Question about Consent...

[HelpmeHelpyou]

If someone could explain to me better or like iam 3, the steps when first providing care to a patient.

Iam reading my AAOS Emergency Care of the Sick and Injured 9th ed. CH. 3

Iam asking mainly about the consent to provide care to a patient and the refusal of care. If iam approaching a patient, Iam needing them to sign a consent forum everytime I approach a mentally and conscious patient? Also if Iam understanding correctly those who are mentally and conscious aware, on a refusal consent of care, Iam to explain to them the consequences of there failure in me providing care? (after there refusal)

Just want to make sure iam understanding this right, before I go on. Maybe someone could give me some more examples in a real life event.

Say someone is sitting on there stairs outside the house and complains of pain in there ankle. I approach them, would my next step be "hey i need you to sign this?" before I take care of you? Could my partner be a witness? I just want to be clear on this. As you might know, I have not started class yet so maybe I should wait. :blush:

 

[Sandog]

First, I and am are two separate words as in I am. Second, consent is not required to be in writing. ie. consent can be expressed as follows;

"Hi I am EMT Joe, may I help you"
A nod or a simple non-refusal of care is considered consent.

 

[Lifeguards For Life]

First, I and am are two separate words as in I am. Second, consent is not required to be in writing. ie. consent can be expressed as follows;

"Hi I am EMT Joe, may I help you"
A nod or a simple non-refusal of care is considered consent.

Cool Story Bro!

 

[Tizzy]

Iam

 

[Sandog]

Iam

Wasn't that a Cat in the Hat thing Sam?

 

[sir.shocksalot]

Say someone is sitting on there stairs outside the house and complains of pain in there ankle. I approach them, would my next step be "hey i need you to sign this?" before I take care of you? Could my partner be a witness? I just want to be clear on this. As you might know, I have not started class yet so maybe I should wait. :blush:

Actually one could interpret the simple act of calling 911 consent for care. Either way consent for care is verbal, the patient simply needs to ask for it. The best advice I could give is you need to tell your patient what you are doing as you go, if you are going to give someone a medication you need to tell them what it is and why so they understand what you are doing and it gives the patient a chance to refuse certain treatments if they wish. Many times I have told a patient that I can give them an IV narcotic or an anti-emetic or something like that and they will refuse it as I am explaining it to them, if I just gave it I would have treated them without their consent.

 

[HelpmeHelpyou]

ok correction noted. I would edit, if I could, but I can't.

I was just getting confused as far as legal issues that might arise on the field with this.

 

[silver]

Actually one could interpret the simple act of calling 911 consent for care.

That is not the best way of approaching consent. Instead I think you should clearly tell them each thing that you are doing, like you said you do. You must remember that informed consent is the correct terminology.

 

[HelpmeHelpyou]

So a Expressed Consent will be adequate? Like a nod,? a "yes" answer? I would not need any type of proof of there consent? I know all this would be documented, just wondering if there has ever been a situation where its the EMT vs the PT word of acknowledgment and the PT later declines ever given consent after transport or care, maybe from EMT not sure of the PT mental status or for whatever reason.

sorry don't mean to be so green on these questions, probably getting to involved in this book, I am sure its not as bad as the book makes it sound, a lot of legal issues are being discussed. I feel like the more I read the less I know in this book. The more I learn the further away I seem to get from being the Ultimate EMT.

 

[JPINFV]

First, I and am are two separate words as in I am. Second, consent is not required to be in writing. ie. consent can be expressed as follows;

"Hi I am EMT Joe, may I help you"
A nod or a simple non-refusal of care is considered consent.

While I agree that that is how consent is done in practice, I'd also argue that "simple non-refusal" is not informed consent to anything. This is also why I argue that a better term is "tacit consent."

The best advice I could give is you need to tell your patient what you are doing as you go, if you are going to give someone a medication you need to tell them what it is and why so they understand what you are doing and it gives the patient a chance to refuse certain treatments if they wish.

Wouldn't informed consent also require you to explain side effects (both common and rare) as well as alternatives? Saying, "I'm going to give you albuterol to help you breath better" is not informed consent as the only thing the patient was informed was the name of the drug and the hoped outcome.

 

[HelpmeHelpyou]

I just realized, looking ahead, maybe i am missing it. EMT-B learn nothing about medicine?

 

[sir.shocksalot]

Wouldn't informed consent also require you to explain side effects (both common and rare) as well as alternatives? Saying, "I'm going to give you albuterol to help you breath better" is not informed consent as the only thing the patient was informed was the name of the drug and the hoped outcome.

Uh, yes lol. How I usually do it is I tell them what I am going to give and what I hope for it to achieve, a brief and very basic description of how it works and a brief of side effects. Some others might have a better or different way of doing it, since I am a new medic I am always open to other suggestions; obviously in an emergent/ambulance setting it's a little harder to get as in depth with what is going on due to time constraints. If someone needs zofran (ondanestron), I could spend my 10 minute drive to the hospital explaining how it works, alternatives, side effects, benefits, consequences etc but if I don't shorten it I will get the patient to the hospital and would have accomplished nothing. Thats my thought process anyway.

@helpme, yes EMT's learn some medicines usually basic ones like asprin, glucose, and nitro.

 

[Aprz]

I just realized, looking ahead, maybe i am missing it. EMT-B learn nothing about medicine?

If you're talking about pharmacology, very little of it, and most classes usually just go over the name of some medications, some indications, contraindications, and the therapeutic effect, but not in great detail. You'll be limited to assist with administering medication that are prescribed and belong to the patient already.

I wouldn't be too concern about getting proof of it, and having the patient signing stuff before you begin to treat them, which is a bit intense. Having witness e.g. a partner, LEO, etc. along with documenting it will be good enough.

 

[Chimpie]

Having witness e.g. a partner, LEO, etc. along with documenting it will be good enough.

But keep in mind that it's not needed. You're in a position of trust and integrity. If you say the patient gave you consent then people will believe you.

(hopefully)

 

[Aprz]

I just believe in CYA

Cover Your...

When I was in school, I did make the mistake of being too worried about consent though. While we practiced our assessment, I'd start off with the whole scene size-up part, and eventually say "Hey, my name is Andrew, I'm an EMT, can I help you?". The other students looked at me like an idiot, and they were like "Yo, don't give them the option to say no. Just tell 'em your an EMT and get on with it already". The reason I did the whole consent thing though was cause that's what I was trained to do in my First Responder class. Bah, made me so mad cause I took First Responder first, I attended an EMT program in Hayward (wasn't a registered student, I just continued to go since I was allowed to by the instructors, and I knew the people from the First Responder since it was the prereq for EMT), and about 35 miles away I was a student in an EMT program in San Jose. While attending both programs, I'd get odd looks from both, haha, and was constantly criticize for being incompetent while learning to cater to the style of both programs.

 

[Chimpie]

, I'd start off with the whole scene size-up part, and eventually say "Hey, my name is Andrew, I'm an EMT, can I help you?". The other students looked at me like an idiot, and they were like "Yo, don't give them the option to say no. Just tell 'em your an EMT and get on with it already".

Curious, how did the instructors react to this?

 

[Aprz]

San Jose instructors reacted to it like I was a fool, haha, but they weren't mean about it either, just a grin. For Hayward, it wasn't unusual since we learned to do that in First Responder, a prereq for EMT, but it became acceptable to truncate it to without asking for consent portion.

 

[Chimpie]

San Jose instructors reacted to it like I was a fool, haha, but they weren't mean about it either, just a grin. For Hayward, it wasn't unusual since we learned to do that in First Responder, a prereq for EMT, but it became acceptable to truncate it to without asking for consent portion.

So the San Jose instructors are saying/teaching that you don't have to ask for consent when arriving at the patient?

 

[Chimpie]

Actually one could interpret the simple act of calling 911 consent for care.

Except when the person who is calling 911 is a passerby or a co-worker. :unsure:

 

[emt seeking first job]

I think generally, EMTs get signatures to document refusals, against emdical advice, in certain situations.