you to provide care or transport. Also known as actual consent. May be nonverbal.

Informed Consent
Permission for treatment given by a competent patient after the potential risks, benefits, and alternatives to treatment have been explained. Valid if given orally, but it may be difficult to prove at a later point in time. Rarely do EMS providers have patients sign a consent form, so it is alway advisable to document consent in your run report. A witness to the patient’s consent may be helpful is the issue of consent is later challenged in court.

Implied Consent
Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. Applies only where a serious medical condition exists and should never be used unless there is a threat to life or limb.

Emergency Doctrine
The principle of law that permits a health care provider to treat a patient in an emergency situation when the patient is incapable of granting consent because of an altered level of consciousness, disability, the effects of drugs or alcohol, or the patient’s age.

Medicolegal
Relates to medical jurisprudence (law) or forensic medicine.

Emancipated Minors
Individuals who, despite being under the legal age in a given state (in most cases the age is 18 years), can be legally treated as adults based on certain circumstances. Examples include if the minor is living away from and no longer relying on his or her parents for support, married, member of the armed services, or if he or she is a parent (who may also give consent for his or her own child).

in loco parentis
Refers to the legal responsibility of a person or organization to take on some of the functions and responsibilities of a parent. You should still make an effort to obtain consent from a parent or legal guardian whenever possible; however, if a true emergency exists and the parent or legal guardian in not available, the consent to treat the minor is implied, just as with an adult.

Forcible Restraint
The act of physically preventing an individual from initiating any physical action. Sometimes necessary when you are confronted with a patient who is in need of medical treatment and transportation but is combative and present a significant risk of danger to himself, herself, or others.

Breach of Confidentiality
Disclosure of information without proper authorization. Communication between you and the patient is considered confidential and generally cannot be disclosed without permission from the patient or a court order.

Confidential Information includes
– Patient History
– Assessment Findings
– Treatment Provided

Protected Health Information (PHI)
Any information about health status, provisions of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient’s medical record or payment history.

Do Not Resuscitate (DNR) Orders
Written documentation by a physician giving permission to medical personnel to not attempt resuscitation in the event of cardiac arrest. Also known as a “do not attempt resuscitation” order).

DNR orders must meet the following requirements:
– Clear statement of the patient’s medical problem(s).
– Signature of the patient or legal guardian.
– Signature of one or more physicians.
– In some states, DNR orders contain an expiration date, whereas in others, no expiration date is included. DNR orders with expiration dates must be dated in the preceding 12 months to be valid.

Competent
Able to make rational decisions about personal well-being.

Advanced Directive
Written documentation that specifies medical treatment for a competent patient should the patient become unable to make decisions, also called a living will, or health care directive. Most commonly used when a patient becomes comatose.

Comfort Care Order
An advanced directive that specifies care a person should receive in the even that they become incompetent. May include nutrition and medication for pain.

Durable Powers of Attorney for Health Care
A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decisions making capacity. Also known as Health Care Proxies.

“Brain Death” Provisions
Refer to irreversible cessation of all functions of the brain and brain stem.

General rule to an absence of DNR orders:
If the body is still warm and intact, initiate emergency medical care. An exception is cold temperature (hypothermia) emergencies.

Hypothermia
A general cooling of the body in which the internal body temperature becomes abnormally low: below 95F (35C). It is considered a serious condition and is often fatal. At 86F (30C), the brain can survive without perfusion for about 10 minutes. When the core temperature drops to 82.4F (28C), the patient is in grave danger; however, individuals have survived hypothermic incidents with temperatures as low as 64F (18C). The patient should not be considered dead until he or she is warm and dead.

Presumptive Signs of Death
– Unresponsiveness to painful stimuli
– Lack of a carotid pulse or heartbeat
– Absence of breath sounds
– No deep tendon or corneal reflexes
– Absence of eye movement
– No systolic blood pressure
– Profound cyanosis (blue or purple coloration of the skin or mucous membranes)
– Lowered or decreased body temperature

Definitive Signs of Death
– Obvious mortal damage, such as a body in parts (decapitation)
– Dependent Lividity
– Rigor Mortis (Occurs sometime between 2 and 12 hours after death)
– Putrefaction (occurs sometime between 40 and 96 hours after death)

Dependent Lividity
Blood settling to the lowest point of the body, causing discoloration of the skin.

Rigor Mortis
The stiffening of body muscles caused by chemical changes within muscle tissue. It develops first in the face and jaw, gradually extending downward until the body is in full rigor. The rate of onset is affected by the body’s ability to lose heat to its surroundings.

Putrefaction
Decomposition of body tissues.

Possible Medical Examiner (or Coroner in some states) cases
– Person is dead on arrival (DOA) (or dead on scene [DOS])
– Death without previous medical care or when the physician is unable to state the cause of death
– Suicide (self-destruction)
– Violent death
– Poisoning, known or suspected
– Death resulting from accidents
– Suspicion of a criminal act

Organ Donor
An individual who has expressed a wish to donate organs.

Scope of Practice
Most commonly defined by state law, outlines the care you are able to provide for the patient. Further defined by your medical director by developing protocols and standing orders. Not to be confused with the standard of care.

Standard of Care
Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.

Emergency
A serious situation, such as an injury or an illness that arises suddenly, threatens the life or welfare of a person or group of people, and requires immediate intervention.

Certification
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.

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

Duty to Act
An individual’s responsibility to provide patient care.

Negligence
The failure to provide the same care that a person with similar training would provide in the same or similar situation. It is deviation from the accepted standard of care that may result in further injury to the patient.

Determination of Negligence is based on four factors:
– Duty
– Breach of Duty
– Damages
– Causation

Duty
The EMT has an obligation to provide care and to do so in a manner that is consistent with the standard of care established by training and local protocols.

Breach of Duty
There is a breach of duty when the EMT does not act within an expected and reasonable standard of care.

Damages
There are damages when a patient is physically or psychologically harmed in some noticeable way.

Causation
There must be a reasonable cause-and-effect relationship between the breach of duty and the damages suffered by the patient.

Proximate Causation
When a person who has a duty abuses it, and causes harm to another individual, the EMT, the agency, and/or the medical director may be sued for negligence.

res ipsa loquitor
When the EMT or an EMS service is held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred.

negligence per se
A theory that may be used when the conduct of the person being sued to alleged to have occurred in clear violation of a statute.

Torts
A wrongful acts that gives rise to a civil suit.

Abandonment
The unilateral termination of care by the EMT without the patient’s consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient. Once care has started, you have assumed a duty that must not stop until an equally competent EMS provider assumes responsibility.

Assault
Unlawfully placing a person in fear of immediate bodily harm.

Battery
Unlawfully touching a person; this includes providing emergency care without consent.

Kidnapping
The seizing, confining, abducting, or carrying away of a person by force.

False Imprisonment
The unauthorized confinement of a person that lasts for an appreciable period of time.

Defamation
The communication of false information that damages the reputation of a person.

Libel
Defamation in writing.

Slander
Defamation that is spoken.

Good Samaritan Laws
Statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care, unless there is wanton, gross, or willful negligence.

Gross Negligence
Conduct that constitutes a willful or reckless disregard for a duty or standard of care.

Ethics
The philosophy of right and wrong, of moral duties, and of the ideal professional behavior.

Morality
A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

Bioethics
The study of ethics related to issues that arise in health care.

Applied Ethics
The manner in which principles of ethics are incorporated into professional conduct.

