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EMS role in PE is supportive: titrate O₂, assist ventilation, give cautious fluids if obstructive shock, rapid transport for definitive care. Field thrombolysis is rarely performed. Bronchodilators don’t treat PE. Observation delays treatment.

After applying a tourniquet, reassess to ensure bleeding has stopped and distal pulses are absent. Document application time and prepare for hemorrhagic shock management. Hemostatic dressings are for junctional sites or when tourniquets are not possible. Cold packs are not priority. Large fluid boluses should be avoided; use permissive hypotension. Paramedic trauma objectives emphasize ongoing reassessment, prevention of hypothermia, rapid transport, and hospital notification for surgical resources.

Pulseless VT and VF are the only shockable arrest rhythms. Asystole and PEA require CPR, epinephrine, and addressing causes, not shocks. Junctional rhythms with pulse are treated based on symptoms. Paramedics must differentiate rhythms rapidly to provide correct intervention.

COPD patients are at risk for hypercapnia, but hypoxemia is more dangerous. Recommended O₂ saturation target = 88–92%. Excess oxygen can worsen CO₂ retention via V/Q mismatch. Withholding oxygen is harmful. Hyperventilation is not appropriate. Paramedics titrate O₂ and prepare for NIV or intubation if worsening.

Patient autonomy allows a competent adult to refuse evaluation or transport after informed discussion. Assess decision-making capacity: orientation, ability to understand information, appreciate consequences, and communicate a choice. Provide a clear explanation of suspected risks (e.g., ACS), benefits of transport, and alternatives (follow-up, calling back). If capacity is intact and no impairment from intoxication, hypoxia, or head injury is suspected, obtain an informed refusal signature per policy, including witness if available. Document the assessment findings, vital signs, ECG if performed, your education provided, the patient’s stated reasons, and explicit return precautions. Forcing transport without legal authority constitutes battery; law enforcement involvement is for safety threats or when a patient lacks capacity. Paramedic legal and ethical objectives stress consent, refusal, EMTALA interface, and meticulous documentation to protect patient rights and provider liability. Encourage re-contact if symptoms worsen and consider involving medical control for high-risk refusals.