10 free AEMT practice questions: Patient Refusal and Capacity Assessment

That the signed form releases EMS from liability: The signature line on a refusal form sits under a paragraph of legal text, so the form can look like a release. A refusal form is documentation, not a waiver. Telling the patient the form protects EMS gives the patient the wrong idea of what they are signing.

That a second call today will not be honored: Telling the patient a second call will not be honored is the reverse of what the patient has to hear. The required element is that EMS can be called again without penalty. Hearing that a second call will be turned down keeps sick people at home.

That the crew cannot leave until the form is signed: When a patient will not sign, you document that the patient refused to sign and have a witness confirm it. The call ends there, and the crew does not need a signature to leave.

Leave the report alone, since a filed report cannot be added to: Being careful about changing a filed report is a good instinct. A late addition is allowed as long as you make it through the amendment function and it shows as a later entry.

Ask a supervisor to delete the report so a correct one can be filed: A clean, complete report is a fair goal. Deleting the original destroys the record instead of correcting it. The system is built to keep every version, not replace one.

Open the filed report and type the findings into the narrative: Adding the findings is the right goal, and the narrative is where they belong. Typing straight into a filed report outside the amendment function hides that the findings were added later. Showing what was added later is the whole reason the amendment function exists.

Only the vital signs, since glucose and saturation are screening tools: Glucose and saturation are quick checks, so calling them screening tools sounds fair. Both numbers measure conditions that impair capacity. Their results are part of the capacity assessment, not an optional extra.

Just the numbers the patient agrees to have written down: The patient does get a say in whether you do an assessment at all. Once the patient let you check the glucose and the saturation, the results go in the record. A report filtered by what the patient wants is not a true record.

Any number that falls outside the normal range for this patient: Abnormal numbers do need to be written down, and reviewers look for them. A normal number is your proof that you checked for a condition that impairs capacity. Leaving the normal numbers out removes the strongest part of your record.

Summarized as the patient being noncompliant with the recommendation: The patient did go against your recommendation, so the label is not made up. Noncompliant is a conclusion about the patient, not an observation. Objective charting leaves conclusions like that out.

Left out, since a statement of intent is not a clinical finding: Leaving out things that are not clinical findings is usually good charting. A refusal record is different, because the refusal record calls for the patient's own words. A statement of intent shows what the patient understood and decided.

Rewritten in clinical language so the record reads consistently: Clinical language does make a report easier to read. Once you reword the statement, the statement is no longer evidence of what the patient actually said. Exact words are the whole reason quotation marks are used.

Accept the refusal, because the capacity finding from earlier still applies: Documenting a capacity assessment when you do one is right, and that record has value on this call. The earlier assessment was about an intravenous line. Refusing transport after vomiting blood is a different decision with a much larger downside. A capacity finding goes with the decision it was made for, not with the whole call.

Recheck orientation to person, place, time, and event, then accept the refusal: Orientation is worth rechecking, and those findings belong in the refusal record. Orientation to person, place, time, and event is a screening finding, not a full capacity assessment. A fully oriented patient can still lack capacity for a decision this big.

Leave the capacity determination to medical control, since this refusal is high risk: Contacting medical control on a high-risk refusal is often expected, and the call is reasonable here. The capacity determination still belongs to you, made at the bedside for this one decision. Medical control advises on the plan but does not decide whether this patient can refuse.

Splinting the arm and leaving once the parent signs the form: Splinting the arm is good care, and the parent may agree to the splint. Splinting and leaving on a signature skips the extra steps a high-risk refusal needs. Those steps are the fuller assessment, the specific risks, and documentation of what worried you.

Transporting the child anyway under implied consent for minors: Implied consent for a minor applies when no parent or guardian can be reached. This parent is on scene and making the decision. That's why implied consent does not apply here.

Accepting the refusal, since a parent may decide for a minor patient: A parent really is the legal decision maker for a minor. Legal standing settles who decides, not how carefully you work the call. This kind of refusal calls for more scrutiny, not less.

Deny the refusal automatically, because a patient who was altered earlier in the call cannot validly refuse later: Denying the refusal would fit a patient who is still altered. This patient's mental status is back to baseline, and capacity has to be reassessed on that. Being altered before treatment does not cancel every decision the patient makes afterward.

Accept the refusal automatically, because the glucose value has been corrected and the patient now appears completely normal: A corrected glucose and a patient who looks normal are good signs. Capacity still has to be reassessed for this patient, not assumed. Accepting the refusal automatically is the same blanket rule as denying it automatically, just in the other direction.

Defer the capacity determination to the receiving hospital, since a recent hypoglycemic episode makes field assessment unreliable: You can assess capacity in the field after the glucose is corrected. Base the assessment on how the patient presents now, after treatment. Leaving the decision to the hospital skips the assessment the refusal needs.

Transport the patient on the authority of the health care proxy: A health care proxy does let the named person make decisions once the patient can no longer decide. This patient knows the date, place, and events, restates the risks, and gives the same answer each time. The adult child's authority has not started yet.

Transport the patient under implied consent because of the fall: Implied consent covers a patient who is unconscious or cannot make a rational, informed decision. A fall alone does not take away capacity. This patient is alert, oriented, and understands the risks, so implied consent does not apply.

Have the adult child sign the refusal form for the patient: The person refusing care is the one who signs the refusal. The patient is the one refusing here. Having the adult child sign in the patient's place makes the form show the wrong person declining care.

Transport the patient, since an unsigned refusal is not valid: An unsigned refusal form can look incomplete. The form only documents the refusal, and the signature is not what makes the refusal valid. This patient has capacity and declined transport each of the three times it was offered. Transporting the patient now would be confining the patient without authority.

Sign the form for the patient and note the circumstances: Signing for the patient makes the form say the patient signed when the patient did not. Writing something false on the form is falsifying a record, and falsifying a record is its own documentation offense.

Record the verbal refusal in the narrative and return to service: The narrative does capture the verbal refusal. A narrative entry has no independent witness behind it. The officer's signature on the form is what gives you that witness.

Transport to the trauma center, since the triage criteria are met: Trauma triage criteria tell you which hospital to recommend. The triage criteria do not decide for the patient. Taking a patient with capacity to a hospital the patient has declined is transport without consent.

Have the patient sign a refusal of care and release the patient: A full refusal of care ends with a signed form and a release. This patient still wants to go to a hospital, just a different one. Care continues, and only the trauma center is documented as refused.

Ask medical direction to authorize overriding the patient's choice: Medical direction guides care within what the law allows. Medical direction cannot give you authority to take a patient with capacity somewhere the patient has declined to go.