Precedence
Basing current action on lessons, rules, or guidelines derived from previous similar experiences.

Statute of Limitations
The time within which a case must be commenced.

Governmental Immunity
If your service is covered by immunity, it may mean that you cannot be sued or it may limit the amount of the monetary judgement that the plaintiff may recover; generally applies only to EMS services that are operated by municipalities or other governmental entities.

Contributory Negligence
A legal defense that may be raised when the defendant feels that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff.

Discovery
The phase of a civil suit where the plaintiff and defense obtain information from each other that will enable the attorneys to have a better understanding of the case and which will assist in negotiating a possible settlement or in preparing for trial. Includes depositions, interrogatories, and demands for production of records.

Interrogatories
Written questions that the defense and plaintiff send to the other.

Depositions
Oral questions asked of parties and witnesses under oath.

Compensatory Damages
Damages awarded in a civil suit that are intended to restore the plaintiff to the same condition that he or she was in prior to the incident complained about in the lawsuit.

Punitive Damages
Damages that are sometimes awarded in a civil suit when the conduct of the defendant was intentional or constituted a reckless disregard for the safety of the public.

Able to make decisions
competent

Specific authorization to provide care expressed by the patient
expressed consent

Confining a person from mental or physical action
forcible restraint

Granted permission
consent

Touching without consent
battery

Legal responsibility to provide care
duty to act

Written documentation that specifies treatment
advance directive

Unlawfully placing a patient in fear of bodily harm
assault

Unilateral termination of care
abandonment

Failure to provide standard of care
negligence

Accepted level of care consistent with training
standard of care

Process that recognizes that a person has met set standards
certification

Legal assumption that treatment was desired
implied consent

Relating to law or forensic medicine
medicolegal

The care that an EMT is able to provide is most commonly defined as a:
a. duty to act
b. competency
c. scope of practice
d. certification
C

How the EMT is required to act or behave is called:
a. the standard of care
b. competency
c. the scope of practice
d. certification
A

The process by which an individual, an institution, or a program is evaluated and recognized as meeting certain standards is called:
a. the standard of care
b. competency
c. the scope of practice
d. certification
D

Negligence is based on the EMT’s duty to act, cause, breach of duty, and:
a. expressed consent
b. termination of care
c. mode of transport
d. real or perceived damages
D

While treating a patient with a suspected head injury, he becomes verbally abusive and tells you to “leave him alone.” If you stop treating him you may be guilty of:
a. neglect
b. battery
c. abandonment
d. slander
C

Good Samaritan laws generally are designed to offer protection to persons who render care in good faith. They do not offer protection from:
a. properly performed CPR
b. acts of negligence
c. improvising splinting materials
d. providing supportive BLS to a DNR patient
B

Which of the following is generally NOT considered confidential?
a. assessment findings
b. a patient’s mental condition
c. a patient’s medical history
d. the location of the emergency
D

An important safeguard against legal implication is:
a. responding to every call with lights and siren
b. checking ambulance equipment
c. transporting every patient to an emergency department
d. writing a complete and accurate run report
D

Your responsibility to provide patient care is called:
a. scope of practice
b. duty to act
c. DNR
d. standard of care
B

Presumptive signs of death would not be adequate in cases of sudden death due to:
a. hypothermia
b. acute poisoning
c. cardiac arrest
d. severe trauma
A

Definitive or conclusive signs of death that are obvious and clear to even nonmedical persons include all of the following except:
a. profound cyanosis
b. dependent lividity
c. rigor mortis
d. putrefaction
A

Medical examiners’ cases include:
a. violent death
b. suicide
c. suspicion of a criminal act
d. all of the above
D

HIPAA is the acronym for the Health Insurance Portability and Accountability Act of 1996. This act:
a. makes ambulance services accountable for transporting patients in a safe manner
b. protects the privacy of health care information and safeguards patient confidentiality
c. allows health insurers to transfer an insurance policy to another carrier if a patient does not pay his or her premium
d. enables emergency personnel to transfer a patient to a lower lever of care when resources are scarce
B

T/F Failure to provide care to a patient once you have been called to the scene is considered negligence.
T

T/F For expressed consent to be valid, the patient must be a minor.
F

T/F If a patient is unconscious and a true emergency exists, the doctrine of implied consent applies.
T

T/F EMTs can legally restrain patients against their will if they pose a threat to themselves or others.
T

T/F DNR orders give you permission not to attempt resuscitation at your discretion.
F

The _______ ________ _________ outline the care you are able to provide.
scope of practice

The _________ ________ __________ is the manner in which the EMT must act when treating patients.
standard of care

The legal responsibility to provide care is called the ______ ______ ______.
duty to act

The determination of __________ is based on duty, breach of duty, damages, and cause.
negligence

Abandonment is __________ of care without transfer to someone of equal or higher training.
termination

____________ consent is given directly by an informed patient, whereas _________ consent is assumed in the unconscious patient.
expressed; implied

Unlawfully placing a person in fear of immediate harm is _________, whereas ___________ is unlawfully touching a person without his or her consent.
assault; battery

A(n) ____________ __________ is a written document that specifies authorized treatment in case a patient becomes unable to make decisions. A written document that authorizes the EMT not to attempt resuscitation efforts is a(n) ___________ ___________.
advance directive; DNR order

Mentally competent patients have the right to __________ ___________.
refuse treatment

Incidents involving child abuse, animal bites, childbirth, and assault have __________ __________ requirements in many states.
special reporting

False and damaging information about a person that is communicated by the spoken work
slander

__________ ____________ laws are statutory provisions enacted by many states to protect citizens from liability for errors and omissions in giving good faith emergency medical care
good samaritan

With _________ consent, a patient gives express authorization for provision of care or transport
expressed

Any information about health status, provision of health care, or payment for health care that can be linked to an individual
PHI

False and damaging information about a person that is communicated in writing
libel

A code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience
morality

Touching a patient or providing emergency care without consent
battery

The philosophy of right and wrong, of moral duties, and of ideal professional behavior
ethics

The study of ethics related to issues that arise in health care
bioethics

Most commonly defined by state law; outlines the care you are able to provide for the patient
scope of practice

Written documentation by a physician giving permission to medical personnel not to attempt resuscitation in the event of cardiac arrest is called a(n) ___________ order
DNR

Permission to render care
consent

Oral questions asked of parties and witnesses under oath
depositions

When a person who has a duty abuses it, and causes harm to another individual, the EMT, the agency, and/or the medical director may be sued for negligence. This is called __________ causation
proximate

Basing current action on lessons, rules, or guidelines, derived from previous similar experiences
precedence

A wrongful act that gives rise to a civil suit
tort

At 2:00am, a 17-year-old boy, accompanied by his 19-year-old girlfriend, had driven to the bar to give his father (who had been drinking large amounts of alcohol) a ride home. On the way back, they were involved in a motor vehicle collision. The boy has a large laceration with profuse bleeding on his forehead. His girlfriend is unconscious in the front passenger floor. The father is standing outside the vehicle, appearing heavily intoxicated, and is refusing care. Should the father be allowed to refuse care?
a. Yes. Consent is required before care can be started.
b. No. He is under the influence of drugs/alcohol and therefore mentally incompetent.
c. Yes, under implied consent.
d. No. You would be guilty of abandonment.
B

