9 free Paramedic practice questions: Ethical and High-Stakes Decision-Making

Expressed consent, because the patient is calm enough to answer questions: A calm patient who answers every question looks like a patient giving expressed consent. Expressed consent is the patient saying yes, and this patient is saying no.

Informed consent, because the risks of staying home were explained on scene: Informed consent is the standard for a patient who is agreeing to care. Informed consent describes how that yes was obtained. There is no yes here for informed consent to describe.

Implied consent, because a threat of self-harm shows impaired judgment: A self-harm threat does raise a real concern about judgment. Implied consent covers a patient who cannot communicate a decision at all. This patient is communicating a decision clearly.

Restraint is lawful only after a patient has been formally placed on a hold: A formal hold does change what you can do with a patient who wants to leave. Restraint to prevent harm does not have to wait for a hold. A hold would not make punishment okay either.

Restraint authority passes to law enforcement the moment an officer boards: Officers often help make restraint physically possible. Once the patient is in your ambulance and in your care, the medical decision to keep the restraints on stays with you.

Restraint may continue only while medical direction stays on the radio: Calling medical direction about a restrained patient is good practice, and many systems want that call. Staying on the radio is not what makes restraint lawful. The reason for the restraint is what makes restraint lawful.

The same universal criteria that govern withholding a resuscitation: Universal criteria are the rules for withholding a resuscitation. Those criteria describe a patient who was obviously dead before you arrived. This patient has been worked by your crew for twenty-eight minutes.

The crew's judgment at the scene, which is what autonomy is built for: Paramedic autonomy is real, and it is broader than at any level below. Autonomy works inside protocol. Termination is one of the decisions the system keeps shared on purpose.

A fixed national rule, which sets termination at three doses of epinephrine: Some systems do put a dose count in their termination criteria. A number from one system is not a national rule. No national rule sets termination at three doses of epinephrine.

A proxy expires each year, and a POLST is permanent once it has been signed: Expiration is a real thing to check. Whether a document is current is one of the four validity questions. Neither a proxy nor a POLST expires each year on its own. Calling a POLST permanent also skips the question of whether it was revoked.

A proxy takes effect at arrest, and a POLST covers every hospital admission: Cardiac arrest is when these papers usually come out of a drawer. A proxy applies any time the patient cannot make a decision. Plenty of those times are nowhere near an arrest.

A proxy is a legal document, and a POLST is a guideline the crew may weigh: A proxy is a legal document, so the first half of option C is right. The second half is wrong. A POLST is not a guideline you weigh against your own read of the scene. A POLST is a physician's medical order, and you follow an order.

The crew's own read, because the patient is dying in front of them right now: A crew with a dying patient does have real authority to act, and holding back feels wrong. Your judgment is for questions the patient has not already answered. This patient answered this one in writing, with a physician.

A call to medical control, because a family objection makes the form unclear: Call medical control the moment any of the four checks comes back unclear. Nothing on this form is unclear. A family objection is not one of the four checks.

The spouse's request, because a family member present can revoke the document: Whether the form was revoked is one of the four things you check. Only the patient who signed the form can revoke it. A family member asking at the bedside is not the patient revoking anything.

Is it billable, is it defensible in court, and is my service protected from it?: Liability does come up on hard calls. A test that starts with billing and protecting the service puts the patient last. An ethical test is supposed to put the patient first.

Have I documented the call, notified medical control, and filed a report on it?: Documenting the call and notifying medical control are real duties, and a hard call gets reviewed based on the record you leave. These are things you do about a decision after you make it. They are not the questions you use to make the decision.

Am I inside my scope, inside protocol, and credentialed for this specific skill?: Scope, protocol, and credentialing are the three layers of authority, and all three have to line up before you act. These three tell you whether you are allowed to do something. They do not tell you whether you should do it.

Honor the family's account of the patient's wishes, and withhold resuscitation, since they know the patient best: The family may know the patient's wishes. Their word alone does not make this document a valid directive. Withholding resuscitation on their account risks withholding it from a patient who has no confirmed valid directive.

Withhold resuscitation because any DNR-like document should be honored regardless of whether it can be verified: A valid DNR that applies to this patient should be honored. This document cannot be verified as valid or as belonging to this patient. An unverified document is not treated as a confirmed directive.

Delay any decision, neither beginning resuscitation nor declining to do so, until the family is able to produce a fully valid document: Waiting for a fully valid document means doing nothing for a patient in cardiac arrest. The standard default is to start resuscitation while you get guidance, instead of putting off every decision.

Ask the physician to leave the patient care area: Asking a bystander to leave is right when the bystander is getting in the way of care, acting abusive, or making the scene unsafe. In those cases, removal is appropriate, with law enforcement if needed. This physician is offering help and showed valid identification. Sending the physician away skips the one step that could make the order usable. Call medical control first. Removal is the fallback if the physician refuses to work inside the system.

Follow the physician's order without further steps: Following an order without further steps is right when the order comes from your own online medical direction or is already in standing protocol. A bystander physician's license does not extend your scope. This drug is not carried in the region at all. Giving the drug puts you outside the system that authorizes you to practice, and you are personally exposed. A physician who is willing to help still has no authority to direct your care.

Give the medication if the physician documents it: The physician documenting the order and taking over care is a real part of this process. Documenting and taking over come after medical direction agrees, not in place of that call. Documentation only records what happened. A signature on the run form does not create authority that was not there before. A signature also does not put the drug inside your protocol.

Enter and remove the patients quickly: Going in to pull the patients out fast is the most common way rescuers die at these scenes. Moving fast does not protect you from bad air. The third worker only got about 30 feet in and came out unable to answer questions. A crew that goes down inside turns two patients into four, and then nobody is left to give care.

Enter wearing an NRB: A nonrebreather mask (NRB) gives a patient oxygen from a tank while the patient still breathes the air around the mask. An NRB is a treatment device, not breathing protection. The mask does not seal the wearer off from the air in the building. An NRB is the right device for these patients after they are brought out. Only a supplied-air system with a sealed facepiece protects someone going in, and the rescue team brings one.

Enter after propping the door open: Opening the door is a step toward ventilation, and ventilation is part of making a confined space safe. Real ventilation means mechanical ventilation, followed by air monitoring that shows the atmosphere is safe. One open door in a windowless building moves almost no air. Nothing here shows the air inside has changed. Someone has to measure the air before anyone goes in.