In the context of decisions made by a patient surrogate, when should EMS personnel follow instructions?

• A. Always follow until medical control intervenes.
• B. Never follow surrogate instructions.
• C. Only follow surrogate instructions if directed by medical control.
• D. If the surrogate is present, defer to their authority regardless of medical control.

Answer: (C)

Surrogate decisions are handled under physician supervision. When a patient cannot consent, a surrogate may provide input about what the patient would want, but EMS personnel do not have unilateral authority to act on those instructions. Instead, the appropriate course is to obtain guidance from medical control. The physician at medical control weighs the surrogate’s wishes, any known advance directives, and the patient’s best interests within legal and departmental policies, then directs the EMS team on what to do.

So, you should follow surrogate instructions only if medical control directs you to do so. This ensures actions are legally authorized, ethically appropriate, and aligned with the patient’s known wishes. It’s not correct to follow surrogate instructions automatically, nor to defer to the surrogate regardless of medical control, and it’s not correct to follow instructions only until medical control intervenes without explicit direction.