At 2:00am, a 17-year-old boy, accompanied by his 19-year-old girlfriend, had driven to the bar to give his father (who had been drinking large amounts of alcohol) a ride home. On the way back, they were involved in a motor vehicle collision. The boy has a large laceration with profuse bleeding on his forehead. His girlfriend is unconscious in the front passenger floor. The father is standing outside the vehicle, appearing heavily intoxicated, and is refusing care. Why is it permissible for you to begin treatment on the girlfriend?
a. consent is implied
b. consent has been expressed
c. consent was informed
d. none of the above
A

At 2:00am, a 17-year-old boy, accompanied by his 19-year-old girlfriend, had driven to the bar to give his father (who had been drinking large amounts of alcohol) a ride home. On the way back, they were involved in a motor vehicle collision. The boy has a large laceration with profuse bleeding on his forehead. His girlfriend is unconscious in the front passenger floor. The father is standing outside the vehicle, appearing heavily intoxicated, and is refusing care. As you progress in your care for the patients, the father becomes unconscious. Can you begin/continue care for him now?
a. Yes. Consent is now implied.
b. No. He made his wishes known before he fell unconscious.
c. No. He just needs to sleep it off.
d. Yes. Unconsciousness indicates informed consent.
A

At 2:00am, a 17-year-old boy, accompanied by his 19-year-old girlfriend, had driven to the bar to give his father (who had been drinking large amounts of alcohol) a ride home. On the way back, they were involved in a motor vehicle collision. The boy has a large laceration with profuse bleeding on his forehead. His girlfriend is unconscious in the front passenger floor. The father is standing outside the vehicle, appearing heavily intoxicated, and is refusing care. With the son being a minor, what is the best way to gain consent to begin care when his father has an altered mental status or is unconscious?
a. phone his mother for consent
b. call his grandparents for consent
c. it is a true emergency, so consent is implied
d. you are covered under the Good Samaritan laws
C

You respond to a single-vehicle crash on the highway west of town. Upon arrival you find a 33-year-old man with an open forearm fracture who has self-extricated from his pickup, which is down the roadside embankment. He does not appear to have suffered any other injuries, is fully coherent, and refuses all medical care. In an effort to obtain consent to treat this patient, you should:
a. summon law enforcement and request that the patient be placed into protective custody
b. clearly explain the consequences of not accepting medical treatment
c. proceed with treatment; consent is not required because the patient is not being rational
d. properly document the refusal of care
B

You respond to a single-vehicle crash on the highway west of town. Upon arrival you find a 33-year-old man with an open forearm fracture who has self-extricated from his pickup, which is down the roadside embankment. He does not appear to have suffered any other injuries, is fully coherent, and refuses all medical care. If you and your partner were out past the end of your scheduled shift and driving the ambulance back to base to go home when you came upon this accident, would you have a legal duty to act?
a. No. If you were not specifically dispatched to the crash, you do not have an obligation to assist.
b. Yes. As a trained and licensed EMT you must assist with every medical emergency that you encounter.
c. No. Because it is past the end of your scheduled shift, you can decide whether you want to stop and help.
d. Yes. As a trained EMT still on-duty for an EMS system, you would have a legal and ethical obligation to stop and assist.
D

What conditions allow a minor to be treated as an adult when consenting to medical treatment?
1. emancipated
2. in the armed services
3. married
4. has a child

When does patient care end?
when patient is transferred to a higher skill level EMS provider or medical facility

What are 5 steps that should be taken to protect both you and the patient when the patient refuses treatment or care?
1. get refusing patient’s signature
2. get witness’s signature
3. keep refusal form with incident report
4. note refusal on report
5. keep copy of refusal for reference

What are the 2 rules of thumb when regarding reports and records?
1. if it wasn’t documented, it didn’t happen
2. incomplete/messy reports means incomplete/bad care

What are 4 steps to take when on a scene involving an organ donor?
1. call medical control
2. treat the patient the same as if not a donor
3. try to preserve life
4. if saving the life is not possible, try to save the organs

Which of the following components are needed to prove negligence?

A) abandonment, breach of duty, damages, and causation
B) breach of duty, injury/damages, abandonment, and causation C) duty to act, breach of duty, injury/damages, and causation
D) duty to act, abandonment, breach of duty, and causation

C) duty to act, breach of duty, injury/damages, and causation

which of the following statements regarding the NREMT is correct?
a) the NREMT is a governmental agency that certifies EMTs
b) the NREMT is the exclusive certifying body for EMTs
c) EMS training standards are regulated by the NREMT
d) the NREMT provides national standard for EMS testing
d) the NREMT provides national standard for EMS testing

which of the following scenarios does NOT involve the administration of ALS?
a) a 64 y/o cardiac arrest patient who is defibrillated with an automated external defrib (AED)
b) a 53 y/o patient who is given glucagon for significant hypoglycemia
c) a 61 y/o trauma patient whose chest is decompressed with a needle
a) a 64 y/o cardiac arrest patient who is defib with an AED (because EMTs are CPR/AED certified)

which of the following is a unique function of the Emergency medical dispatcher?
a) providing callers with life-saving instructions
b) obtaining patient info from the caller
c) relaying relevant info to the EMTs
d) directing the ambulance to the correct address
a) providing callers with life-saving instructions

EMRs such as fire fightesr, police, and park rangers, are an integral part of the EMS system because…
a) the avg response time for the EMT crew is approx 15 mins
b) the presence of a person trained to initiate BLS care cannot be ensured
c) they are usually trained to assist paramedics w/ certain procedures
B

according to the National EMS Scope of Practice model, an EMT would require special permission from the Med Director and the state EMS office in order to…
a) give aspirin to a patient with chest pain
b) apply and interpret a pulse oximeter
c) perform blood glucose monitoring
d) use an automatic transport ventilator
c) perform bloood glucose monitoring

The continuous quality improvement (CQI) process is designed to…
identify ares of improvement and provide remedial training if needed

The criteria to be licensed and employed as an EMT include:
proof of immunization against certain communicable diseases

EMT training in nearly every state meets or exceeds the guidelines recommended by the…
National Highway Traffic Safety Administration (NHTSA)

The person who is responsible for authorizing EMTs to perform emergency medical care in the field is the…
medical director

Why are prehospital emergency care guidelines updated on a regular basis?
additional information and evidence indicate that the effectiveness of certain interventions has changed

obtaining continuing medical education is the responsibility of the:
individual EMT

if an EMT candidate has been convicted of a felony or misdemeanor, he or she should…
contact the state EMS office and provide them with the required documentation

an appropriate demonstration of professionalism when your patient is frightened, demanding or unpleasant is to:
continue to be nonjudgemental, compassionate, and respectful

cardiac monitoring, pharmacological interventions, and other advanced treatment skills are the function of a…
paramedic

the standards for prehospital emergency care and the individuals who provide it are typically regulated by the:
state office of EMS

laypeople are often trained to perform all of the following skills, EXCEPT:
a) splinting of possible fracture
b) insertion of an OPA
c) control of life-threatening bleeding
d) one- or two-rescuer CPR
B

as an EMT you may be authorized to administer aspirin to a patient with chest pain based on…
local EMS protocols

which of the following errors is an example of knowledge-based failure?
an EMT administers the wrong drug to a patient bc she did not know the pertinent information about the drug

which of the following is an example of a primary prevention strategy??
community awareness programs that emphasize the dangers of drinking and driving

which of the following skills or interventions is included at every level of prehospital emergency training?
a) AED
b) oral glucose for hypoglycemia
c) intranasal medication administration
d) use of a manually triggered ventilator
A) AED

the _____ deals with well-being of the EMT, career progression, and EMT compensation.
human resources department

an EMS provider who has extensive training in various aspects of ALS is called a…
paramedic

If a defibrillator manufacturer calims that its device terminates ventricular fibrillation on the first shock 95% of the time, you should..
recognize that this does mean it will save more lives

The determination that prompt surgical care in the hospital is more important than performing time- consuming procedures in the field on a major trauma patient is based MOSTLY on:

A) the lead EMT’s decision.
B) EMS research.
C) regional trauma guidelines.
D) local protocols.

