What should be done if a patient surrogate is presenting to make decisions?

• A. EMS should always follow surrogate instructions.
• B. EMS should not contact medical control for surrogates.
• C. EMS personnel should not follow their instructions unless directed by medical control.
• D. EMS should override any surrogate instruction if it conflicts with policy.

Answer: (C)

When a patient can’t make decisions and a surrogate is present, decisions must come under medical control guidance rather than being made solely by the surrogate. The surrogate’s input is important but not automatically binding; medical control can verify the surrogate’s authority, review any advance directives or DNR orders, and provide directions that align with policy and the patient’s best interests. Because of that, EMS personnel should not act on surrogate instructions unless medical control directs them to do so. In practice, you assess capacity, gather any available directives, try to contact medical control for authorization, and document the decision pathway. If a surrogate’s request would conflict with policy or patient values, medical control’s directive takes precedence.