FISDAP EMS Legal and Ethical Principles — Questions and Answers
Question 1: A competent adult patient with a painful leg fracture refuses transport to the hospital. What is the EMT's most important next step?
- Ensure the patient is informed of the risks of refusal and have them sign a refusal form (Correct answer)
- Contact medical direction and transport the patient anyway
- Document the refusal in your mind and leave the scene immediately
- Call law enforcement to force transport
Correct answer: Ensure the patient is informed of the risks of refusal and have them sign a refusal form
A competent adult has the legal right to refuse care. The EMT must ensure the patient is fully informed of the potential consequences (including death or serious harm), make a good-faith effort to persuade them to accept care, and then document the informed refusal with a signed form and witness if possible.
Question 2: An EMT arrives to find an unresponsive adult patient with no family present and no advance directive. Under what legal doctrine can the EMT treat the patient without explicit consent?
- Expressed consent
- Implied consent (Correct answer)
- Involuntary consent
- Presumed refusal
Correct answer: Implied consent
Implied consent is the legal doctrine that assumes an unconscious or otherwise incapacitated adult would consent to emergency treatment if they were able to do so. It allows EMTs to provide necessary care when the patient cannot express consent.
Question 3: Which of the following actions by an EMT would most likely constitute abandonment?
- Transferring care to a paramedic crew at the scene
- Leaving the patient at the hospital with nursing staff
- Stopping care and leaving before transferring to an equal or higher level of care (Correct answer)
- Declining a non-emergency call because another unit is closer
Correct answer: Stopping care and leaving before transferring to an equal or higher level of care
Abandonment occurs when an EMT unilaterally ends the care relationship without transferring the patient to an equal or higher level of provider. Once care has begun, the EMT is legally obligated to continue until a proper handoff is made.
Question 4: A patient presents with a valid Do Not Resuscitate (DNR) order. The patient goes into cardiac arrest. What should the EMT do?
- Initiate CPR because DNR orders are not valid in the field
- Honor the DNR, withhold resuscitation, and provide comfort measures (Correct answer)
- Contact the family to override the DNR
- Begin CPR until medical direction is reached
Correct answer: Honor the DNR, withhold resuscitation, and provide comfort measures
A valid DNR order is a legal document that instructs providers not to perform resuscitation. EMTs must honor valid advance directives including DNRs. Providing comfort measures (positioning, oxygen, pain management) is still appropriate.
Question 5: Under HIPAA, which of the following disclosures of patient information is PERMITTED without the patient's authorization?
- Sharing the patient's diagnosis with their employer
- Posting patient information on social media for training purposes
- Releasing information to another treating provider for continuity of care (Correct answer)
- Discussing patient details with a neighbor who witnessed the call
Correct answer: Releasing information to another treating provider for continuity of care
HIPAA permits disclosure of protected health information (PHI) for treatment, payment, and healthcare operations (TPO) without patient authorization. Sharing information with other treating providers directly involved in the patient's care falls within the treatment exception.
Question 6: An EMT performs an intervention that is outside their certification level without physician authorization. This is best described as acting outside their:
- Standard of care
- Duty to act
- Scope of practice (Correct answer)
- Chain of command
Correct answer: Scope of practice
Scope of practice defines the legally authorized procedures an EMS provider may perform at their certification level. Performing skills outside that defined scope — even with good intentions — is illegal and can result in disciplinary action, civil liability, or criminal charges.
FISDAP EMS Legal and Ethical Principles
A competent adult patient with a painful leg fracture refuses transport to the hospital.
What is the EMT's most important next step?