EMS research

Which of the following statements regarding the Americans with Disabilities Act of 1990 is correct?
ADA prohibits employers from failing to provide full and equal employment to the disabled

according to the National EMS scope of practice model, an EMT should be able to:
assist a patient with certain prescribed meds

Which of the following descriptions MOST accurately portrays emergency medical services (EMS)?
A. a team of health care professionals who are responsible for providing emergency care and transportation to the sick and injured
B. a team of paramedics and emergency physicians who are responsible for providing emergency care to critically injured patients
C. a system composed exclusively of emergency medical responders (EMRs) and emergency medical technicians (EMTs) who are responsible for providing care to sick and injured patients
A

Continuing education in EMS serves to…
A. maintain, update, and expand your knowledge and skills.
B. enforce mandatory attendance to agency-specific training.
C. provide an ongoing review and audit of the EMS system.
A. maintain, update, and expand your knowledge and skills

What type of medical direction do standing orders and protocols describe?
off-line

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:
being 2 rescuer CPR and apply the AED as soon as possible

In which of the following circumstances can the EMT legally release confidential patient information?
A. the family requests a copy for insurance purposes
B. the patient is competent and signs a release form
C. a media representative inquires about the patient
D. a police officer requests a copy to place on file
b. the patient is competent and signs a release form

You are assessing a woman who was thrown from her horse. She is located in a large field and you can see that a thunderstorm is rapidly approaching. Suddenly, you feel your skin begin to tingle and the hair on your arms stands on end. The ambulance is located about 30 yards away. You should:
crouch down in a position so that only your feet are touching the ground

Which of the following scenarios MOST accurately depicts abandonment?
A. An AEMT transfers patient care to a paramedic.
B. A physician assumes patient care from an EMT.
C. An EMT gives a verbal report to an emergency room nurse.
D. A paramedic transfers patient care to an EMT.
D.

You and your partner respond to the residence of a 66-year-old male with shortness of breath. As you are assessing the patient, his wife tells you that he was recently diagnosed with lung cancer. The patient is verbally abusive and tells you that failure of the health care system caused his disease. What stage of the grieving process is this patient’s behavior consistent with?
anger

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:
A. transport the child to the closest hospital and let them provide any treatment.
B. recognize that you cannot begin treatment without expressed parental consent.
C. administer oxygen only until you receive parental consent for further treatment.
D. provide treatment up to your level of training and transport the child at once.
D.

Maintaining the chain of evidence at the scene of a crime should include:
not cutting through holes in clothing that were caused by weapons.

While on duty, your partner asks you out on a date and touches you in an inappropriate location without your consent. You should:
tell ur partner to stop and report the incident to your supervisor

Your BEST protection against legal liability when a competent patient refuses EMS care and transport is to:
thoroughly document the entire event

Physiologic manifestations of stress include:
perspiration, increased blood glucose levels, and dilated pupils.

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

Where would you MOST likely find information regarding a patient’s wishes to be an organ donor?
DRIVER’s license

In the eyes of the court, an incomplete or untidy patient care form indicates:
inadequate patient care was administered

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 him or her of the error

Which of the following statements regarding the Good Samaritan law is correct?
A. It provides the EMT immunity from a lawsuit.
B. The law does not protect EMTs who are off duty.
C. It guarantees that the EMT will not be held liable if he or she is sued.
D. It will not protect the EMT in cases of gross negligence.
D. it will not protect the EMT in cases of gross negligence

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. What type of consent is her agreement considered?
expressed

As an EMT, it is important to remember that the signs and symptoms of cumulative stress:
May not be obvious or present all the time

If you use a waterless handwashing substitute in the field, it is important to:
wash your hands with soap and water at the hospital

You are dispatched to the scene of a crash involving a large tanker truck. While you are en route, dispatch advises you that there are multiple patients and that the fire department is en route as well. As you approach the scene, you should..
maintain a safe distance and try to read the placard with binoculars

vector borne transmission of an infectious organism occurs via:
animals or insects

You arrive at the scene of a domestic violence situation. As you approach the doorway of the apartment, you hear screaming and the statement “He has a gun!” Your MOST appropriate action should be to:
seek a safe place and request law enforcement assistance

Gloves, a mask, eye protection, and a face shield should be used:
when performing endotracheal intubation

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

your partner, a veteran EMT who u have worked with regularly for the past 4 years, seems agitated during a call involving an elderly patient. upon arrival back at your station, you note the obvius smell of alcohol on his breath. what do you do?
discreetly report your suspicions to your supervisor

what should you do before attempting to access a patient trapped in a vehicle?
ensure the vehicle is stable

the manner in which the EMT must act or behave when caring for a patient is called the.
standard of care

you arrive at the scene of an apparent death. when evaluating the patient which of the following is a definitive sign of death?
A. absent breath sounds
b. dependent lividity
c. absence of a pulse
B

at the scene of a MCI, you have a patient as an organ donor. when triaging the other patients, you:
may have to assign the donor patient a lower triage priority

you have been working at the scene of a major building collapse for 8 hours. many injured people are still being removed, and everyone is becoming frustrated and losing focus. this situation is most effectively managed by:
requesting a CISM team to provide on-scene peer support

which of the following types of consent allows treatment of a patient who is unconscious or mentally incapacitated?
implied

upon arriving at the scene of a MVC, you note that two small cars collided head-on. the fire department is in the process of stabilizing the vehicles and law enforcement personnel are directing traffic. after parking the ambulance at a safe distance, you and your partner should:
put on high-visibility safety vests

you respond to the home of a 59-year-old man who is unconscious and has a weak pulse. the family states that the patient has terminal brain cancer and does not wish to be resuscitated. they are unable to locate the DNR order. what should you?
begin treatment and contact medical control as needed

which of the following statements regarding the hepatitis B vaccine is correct?
OSHA requires that your employer offer you the vaccine free of charge

the final stage of death and dying is most commonly displayed as:
acceptance

determination of exposure is an important component of an infection control plan because it:
defines who is at risk for contact with blood and body fluids and which tasks pose a risk of exposure

to minimize the risk of litigation, the EMT should always…
provide competent care that meets current standards

when a patient is dying, he or she may experience regression. this is most accurately defined as:
behavioral consistent with an earlier developmental stage

which of the following statements would not be appropriate to say to the family of a dying patient..
A.”things will get better in time”
b. “tell me how you are feeling”
c. “this must be painful for you”
d. “it is okay to be angry and sad”
A.

which of the following statements regarding consent is most correct??
a patient can consent to transport but can legally refuse to be treated

which of the following is the most effective strategy for managing stress?
focus on delivering high-quality patient care

