ECC Regulatory Compliance & Legal Framework 3 — Questions and Answers
Question 1: When a patient with a valid DNR order goes into cardiac arrest in an emergency department, the legal obligation of the treating team is to:
- Initiate full resuscitation until the DNR is verified
- Honor the DNR and provide comfort-focused care (Correct answer)
- Contact hospital legal counsel before acting
- Transfer the patient to a different department
Correct answer: Honor the DNR and provide comfort-focused care
A valid DNR order in the ED must be honored, and care should shift to comfort measures consistent with the patient's documented wishes.
Question 2: Which federal law requires hospitals participating in Medicare and Medicaid to inform adult patients of their rights regarding advance directives?
- EMTALA
- The Patient Self-Determination Act (PSDA) (Correct answer)
- HIPAA
- The Affordable Care Act
Correct answer: The Patient Self-Determination Act (PSDA)
The Patient Self-Determination Act requires healthcare organizations receiving federal funds to inform patients of their right to create advance directives.
Question 3: A paramedic administers epinephrine to a patient per off-line medical control protocols. If an adverse outcome occurs, which party bears primary legal responsibility?
- The paramedic acting independently
- The medical director who authorized the protocol (Correct answer)
- The hospital that owns the ambulance
- The state EMS licensing board
Correct answer: The medical director who authorized the protocol
The medical director bears primary legal responsibility for off-line protocols because paramedics act as extensions of the physician's license when following standing orders.
Question 4: Which accreditation body requires hospitals to have documented policies for managing do-not-resuscitate orders in the perioperative setting?
- American Heart Association
- National Registry of EMTs
- The Joint Commission (Correct answer)
- American College of Emergency Physicians
Correct answer: The Joint Commission
The Joint Commission requires accredited hospitals to have clear policies addressing DNR orders when patients undergo surgical procedures.
Question 5: In most US states, an out-of-hospital DNR order is legally binding on EMS providers when it:
- Is verbally communicated by the family
- Is a written, signed order in the correct state-approved format (Correct answer)
- Is communicated through the patient's medical alert bracelet only
- Is confirmed by the patient's primary care physician by phone
Correct answer: Is a written, signed order in the correct state-approved format
EMS providers are typically required to honor written, state-approved DNR forms that bear the required signatures, not verbal or informal communications.
Question 6: Which CMS Condition of Participation requires hospitals to maintain a written policy for reporting patient deaths related to restraint or seclusion?
- 42 CFR Part 482.13 (Correct answer)
- EMTALA Section 1867
- HIPAA Privacy Rule 45 CFR 164
- Cardiac Arrest Survival Act Section 402
Correct answer: 42 CFR Part 482.13
42 CFR Part 482.13 includes the Patient Rights Conditions of Participation, requiring hospitals to report deaths related to restraint or seclusion to CMS.
Question 7: In the context of cardiac emergency care, 'scope of practice' is primarily defined by:
- Individual hospital policy alone
- State law and EMS licensure regulations (Correct answer)
- National AHA guidelines exclusively
- The treating physician's personal judgment
Correct answer: State law and EMS licensure regulations
Scope of practice for EMS and cardiac care providers is legally defined by state law and the specific licensure category held by the provider.
ECC Regulatory Compliance & Legal Framework 3
When a patient with a valid DNR order goes into cardiac arrest in an emergency department, the legal obligation of the treating team is to: