JimMIA
There's more to life than mice...
- Joined
- Feb 16, 2005
- Messages
- 21,168
There was a recent thread on the DVC Planning Board which inquired about carrying some type of medical authorization forms for guests accompanying your family on WDW visits. Since many of us bring guests, and those guests are often our kids’ friends, this is an important question for many of us.
Unfortunately, the thread got moved to the Community Board where it quickly disappeared under the usual Community Board stuff. Hopefully this thread will stay here and will be helpful to families taking guests to WDW.
There are three scenarios which could arise when someone in your party needs medical attention, depending on the age and medical status of the patient. The main question here is consent, and who is permitted to make medical treatment decisions in various scenarios.
Consent Generally
Medical professionals generally cannot treat patients without the patient’s consent. Consent can be granted in many ways: verbally, non-verbally, or in writing.
The only exception to this general rule is if the patient has a life-threatening medical condition and is unable to express their consent (e.g. unconscious). In this situation, there is a legal presumption that the patient would want their life saved, and medical personnel have “implied consent” to treat the patient. In fact, we are required to treat them.
Understand that life-threatening means exactly that – the patient is going to die without medical treatment. What may be a dire emergency to you is irrelevant – the key is the medical provider’s assessment of the patient. If, in our opinion, the patient has a life-threatening condition, we have “implied consent.” A patient can be very gravely ill, or very badly injured, and not meet this life-threatening threshold.
One of the issues with consent is that medical practice – both by physicians and EMS providers – is governed by state law, and state laws vary widely. What is standard practice in your state may not be valid in Florida at all – in fact, it might be illegal in Florida. All opinions expressed here are based on Florida law because we are talking about visits to WDW and Florida law will govern all medical care there
Adult Patient
Any patient over the age of 18 may give – or withhold – consent for medical treatment. As long as the patient is mentally competent, they have the right to make good decisions, bad decisions – even stupid decisions – about their medical treatment. Medical practitioners can reason with the patient if they appear to be making the wrong choice, but we cannot compel them to submit to medical care.
Child Patient
If the patient is younger than 18 years (even one day younger), they are a child under Florida law and they cannot make decisions about their medical care. There are exceptions for married or “emancipated” persons under 18, but this is the general rule: parental consent is required unless the child’s medical condition is life-threatening. If the parent is with the child, obviously this is a non-issue. If the parent is not present, consent can be a big problem.
I’ll give you a good example. A week ago, I had a 12 year-old patient with severe abdominal pain. There are probably a dozen things which could cause abdominal pain and about ten of them are bad – but it’s hard to call pain life-threatening. Fortunately, the school involved had a parental consent form. A copy of the form went to the hospital with the patient in the Rescue unit, giving the medics and the hospital consent to treat the patient. The boy had appendicitis and underwent emergency surgery before anyone was able to reach his father, who was out of town. The parental consent form allowed him to be treated before his condition deteriorated to life-threatening.
Most schools, church groups, scout groups etc have standard parental consent forms which they require whenever kids go on trips. Samples of these authorizations can be Googled and modified as needed. A written document is always preferable to telephone contact with a parent in an emergency, because the patient is going to be treated by a series of medical professionals – not one – and each of those professionals must have parental consent.
In Florida, there is no set format required and the form does not have to be notarized. Two things are important: 1) it must authorize TREATMENT by medical providers if they think the patient’s condition warrants treatment, and 2) it must bear the name and signature of the child’s parent or legal guardian.
The document should also contain the parent’s contact information, and that information should be a cell phone or other method by which the parent can ALWAYS be reached quickly. Murphy’s Law is in full effect in medical emergencies, and they always seem to occur at the worst possible moment for reaching a parent. If you are on a five hour coast-to-coast flight, we'll be dialing your number during your takeoff roll!
Another critical point with parental consent forms is that they must be with the child at the time of the emergency. If you have the form at MK and the child breaks their arm at Epcot, nobody can treat them until either you respond with the form or the EMS provider personally contacts the parent. If your guests are old enough to go to the parks unaccompanied, it’s a good idea to have multiple copies of the form with the kid always having one in their possession.
It is also obviously a good idea for a child traveling without their parents to have relevant information about any medical conditions they have or have had recently, medications they take, allergies you are aware of, etc. And, it’s a good idea for the child to have their insurance card, or a photocopy of both sides of the card, with them. Treatment will not be withheld without the card in emergency situations, but having the card eliminates one big loose end to tidy up later.