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

during your monthly internal quality improvement meeting, you review several patient care reports 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 EMT’s in the field. by taking this approach to the QI process, you…
are in violation of HIPAA bc you did not remove the PHI from the PCR beforehand

according to the occupational safety and health administration regulations, an employer must:
offer a workplace environment that reduces the risk for exposure

if it is not possivle to adequately claean your ambulance at the hospital following a call, you should..
clean the ambulance at your station in a designated area that is well ventilated

when performing his or her duties, the EMT is generally expected to:
exercise reasonable care and act prudently

you arrive at the scene of a motor vehicle vs. pedestrian accident. the patient, a 13-year-old, 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 approx 15 mins. what should you do?
transport the child immediately and have the parents meet you at the hospital

the compliance monitoring component of an infection control plan should:
ensure that employees understand what they should do and why it is important

the most serious consequence of drug or alcohol abuse among EMS personnel is:
substandard or inappropiate patient care

if you are exposed to a patient’s blood or other bodily fluid, your first action should be to:
transfer care of your patient to another EMS provider

a patient regains consciousness en route from his office to the emergency department. the patient tells you that he feels fine and doesnt want to go to ths hopistal. under these circumstances, you should:
assess whether or not the patients mental condition is impaired

while decontaminating the back of your ambulance after a call, you should:
allow surfaces to air dry unless otherwise indicated in the product directions

in order for a DNR order to be valid it must…
clearly state the patient’s medical problem

which of the following is not considered to be protected health information? (PHI)
location of the call

prescription glasses do not provide adequate eye protection bc they:
offer little to no side protection

which of the following situations requires you to notify the appropriate authorities?
accidental knife wound, drug overdose, attempted suicide, or cardiac arrest
attempted suicide

you are assessing a middle-aged man with chest pain that you suspect is caused by a cardiac problem. the patient tells you that he does not want to go to teh hospital and wants you to leave him alone.
explain the seriousness of hte situation to him but avoid causing undue alarm

which of the following most accurately depicts informed consent?
a) an EMT advises a patient of the risks of receiving treatment
b) a patient advises an EMT of why he or she is refusing care
c) a patient is advised by an EMT of the risks of refusing care
d) an EMT initiates immediate care for an unconscious adult
A. an EMT advises a patient of the risks of receiving treatment

common factors that influence how a patient reacts to the stress of an illness/injury include all of the following EXCEPT:
mental disorders
distrust of the EMT
history of chronic disease
fear of medical personnel
distrust of the EMT

hazards that are associated with a structural fire include all of the following except…
high ambient temperatures
carbon dioxide deficiency
smoke and toxic gases
the risk of building collapse
carbon dioxide deficiency

which of the following scenarios most accurately depicts a PTSD reaction?
an EMT becomes distracted at the scene of a MVC involving the same type of car in which a child was previously killed

if a person is partially immune to a particular disease, he or she…
may develop illness from germs that lie dormant from the initial infection

Patients who become dependent upon EMS personnel or other health care providers often feel:

A) superior.
B) hopeful.
C) relieved.
D) shamed.

shamed

the manner in which the EMT act or behave when caring for a patient is called the
standard of care

you are summoned to a center for an 88 y/o female with an altered mental status. a staff nurse advises you that the patient has terminal cancer and is going to die within the next few hours, a valid DNR form is presented to you. when caring for the patient you should…
make her comfortable and provide emotional support

a positive skin TB test indicates that..
you have been exposed to the disease

when performing his or her duties, the EMT is generally expected to…
exercise reasonable care and act prudently

the PCR ensures…
continuity of care

you could be sued for _____ if your radio report to the hospital describes the patient in a manner that injuries his or her rep
slander

any radio hardware containing a transmitter and receiver that is located in a fixed location is called…
base station

after being dispatched, you should expect the dispatcher to provide you with all of the following info EXCEPT
general geographic location of the incident

while at the scene of a MVC, you attempt to contact the dispatcher with your portable radio but are unsuccessful, you should
use the mobile radio in the ambulance to contact dispatch

ethnocentrism is defined as:
considering your own cultural values as more important when interacting with people of a diff culture

a 4 y/o boy had a seizure. he is conscious and calm and is sitting on his mother’s lap, his fther is sitting nearby. the child’s mother suddenly begins crying uncontrollably, which causes the child to start crying. you should:
consider asking the father to hold the child so you can assess him while your partner tries to calm the mother

when you begin an oral report you should state the pts age, sex and..
cheif complaint

dedicated line?
it is a constantly open line of communication that cannot be accessed by outside users

you and your partner are attempting to resuscitate a female in cardiac arrest. bc of remote location you are in, you are unable to contact medical control. what should you do??
follow locally established protocols or standing orders

during your assessment of a 20 year old man with a sever headache, you ask him when his headache began but he doesnt answer your question immediately. you should:
allow him time to think about the question and respond to it

what type of communications equipment functions as a radio receiver and searchers across several frequencies?
scanner

general guidelines for effective radio communications include all of the following except:
using 10 codes to ensure radio traffic confidentiality

two-way communication that requires the EMT to “push to talk” and “release to listen” describes what model?
simplex

which of the following is not appro to document in the narrative section of a PCR?
“general impression revealed the patient was intoxicated”

when obtaining patient care orders from a physician via a two-way radio, it is most important to remember that:
his/her instructions are based on the info YOU provide

You are interviewing a 52-year-old man who complains of chest discomfort. The patient is a retired paramedic and is very anxious because he thinks he is having a heart attack. Which of the following statements would be appropriate to say
“It is possible that you are experiencing a heart attack. I am going to give you four baby aspirin to chew and swallow.”

When communicating information over the radio, you should:
use the words “Affirmative” and “negative” instead of yes and no

You are assessing a 75-year-old woman with mild shortness of breath. As you are asking her questions regarding her chief complaint and medical history, you progressively move closer and closer to her.
as you physically get closer to the patient, a greater and greater sense of trust must be established.

Typical components of an oral patient report include all of the following, EXCEPT:
the set of baseline vital signs taken at the scene.

Communicating with hearing-impaired patients can be facilitated by doing all of the following, EXCEPT:
elevating the tone of your voice and exaggerating word pronunciation

Medical control gives you an order that seems inappropriate for the patient’s condition. After confirming that you heard the physician correctly, you should:
advise the physician that the order is unclear and ask for clarification.

A 60-year-old man complains of chest pain. He is conscious and alert and denies shortness of breath. Which of the following questions would be the MOST appropriate to ask him?
“Do you have any heart problems or take any medications?”

All information recorded on the PCR must be:
considered confidential

Which of the following statements regarding standing orders is MOST correct?
A. Standing orders only highlight the care that you may provide.
B. Standing orders should be followed when physician contact is not possible.
C. Standing orders have less legal authority than orders given via radio.
D. Standing orders require you to contact medical control first.
B. Standing orders should be followed when physician contact is not possible.

Which of the following incidents does NOT require a report to be filed with local authorities?
A. spousal abuse
B. gunshot wounds
C. animal bites
D. cardiac arrest
D

A patient’s refusal for EMS treatment and/or transport must be:
an informed refusal

Which of the following statements regarding a patient refusal is MOST correct?
A. A mentally competent adult has the legal right to refuse EMS care and transport.
B. A patient who consumed a few beers will likely be able to refuse EMS treatment.
C. Advice given to a patient who refuses EMS treatment should not be documented.
D. Documentation of proposed care is unnecessary if the patient refuses treatment.
A. A mentally competent adult has the legal right to refuse EMS care and transport.

