As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPS?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address consent. This will be a two-part series as we will be explaining the difference between informed consent and implied consent.
2.2 Consent
Consent in paramedicine can be achieved by either informed or implied consent.
2.2.1 Informed Consent
Regulated members must communicate to and discuss with the patient the indications, risk of harm and contraindications of treatment (including medication) to enable the patient/alternate decision maker to be able to provide informed consent prior to treatment.
A regulated member must:
- Disclose the nature of the proposed examination and give the patient/alternate decision maker the opportunity to ask questions.
- Inform the patient/alternate decision maker of the assessment/diagnosis and proposed treatment.
- Inform the patient/alternate decision maker of the benefits and any potential risks of the proposed treatment.
- Address any questions the patient/alternate decision maker has about the assessment/diagnosis and proposed treatment and any risks.
- Receive informed consent either written or verbally or allow the patient/alternate decision maker to refuse care by not providing consent.
- Respect the patient/alternate decision maker’s right to withdraw consent at any time.
Scenario:
Don is a seasoned PCP working near the remote community of Rainbow Lake. Don is dispatched to an industrial site for a 52-year-old male complaining of “chest tightness”. Upon arrival at the industrial site, Don and his partner Lindsey are greeted by the Occupational Health and Safety (OHS) Officer on site who guides them to the medical trailer where the patient is located. The OHS Officer lets Don and Lindsey know that this gentleman has already stated he did not want to be taken to hospital or go through the process of flying out of camp, but he is open to getting an assessment done. Don and Lindsey thank the Officer for this information and proceed to enter the medical trailer to perform their assessment on the 52-year-old male.
Don and Lindsey enter the trailer and observe a 52-year-old male patient, Henry, sitting in a tripod position, looking diaphoretic and quite anxious. They proceed to introduce themselves as paramedics and let Henry know the nature of their proposed examinations while inviting him to ask any questions that he might have. Henry, while seeming skeptical and reiterating that he wants to stay at work, agrees to let them assess him before any treatment or transport decisions are made. Don immediately takes the lead and begins to obtain a chief complaint and medical history on this call while Lindsey obtains a full set of vitals.
After Don and Lindsey have completed their assessment, they inform Henry of their assessment/diagnosis and proposed treatment. Because Henry is showing signs and symptoms of cardiac-related chest pain, they tell him they would like to perform a 12-lead, initiate an IV and administer some medications. Henry at first is reluctant and states he believes it to be some indigestion and asks for some Tums. Don and Lindsey let Henry know that he has the right to give or withdraw consent prior to them performing any treatments or administering medications. They also ensure that Henry understands his condition could be very serious and come with many potential risks, including cardiac arrest. They go on to explain further what a 12-lead and IV initiation is and what medications would be appropriate.
After hearing Don and Lindsey fully explain the treatment plan and the risks and benefits that accompany that plan, Henry provides verbal consent to allow for a 12-lead to be performed, an IV initiated and medication administration. Don and Lindsey proceed with the treatment plan and let Henry know that they will keep him informed of their findings and will discuss what transport decision might be best, respecting Henry’s right to withdraw consent at any time.
In this example, Don and Lindsey both demonstrate their knowledge and adherence to the Standard 2.2.1 Informed Consent, where regulated members must communicate to and discuss with the patient the indications, risk of harm and contraindications of treatment (including medication) to enable the patient/alternate decision maker to be able to provide informed consent prior to treatment. Both paramedics were able to provide information to their patient about the assessment, diagnosis and proposed treatment, as well as give him the opportunity to ask any questions. They informed Henry of the benefits and risks of the proposed treatment as well as the risks associated with not getting any treatment and remaining at camp. They received informed consent from their patient and respected that Henry had the right to withdraw that consent at any time.