Question

Discussion Question #1: In some states, state law allows EMTs to do what is right for the patient when transporting them for care. In other states, the law may say EMTs must obey the patient's instructions, regardless of what those instructions are. You are an EMT in a state where state law says the patient has the last word. The patient has been injured in a car accident, and you want to take him to a hospital with a level 1 trauma center, but he says no, take him to a different hospital, without a level 1 trauma center. Legally and ethically, what will you do?

Answer 1

In the case of a state where the law says the patient has the last word, the following options are there legally and ethically:

• Legal option 1: The patient has the right to decide and the EMT is obliged to obey the patient's instructions. The EMT should take the patient to the hospital where the patient wants to go even if it is without a level 1 trauma center.
• Legal option 2: The EMT can always take the patient to a Veterans Hospital if the patient is a veteran since it comes under federal law and state law is not applicable. Usually, veterans hospitals have a level 1 trauma center and have a higher level of performance.
• Legal and ethical combined option: The EMT can discuss the advantages of going to a hospital with a level 1 trauma center and take him there with his consent.

The EMT is bound by the EMT oath quoted below:

“Be it pledged as an Emergency Medical Technician, I will honor physical and judicial laws. I will follow that regimen which, according to my ability and judgment, I consider for the benefit of patients and abstain from whatever is deleterious and mischievous, nor shall I suggest any such counsel. Into whatever homes I enter, I will go into them for the benefit of only the sick and injured, never revealing what I see or hear in the lives of men unless required by law.

I shall also share my medical knowledge with those who may benefit from what I have learned. I will serve unselfishly and continuously in order to help make a better world for all mankind.

While I continue to keep this oath unviolated, may it be granted to me to enjoy life, and the practice of the art, respected by all men, in all times. Should I trespass or violate this oath, may the reverse be my lot.”

The EMT is not expected to violate this oath and whatever decision he makes should be based on this. The first option I would choose would be the above legal and ethical combined option if the patient is not a veteran. If the patient is a veteran, I would choose the second legal option and take him to the Veterans Hospital.