Which of the following statements regarding anaerobic metabolism is correct?
A. Without anaerobic metabolism, perfusion to the body would suffer and cellular death would occur.
B. Anaerobic metabolism can be supported in most of the body’s cells for up to 10 minutes.
C. Anaerobic metabolism produces lactic acid and occurs when cellular oxygen is limited.
D. The body functions optimally and produces maximum ATP during anaerobic metabolism.
C.

The inferior cartilaginous tip of the sternum is called the:
xiphoid process

What is the function of the fallopian tubes?
A. transport a mature egg to the uterus

Which of the following signs of respiratory distress is typically unique to infants and children?
seesaw respirations

The connecting nerve, a nerve of the peripheral nervous system, functions by:
connecting the sensory and motor nerves and bypassing the brain.

Which of the following statements regarding nervous system control of the cardiovascular system is correct?
Baroreceptors located throughout the body provide information to the brain regarding the blood pressure.

The ___________ of the heart is the inferior portion of the left ventricles.
apex

If an average-sized patient’s chest barely moves during inhalation, even if his or her respiratory rate is normal, you should suspect that:
minute volume is decreased.

Which of the following statements regarding smooth muscle is correct?
B. A person has no voluntary control over smooth muscle.

Which of the following statements regarding the kidneys is correct?
C. The kidneys eliminate toxic waste products from the body and control its balance of water and salt.

What is the minute volume of a patient with a tidal volume of 500 mL, a dead space volume of 150 mL, and a respiratory rate of 16 breaths/min?
5600 mL

Which of the following skin layers contains sweat and oil glands, hair follicles, blood vessels, and nerve endings?
dermis

Which of the following statements regarding the heart is correct?
under control of the autonomic NS

Which of the following glands regulates the function of all other endocrine glands in the body?
pituitary

The ____________ is a muscular dome that forms the inferior boundary of the thorax, separating the thorax from the abdomen.
diaphragm

The __________ fills the entire anteroposterior depth of the right upper quadrant (RUQ) of the abdomen.
liver

Abnormalities in metabolism are MOST likely caused by dysfunction of the:
pancreas

A patient has a blood pressure of 130/70 mm Hg. The “130” represents:
D. ventricular contraction.

Stimulation of alpha-adrenergic receptors results in:
constriction of the blood vessels

The bones that comprise the fingers and toes are called:
phalanges

Movement or motion away from the body’s midline is called:
abduction

The atlas is the:
D. first cervical vertebra, which articulates with the skull.

The primary function of the right atrium is to:
receive blood from the vena cava

What set of nerves is responsible for carrying information from the body to the central nervous system?
sensory

The average adult has approximately ___________ of blood in his or her body.
6L

The largest portion of the brain, which is commonly referred to as the “gray matter,” is called the:
cerebrum

An intoxicated 40-year-old male is found lying face down. How would you document his body’s position?
prone

The dorsal respiratory group (DRG) is a part of the brain stem and is responsible for:
initiating respiration

Which of the following organs or structures lies within the retroperitoneal space?
kidneys..or pancreas

The electrical impulse of the heart normally begins at the:
sinoatrial node

The elbow is an example of a ____________ joint.
hinge

During each heartbeat, ___________ of blood is ejected from the adult heart. This is called stroke volume (SV).
70-80 mL

How does respiration differ from ventilation?
D. Respiration is the process of gas exchange, whereas ventilation is the simple movement of air between the lungs and the environment.

What happens when blood volume is lost from the body?
arteries contract to increase BP

What function does the pneumotaxic center serve?
A. inhibits the DRG, resulting in shorter, faster respirations

Relative to the adult’s airway, the child’s:
C. pharynx is smaller and less deeply curved.

The primary organ responsible for absorption of products of digestion is the:
small intestine

Capillary sphincter closure during internal or external bleeding is detrimental because:
A. waste products are not removed and nutrients are not delivered to the cells.

Which of the following statements regarding the medulla oblongata is correct?
B. The medulla is sensitive to pH changes and sends messages via the phrenic nerve to contract the diaphragm.

Relative to the kidneys, the liver is:
unilateral

Large amounts of adenosine triphosphate (ATP) is generated when:
B. the cells function with adequate oxygen.

Negative pressure breathing involves:
C. a drop in pressure within the chest cavity.

The bony prominence on the lateral/superior aspect of the thigh is called the:
greater trochanter

The air you breathe is _______ oxygen, and the air you exhale is _______ oxygen.
D. 21%, 16%

Key hormones of the sympathetic nervous system include:
epi and nor-epi

Select the areas of the spinal column in descending order.
cervical
thoracic
lumbar
sacral
coccyx

A patient in a semireclined position with the head elevated to facilitate breathing is in the ___________ position:
fowler’s

Urine is transported from the kidneys to the urinary bladder via the:
ureters

the vocal cords are located in the:
larynx

The supporting bone of the arm is the:
humerus

The part of the brain that controls the left side of the body is the:
right side of cerebrum

The Hering-Breuer reflex is stimulated when:
D. stretch receptors in the chest wall detect that the lungs are too full.

Deoxygenated blood from the abdomen, pelvis, and lower extremities is returned to the right atrium via the:
A. inferior vena cava.

Stimulation of the parasympathetic nervous system would result in:
a slow heart rate

Which of the following is NOT a facial bone?
mastoid

Which of the following statements regarding agonal respirations is correct?
C. Agonal respirations are characterized by fast irregular breaths.

The ___________ is made up of the maxilla and zygoma, as well as the frontal bone of the cranium.
orbit

The diaphragm is a unique muscle because it:
D. is both a voluntary and involuntary muscle.

Cardiac output (CO) is affected by:
SV and HR

All necessary life functions are coordinated in what part of the brain?
brain stem

Your ability to remain awake is a function of the:
C. reticular activating system.

A 5-year-old boy has fallen and has a severe deformity of the forearm near the wrist. He has possibly sustained a fracture of the:
distal forearm

The topographic term used to describe the location of body parts that are closer toward the midline or center of the body is:
medial

the most superior portion of the sternum is called the:
manubrium

____ pressure is the pressure exerted by a liquid and occurs when blood is moved through the artery at relatively high pressure
hydrostatic

the cervical spine is composed how __ vertebrae
7

The CNS is composed of:
brain and spinal cord

which of the following are central pulses?
femoral and carotid

leaf-shaped flap that prevents food and liquid from entering the trachea
epiglottis

the kidney and pancreas are called retroperitoneal organs bc they:
are located behind the abdominal cavity

the ____ of the heart is the inferior portion of the left ventricles
base

the brain connects to the spinal cord thru a large opening at the base of the skull called the
foramen magnum

the axial skeleton is composed of:
skull, face, thorax, and vertebral column

does the skeletal system contain smooth muscle?
no

the large flat triangular bone that overlies the posterior thoracic wall is:
scapula

which part of the CNS is respon for coordinating bodily movements such as writing or sewing?
cerebellum

waste products of aerobic metabolism include:
CO2 and water

the ___ is made up of the maxilla and zygoma, as well as the frontal bone of the cranium
orbit

trauma to the _____ lobe of the brain would likely result in visual disturbances
occipital

signs of adequate breathing in an adult including all of the following EXCEPT:
reduction in tidal volume

the backup system of respirtatory control which is based on low concentrations of oxygen in the blood is called the:
hypoxic drive

trendelenburg’s position is accurately defined as:
supine position w/ legs elevated 6-12″ higher than the head

each pelvic bone is formed by the fusion of the:
ilium, ischium, and pubis

activities such as walking, talking, and writing are regulated by:
somatic nervous system