Terminally Ill Patients – Do Not Resuscitate Orders (DNRO)
A DNRO is a written order from a physician directing other medical practitioners to withhold resuscitation of a patient if they go into cardiac or respiratory arrest. A DNRO is usually used with terminally ill/end stage patients who have expressed a desire not to be resuscitated.
If the patient is already in a hospital, the DNR question is usually a non-issue. The attending physician will consult with the patient or their family and issue a DNRO in appropriate situations.
“Advanced directives” such as living wills, durable powers of attorney, health care surrogate designations, etc. are very helpful inside a hospital because they serve as guidance regarding the patient/family wishes. However, outside the hospital in Florida, advanced directives have zero legal validity in resuscitation situations.
It is in the field – in the pre-hospital environment – where resuscitation questions can become very difficult. These issues are governed by the laws of the state where the patient IS – not where they are from – and Florida Law is very specific and very restrictive on DNROs.
Regardless of what your state law says, Florida law mandates that only a Florida Do Not Resuscitate Order is valid here. The Florida Law is so strict that it requires a specific form to be printed in black ink on yellow paper. Photocopies are only acceptable if they are printed in black ink on yellow paper.
The form can be downloaded from the Florida Department of Health website here, printed on yellow paper, appropriately filled out and signed, and can be carried by the patient or family member. If you look elsewhere on the DOH website (www.doh.state.fl.us), you will see additional information on Florida’s DNR law.
In Florida, in the pre-hospital environment, it is also required that the DNRO be physically presented to the EMS responders. We cannot honor a DNR unless we actually read the order and are satisfied that it meets the requirements. If there is any doubt at all, we are required to begin resuscitation immediately, no matter what the patient/family wishes might be. We have no latitude; if we do otherwise we face both criminal prosecution and loss of license.
DNROs apply only in cardiac or respiratory arrest, so the patient will be treated normally up to the point where they code. A patient with chest pains is going to be treated for chest pains and every effort must be made to prevent the patient from arresting. If the patient does code, we will do everything we can to make them as comfortable as possible and let nature take its course.
Hopefully this information is helpful, and any additional comments, tips, links, etc. are welcome.
Unfortunately, the thread got moved to the Community Board where it quickly disappeared under the usual Community Board stuff. Hopefully this thread will stay here and will be helpful to families taking guests to WDW.
There are three scenarios which could arise when someone in your party needs medical attention, depending on the age and medical status of the patient. The main question here is consent, and who is permitted to make medical treatment decisions in various scenarios.
Consent Generally
Medical professionals generally cannot treat patients without the patient’s consent. Consent can be granted in many ways: verbally, non-verbally, or in writing.
The only exception to this general rule is if the patient has a life-threatening medical condition and is unable to express their consent (e.g. unconscious). In this situation, there is a legal presumption that the patient would want their life saved, and medical personnel have “implied consent” to treat the patient. In fact, we are required to treat them.
Understand that life-threatening means exactly that – the patient is going to die without medical treatment. What may be a dire emergency to you is irrelevant – the key is the medical provider’s assessment of the patient. If, in our opinion, the patient has a life-threatening condition, we have “implied consent.” A patient can be very gravely ill, or very badly injured, and not meet this life-threatening threshold.
One of the issues with consent is that medical practice – both by physicians and EMS providers – is governed by state law, and state laws vary widely. What is standard practice in your state may not be valid in Florida at all – in fact, it might be illegal in Florida. All opinions expressed here are based on Florida law because we are talking about visits to WDW and Florida law will govern all medical care there
Adult Patient
Any patient over the age of 18 may give – or withhold – consent for medical treatment. As long as the patient is mentally competent, they have the right to make good decisions, bad decisions – even stupid decisions – about their medical treatment. Medical practitioners can reason with the patient if they appear to be making the wrong choice, but we cannot compel them to submit to medical care.
Child Patient
If the patient is younger than 18 years (even one day younger), they are a child under Florida law and they cannot make decisions about their medical care. There are exceptions for married or “emancipated” persons under 18, but this is the general rule: parental consent is required unless the child’s medical condition is life-threatening. If the parent is with the child, obviously this is a non-issue. If the parent is not present, consent can be a big problem.
I’ll give you a good example. A week ago, I had a 12 year-old patient with severe abdominal pain. There are probably a dozen things which could cause abdominal pain and about ten of them are bad – but it’s hard to call pain life-threatening. Fortunately, the school involved had a parental consent form. A copy of the form went to the hospital with the patient in the Rescue unit, giving the medics and the hospital consent to treat the patient. The boy had appendicitis and underwent emergency surgery before anyone was able to reach his father, who was out of town. The parental consent form allowed him to be treated before his condition deteriorated to life-threatening.
Most schools, church groups, scout groups etc have standard parental consent forms which they require whenever kids go on trips. Samples of these authorizations can be Googled and modified as needed. A written document is always preferable to telephone contact with a parent in an emergency, because the patient is going to be treated by a series of medical professionals – not one – and each of those professionals must have parental consent.
In Florida, there is no set format required and the form does not have to be notarized. Two things are important: 1) it must authorize TREATMENT by medical providers if they think the patient’s condition warrants treatment, and 2) it must bear the name and signature of the child’s parent or legal guardian.
The document should also contain the parent’s contact information, and that information should be a cell phone or other method by which the parent can ALWAYS be reached quickly. Murphy’s Law is in full effect in medical emergencies, and they always seem to occur at the worst possible moment for reaching a parent. If you are on a five hour coast-to-coast flight, we'll be dialing your number during your takeoff roll!
Another critical point with parental consent forms is that they must be with the child at the time of the emergency. If you have the form at MK and the child breaks their arm at Epcot, nobody can treat them until either you respond with the form or the EMS provider personally contacts the parent. If your guests are old enough to go to the parks unaccompanied, it’s a good idea to have multiple copies of the form with the kid always having one in their possession.
It is also obviously a good idea for a child traveling without their parents to have relevant information about any medical conditions they have or have had recently, medications they take, allergies you are aware of, etc. And, it’s a good idea for the child to have their insurance card, or a photocopy of both sides of the card, with them. Treatment will not be withheld without the card in emergency situations, but having the card eliminates one big loose end to tidy up later.
Terminally Ill Patients – Do Not Resuscitate Orders (DNRO)
A DNRO is a written order from a physician directing other medical practitioners to withhold resuscitation of a patient if they go into cardiac or respiratory arrest. A DNRO is usually used with terminally ill/end stage patients who have expressed a desire not to be resuscitated.
If the patient is already in a hospital, the DNR question is usually a non-issue. The attending physician will consult with the patient or their family and issue a DNRO in appropriate situations.
“Advanced directives” such as living wills, durable powers of attorney, health care surrogate designations, etc. are very helpful inside a hospital because they serve as guidance regarding the patient/family wishes. However, outside the hospital in Florida, advanced directives have zero legal validity in resuscitation situations.
It is in the field – in the pre-hospital environment – where resuscitation questions can become very difficult. These issues are governed by the laws of the state where the patient IS – not where they are from – and Florida Law is very specific and very restrictive on DNROs.
Regardless of what your state law says, Florida law mandates that only a Florida Do Not Resuscitate Order is valid here. The Florida Law is so strict that it requires a specific form to be printed in black ink on yellow paper. Photocopies are only acceptable if they are printed in black ink on yellow paper.
The form can be downloaded from the Florida Department of Health website here, printed on yellow paper, appropriately filled out and signed, and can be carried by the patient or family member. If you look elsewhere on the DOH website (www.doh.state.fl.us), you will see additional information on Florida’s DNR law.
In Florida, in the pre-hospital environment, it is also required that the DNRO be physically presented to the EMS responders. We cannot honor a DNR unless we actually read the order and are satisfied that it meets the requirements. If there is any doubt at all, we are required to begin resuscitation immediately, no matter what the patient/family wishes might be. We have no latitude; if we do otherwise we face both criminal prosecution and loss of license.
DNROs apply only in cardiac or respiratory arrest, so the patient will be treated normally up to the point where they code. A patient with chest pains is going to be treated for chest pains and every effort must be made to prevent the patient from arresting. If the patient does code, we will do everything we can to make them as comfortable as possible and let nature take its course.
Hopefully this information is helpful, and any additional comments, tips, links, etc. are welcome.
