Patient #1

You are dispatched to the local park for child that has fallen. You respond to the playground and find a 6-year-old male complaining of right radius/ulnar pain with an obvious deformity. The patient appears unusually calm and quiet. The patient states that they fell from the top of the slide, which is approximately 10 feet high. Witnesses support the stated events. The patient’s 12-year-old sister is present and is sitting with the patient. The patient is resisting your attempts to assess them and will not answer your questions. They are becoming more agitated as you try to assess and treat them. When asked, the 12-year-old will only mumble and give vague responses. To keep the patient calm and treat the potential head or spine injury, you decide to let them stay sitting next to their sister. You explain the importance of sitting still and give them some space.

An adult that witnessed the fall offers to help you get in touch with the parents. They know the family and have the parent’s phone number. They state that the parents are very active with their kids and that they are surprised that the parents are not at the park too. You get the phone number and call the parents. You speak with Dad and explain what has happened and what you need to be able to transport the patient.

You tell the patient that their parents are coming. The patient does not respond however the sister starts to whisper urgently into the patient’s ear. When the parents arrive, they rush over to the kids and begin talking quietly. After a few moments they turn to you to discuss what happened. The dad keeps looking at the children with concern but does not go to them. The children continue to keep their eyes down and only glance at each other. The Mom seems upset about having to come over and seems very impatient as you talk.

Your partner explains to them the severity of the arm injury and the potential for a spinal or head injury. The parents give you permission to splint the arm. Mom has refused transport, stating she will take care of getting them to the doctor and that the child appears fine to her. The Dad keeps trying to convince mom to allow you to transport.

As you are splinting the arm you notice several small scars bruising on the patient’s upper arm and upper back. The bruises are in different stages of healing. The 12year-old notices you are looking at the scars and bruising. They quickly begin telling you how active their brother is and that he is also uncoordinated. They continue that the boy has no fears and loves to jump of if high stuff. The dad comes to the patient and tries to comfort them. The patient allows dad to comfort them and the sister moves a little closer to her brother and father.

The dad begins asking you questions and pleading for you to transport the boy. As you are talking with him, a police officer approaches you. He explains that he was patrolling the park and say your Ambulance. He came over to see if you needed any assistance. You notice the dad becoming more and more nervous as you and the office begin discussing what happened and your concerns.

Questions for Patient #1
1- You suspect that the patient is being abused. Provide examples from the scenario to support your suspicion and explain why those examples make you think the patient is being abused. (8 points)
2- Who can give consent or refusal for this patient? What consent or refusal issues were present with this patient? (6 points)
3- How would you adjust your patient interaction, assessment, treatment, and transportation for this scenario? (8 points)
4- What information can be shared with the police officer in this scenario? (5 points)
5- How was the patient’s privacy protected in this scenario and how could you have better protected their privacy? (5 points)
6- Write the narrative section of the EMS run form for this situation. (18 points)

Patient #2

You are dispatched to a residence for a fall. You respond to an older, well-kept home that has several cars parked in front. When you enter the home you see several people, all around the same age (early to mid 60s). You are led to the bathroom, where you see an 84-year-old female sitting on the floor against the tub. The patient is complaining of left side chest pain and shortness of breath.

As your partner begins assessing the patient, you have several adults approach you and begin asking questions. Some are demanding you transport her, and others are demanding she stay where she is. You find out that these are the patient’s children and their spouses. You are told that she has Emphysema and is typically on oxygen. The patient was going in to take a shower when she fell so she was not on her oxygen. You calm everyone down and are told she has a DNR and a power of attorney. From what you can piece together, the family works together to care for their mother. One daughter lives in the home and is the power of attorney. She is not currently there but on her way.

Your partner calls you over and explains that the patient is confused and disoriented. She is normally very aware of what is happening and has typically has no cognitive impairment. The patient is refusing transport and is being uncooperative with the assessment. Your partner can see a bruise forming on the left side of her upper chest. They are not able to obtain vital signs.

You try to calm the family down and begin explaining that their mother may have internal injuries. As you try to speak, one of the patient’s sons becomes angry and reaffirms she has a DNR. They hand you with the paper work. He continues saying that the Ambulance should not have been called and that you and your partner are going against her wishes and breaking the law.

One of the patient’s daughters becomes emotional then and begins begging you to treat and transport the patient. They state that their mom would want the help if she wasn’t acting so confused.

Questions for Patient #2
1- How was the patient’s privacy protected in this scenario and how could you have better protected their privacy? (5 points)
2- Who can give consent or refusal for this patient? What consent or refusal issues were present with this patient? (6 points)
3- What information can be shared with the family in this scenario? (5 points)
4- How would you adjust your patient interaction, assessment, treatment, and transportation for this scenario? (8 points)
5- How does the patient’s DNR and power of attorney impact your treatment and transport options for this patient? (8)
6- Write the narrative section of the EMS run form for this situation. (18 points)