a fracture of the humerus just above the elbow would be described as a :
distal humerus fracture

a by-product of involuntary muscle contraction and relaxation is:
heat

the major artery that supplies all other arteries with blood is:
aorta

bile is produced in the liver and concentrated and stored in the…
gallbladder

the diaphragm and intercostal muscles contract during
inhalation

the ____ plane separates the body into left and right halves
midsagittal

the distal aspect of the tibia forms the:
medial malleolus

which of the following organs is not part of the digestive system:
kidney

which of the following arteries does NOT carry highly oxygenated blood
pulmonary

a young male jumped from a tree and landed feet first, what aspect of his body sustained the initial injury
plantar

what layer of the skin is composed of fatty tissue and serves as an insulator for the body
subcutaneous

the ___ portion of hte spinal column is joined to the iliac bones of the pelvis
sacrum

the carpal bones form the:
wrist

the femoral head forms a ball-and-socket joint with the:
acetabulum

an increase in HR and contractility occurs due to stimulation of:
beta-1 receptors

the phase of the cardiac cycle in which the ventricles fill with blood is called
diastole

the descending aorta branches into the:
common iliac arteries

the left side of the heart receives oxygenated blood from the lungs through the:
pulmonary veins (arteries take AWAY)

function of the upper airway
warms and humidifies inhaled air

In ___________ administration, you are administering medication to yourself or your partner.
peer-assisted

You are dispatched to a movie theater for a 39-year-old female with signs and symptoms of an allergic reaction. As you are assessing her, she pulls an epinephrine auto-injector out of her purse and hands it to you. After administering 100% oxygen, you should:
contact medical control

Infants are often referred to as “belly breathers” because:
C. their rib cage is less rigid and the ribs sit horizontally.

Which of the following is an anatomic difference between children and adults?
D. An infant’s tongue is proportionately larger than an adult’s.

You are assessing a 13-month-old female who is running a fever and has been vomiting. While you are performing your physical examination on this child, you will MOST likely find that she:
A. responds to her name but is fearful of your presence.

A 37-year-old male is found unconscious in his car. His airway is patent and his respirations are rapid and labored. As you and your partner are assessing and treating the patient, a police officer hands you a medication named Alupent, which he found in the backseat of the patient’s car. This medication suggests that the patient has a history of:
asthma

You are treating a middle-aged man with chest discomfort. He has a history of three previous heart attacks and takes nitroglycerin as needed for chest pain. You have standing orders to administer aspirin to patients with suspected cardiac-related chest pain or discomfort. While your partner is preparing to give oxygen to the patient, you should:
B. confirm that the patient is not allergic to aspirin, give him the appropriate dose of aspirin, and document the time and dose given.

Which of the following is an example of a drug’s generic name?
aspirin

An EMT may administer aspirin to a patient if:
B. authorization from medical control has been obtained.

When communicating with an older patient, it is important to remember that:
A. age-related changes diminish the effectiveness of the eyes and ears.

A 31-year-old female is experiencing an acute asthma attack. She is conscious and alert, but in obvious respiratory distress. After assisting her with her prescribed MDI, you should:
B. reassess the patient and document her response to the medication.

When assessing an 80-year-old patient in shock, it is important to remember that:
A. age-related changes in the cardiovascular system may make the patient less able to compensate for decreased perfusion.

The risk of bleeding in the skull, which increases with age, is MOST directly related to:
shrinkage of the brain

The process of binding or sticking to a surface is called:
adsorption

Activated charcoal is frequently suspended in sorbitol, a complex sugar that:
D. facilitates movement through the digestive system.

In late adults, the amount of air left in the lungs after expiration of the maximum amount of air:
A. increases, which hampers diffusion of gases because of stagnant air that remains in the alveoli.

Which of the following is the MOST rapidly acting medication administration route?
IV

In contrast to secure attachment, anxious-avoidant attachment occurs when a child:
shows little emotional response to a parent or caregiver following repeated rejection.

Which of the following statements regarding toddlers and preschoolers is correct?
Toddlers and preschoolers commonly experience upper respiratory infections because of a loss of passive immunity.

Activated charcoal is an example of a :
suspension

Which of the following medication routes would be the MOST appropriate to use in an unconscious patient when intravenous access cannot be obtained?
intraossueos

The human body should be functioning at its optimal level between the ages of:
19 -25

Shortly after assisting a 65-year-old female with her prescribed nitroglycerin, she begins complaining of dizziness and experiences a drop of 30 mm Hg in her systolic blood pressure. The patient remains conscious and her breathing is adequate. You should:
place her supine and elevate her legs

Which of the following statements regarding age-related changes in the nervous system is correct?
Interconnections between brain cells often prevent a loss of knowledge or skill, despite a loss of neurons.

You are dispatched to a call for a 4-month-old infant with respiratory distress. While you prepare to take care of this child, you must remember that:
small infants are nose breathers and require clear nasal passages at all times.

The average pulse rate of individuals between 19 and 60 years of age is typically:
70 bpm

Why does the incidence of diabetes mellitus increase with age?
decreased physical activity, increased weight gain, and decreased insulin production

Age-related changes in the renal system result in:
C. a decreased ability to clear wastes from the body and a decreased ability to conserve fluids when needed.

Which of the following describes the Moro reflex?
The neonate opens his or her arms wide, spreads his or her fingers, and seems to grasp at something after being startled.

With the flowmeter set at 6 L/min, the nasal cannula will deliver up to _______ oxygen.
44%

Which of the following is NOT a characteristic of epinephrine?
decreases HR and BP

When gathering a patient’s medications, you find the following: Isordil, Lasix, Motrin, and Digoxin. Which of these medications can be obtained over-the-counter (OTC)?
motrin

After taking diphendydramine (Benadryl) for an allergic reaction, a person begins experiencing drowsiness and a dry mouth. These findings are an example of a :
side effect

Factors that contribute to a decline in the vital capacity of an elderly patient include all of the following, EXCEPT:
A. increased surface area available for air exchange.
B. decreased residual volume.
C. increased stiffness of the thoracic cage.
D. a loss of respiratory muscle mass.
A

The pulse rate of a child from ages 6 to 12 years is approximately:
70-120bpm

You suspect that a 75-year-old man has internal injuries after he fell and struck his ribs and abdomen on the corner of a table. When assessing and treating an injured patient of this age, you must recall that:
C. his ability to physiologically compensate for his injury may be impaired due to an inability to increase cardiac output.

which of the following med routes has the slowest rate of absorption?
oral

physical changes that occur in early adults include:
increase in fatty tissue which leads to weight gain

the low normal systolic bp for a 30 year old is
90 mm Hg

which of the following statements regarding parenteral meds is correct?
parenteral meds are absorbed more quickly than enteral meds

which of the following statements regarding middle adults is correct?
CV health bcomes an issue as does the greater incidence of cancer

noticeable characteristics of a 9-month-old infant?
places objects in his mouth, pulls himself up

what medication form does oral glucose come in?
gel

breathing is more labor intensive in older adults bc:
elasticity of the lungs decreases

with increasing age, the heart must work harder to move blood effectively bc:
the blood vessels become stiff

the anterior fontanelle fuses together b/w the ages of:
9 and 18 months

GLUCOSE IS A SIMPLE SUGAR THAT IS READILY ABSORBED BY THE BLOODSTREAM
yes.

which of the following statements regarding an infant’s vital signs is correct
infant’s normal body temp is higher than a preschoolers

age-related changes in the renal system result in:
decreased ability to clear wastes from the body and a decreased ability to conserve fluids when needed

physical change that typically occurs in the adolescent age group?
secondary sexual development begins

aspirin is beneficial to patients suspected of having a heart attack bc:
prevents the aggregation of platelets

a mucosal automizer device (MAD) is used to deliver meds via the:
intranasal route

the decline in cardiac function tht commonly occurs in late adulthood is most often related to:
atherosclerosis

The manner in which the EMT must act or behave when caring for a patient is called the:

A. scope of practice.
B. code of ethics.
C. standard of care.
D. EMT oath.

C

When faced with a situation in which a patient is in cardiac arrest, and a valid living will or DNR order cannot be located, you should:

A. contact medical control first.
B. notify the coroner immediately.
C. begin resuscitation at once.
D. determine the patient’s illness.

