First Responder EMS Curriculum for Training Centers in Eurasia

a. Expressed ConsentExpressed consent is defined as the verbal consent given by a conscious patient to allowthe First Responder to render emergency care. Consent must be obtained from aresponsive, competent adult. Re-stated, the patient must be competent and of legal age.The patient must be informed of the steps of the procedures/ interventions and all therelated risks. Use three simple steps to obtain expressed consent:1. Identify yourself.2. Inform the patient of your level of training.3. Explain the benefits and risks of the procedures to the patient.b. Implied ConsentImplied consent is based on the assumption that the unresponsive patient would, ifresponsive, consent to life-saving interventions.Children and mentally incompetent adults (e.g., because of mental illness, retardation,drug/alcohol intoxication, confusion resulting from serious illness) deserve specialconsideration. As a general rule, when life-threatening situations exist and the parent orlegal guardian is not available for consent, emergency medical care should be providedbased on implied consent. Expressed consent must be obtained if the parent or legalguardian is present.6. Advanced Directives/Do Not Resuscitate OrdersA patient has the right to refuse resuscitative efforts. The legality related to advanceddirectives may vary from region to region. If there is any doubt regarding the patient’sadvance directives, however, the First Responder should institute resuscitative efforts.7. RefusalsA competent adult patient has the right to refuse emergency medical care. The patient mayrefuse care, even if the First Responder knows this decision is not in the patient’s own bestinterest. The patient may withdraw from emergency care at any time, as long as the patientis believed to be competent. The rules of expressed consent must be followed at all times.In other words, the patient must be informed of and fully understand all the risks andconsequences associated with refusal of emergency medical care. While awaiting thearrival of additional EMS personnel, the First Responder should try to persuade the patientto accept care, informing the patient why he/she should accept care and what may happenas a consequence of the refusal. Determine if the patient is able to make a rational,informed decision (e.g., observe for effects of alcohol, drugs, or serious illness or injury).Consult medical oversight if possible. If there is any doubt regarding the patient’scompetency, provide care to the best of your ability. In all cases, record all assessments andinterventions made, as well as the patient’s consent or refusal of emergency care.Documentation is vitally important.8. Assault/BatteryThese terms are defined as unlawfully touching a patient without consent, or providingemergency medical care when a competent patient does not consent to this care. Theprecise definition of assault/battery, however, may differ from region to region.First Responder EMS Curriculum/AIHA, July 2002 23