C

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:

A. acted appropriately but must have each EMT sign a waiver stating that he or she will not discuss the cases with others.
B. violated the patient’s privacy because you should have only discussed the information with the EMTs who provided it.
C. adequately safeguarded the patient’s PHI because the cases were discussed internally.
D. are in violation of HIPAA because you did not remove the PHI from the PCR beforehand.

D

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

A. It provides the EMT immunity from a lawsuit.
B. The law does not protect EMTs who are off duty.
C. It guarantees that the EMT will not be held liable if he or she is sued.
D. It will not protect the EMT in cases of gross negligence.

D

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. ventilate the patient for 5 minutes and then stop if there is no response.
C. stop any active bleeding and advise dispatch to send a paramedic crew.
D. request the fire department to extricate the patient so you can begin cardiopulmonary resuscitation (CPR).

A

Which of the following scenarios MOST accurately depicts informed consent?

A. An EMT initiates immediate care for an unconscious adult.
B. A patient is advised by an EMT of the risks of refusing care.
C. A patient advises an EMT of why he or she is refusing care.
D. An EMT advises a patient of the risks of receiving treatment.

D

Which of the following types of consent allows treatment of a patient who is unconscious or mentally incapacitated?

A. actual
B. informed
C. implied
D. expressed

C

You are treating a man with a closed head injury following an assault by a burglar. The patient, who has slurred speech, becomes verbally abusive and tells you to leave him alone. You should:

A. have the police arrest him so that you can legally begin treatment.
B. proceed with treatment and utilize law enforcement if necessary.
C. allow him to refuse treatment since the injury was not his fault.
D. ask a police officer to transport the patient to the hospital.

B

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. What type of consent is her agreement considered?

A. implied
B. expressed
C. minor’s
D. informed

B

At the scene of a mass-casualty incident, you identify a patient as an organ donor. When triaging the other patients, you:

A. should transport the donor patient before critical patients.
B. may have to assign the donor patient a lower triage priority.
C. should use a separate ambulance to transport the donor patient.
D. must assign the donor the highest priority regardless of injuries.

B

Which of the following general statements regarding consent is MOST correct?

A. Patients who are intoxicated are generally allowed to refuse treatment.
B. All patients older than 18 years can legally refuse treatment or transport.
C. A patient can consent to transport but can legally refuse to be treated.
D. Expressed consent is valid only if given in writing by a family member.

C

In order for a do not resuscitate (DNR) order to be valid, it must:

A. clearly state the patient’s medical problem.
B. be updated a minimum of every 6 months.
C. be dated within the previous 24 months.
D. be signed by the local justice of the peace.

A

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

A. the medical director.
B. the general public.
C. a paramedic supervisor.
D. another EMT.

D

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. begin two-rescuer CPR and apply the automated external defibrillator (AED) as soon as possible.
B. obtain permission from medical control to not attempt resuscitation.
C. wait for the backup ambulance while your partner performs CPR.
D. advise your partner that you cannot provide care to this patient.

A

In which of the following situations does the EMT NOT have a legal duty to act?

A. Local policy requires you to assist in any emergency.
B. a response to the residence of a patient who fell
C. a response to a motor vehicle crash while off duty
D. a response to an injured patient while off duty

C

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

A. terminated care of a competent adult patient at his or her request.
B. did not make provisions for continued care of an injured patient.
C. remained at the hospital for 30 minutes to give a patient report.
D. refused to care for a violent patient who is armed with a knife.

B

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

A. libel.
B. assault.
C. negligence.
D. battery.

B

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

A. the family requests a copy for insurance purposes
B. a police officer requests a copy to place on file
C. a media representative inquires about the patient
D. the patient is competent and signs a release form

D

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

A. stop and triage the patients while your partner remains in the ambulance.
B. ask a bystander to remain with your patient as you treat the crash victims.
C. remain at the scene until law enforcement and another ambulance arrive.
D. continue transporting your patient and notify the dispatcher of the crash.

D

Maintaining the chain of evidence at the scene of a crime should include:
A) placing the patient in a private area until the police arrive.
B) not cutting through holes in clothing that were caused by weapons.
C) making brief notes at the scene and then completing them later.
D) quickly moving any weapons out of the patient’s sight.
B) not cutting through holes in clothing that were caused by weapons.

You and your partner are dispatched to a residence for an “ill person.” When you arrive, you find that the patient, a 44-year-old man, does not speak English. There are no relatives or bystanders present who can act as an interpreter. You should:
A) speak to the patient with a moderately louder voice to facilitate his ability to understand what you are saying.
B) use short, simple questions and point to specific parts of your body to try to determine the source of the patient’s complaint.
C) give the patient oxygen, assess his vital signs, and transport him to the hospital in a position of comfort.
D) refrain from performing any assessment or treatment until you can contact someone who can function as an interpreter.
B) use short, simple questions and point to specific parts of your body to try to determine the source of the patient’s complaint.

You are dispatched to the residence of an Asian family for a child with a high fever. When you assess the child, you note that he has numerous red marks on his back. The child’s parents explain that these marks represent coining—a traditional Asian healing practice in which hot coins are rubbed on the back. You should:

A) advise the emergency department physician that you feel as though the child was intentionally abused by his parents.
B) document this on your patient care report and advise the emergency department staff of what the
child’s parents told you.
C) advise the child’s parents that this is a harmful practice and is considered a form of child abuse in the
United States.
D) acknowledge and respect this practice as a cultural belief, but advise the child’s parents that it has no
healing power.

B) document this on your patient care report and advise the emergency department staff of what the
child’s parents told you.

In which of the following situations does the EMT NOT have a legal duty to act?

A) a response to the residence of a patient who fell
B) Local policy requires you to assist in any emergency.
C) a response to an injured patient while off duty
D) a response to a motor vehicle crash while off duty

D) a response to a motor vehicle crash while off duty

The concept of health promotion consists of efforts to prevent rather than to cure disease or disability. This description best describes: a. tertiary prevention b. secondary prevention c. primary prevention d. morbidity prevention c Standards for well child care and …

The nurse is participating at a health fair at the local mall giving influenza vaccines to senior citizens. What level of prevention is the nurse practicing? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Quaternary prevention Primary prevention …

The vagina and the neck of the uterus comprise the: A. Womb. B. Cervix. C. Fundus. D. Birth Canal. D. Birth Canal. 1108 From what internal female organ is the fetus expelled during delivery? A. Vagina. B. Uterus. C. Cervix. …

Which one of the following instructions or questions to a patient who has suffered a possible concussion indicates that the EMT is properly assessing for sensory function in the hands? “Squeeze my fingers with both hands.” Do you feel me …

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