A 78-year-old male is having difficulty breathing. He has a history of dementia and COPD. His daughter tells you his breathing gets worse when he walks up the steps. He tells you that he is fine and doesn't want to go to the hospital. He is dyspneic and unable to identify his daughter. You should:

• A. Explain the risks and allow him to refuse service.
• B. Administer oxygen and transport him.
• C. Secure all four limbs and transport him.
• D. Ask him to walk up the stairs.

Answer: (B)

When someone is elderly with COPD who is suddenly short of breath and also appears confused or unable to recognize family, you must assume impaired decision-making capacity. In EMS, that means you don’t rely on a patient’s stated wish to avoid care if they can’t reliably consent. The priority is to relieve life-threatening symptoms and get definitive treatment, which is best done by administering oxygen to correct hypoxemia and transporting to a hospital for evaluation and treatment.

Oxygen helps ease his work of breathing and improves circulating oxygen to tissues, which is crucial in COPD exacerbations and in someone who may be hypoxic. Transport ensures he receives timely medical assessment and therapy, such as bronchodilators or other COPD treatments as indicated.

Avoid options that place him at greater risk or that assume capacity you don’t have: asking him to walk up stairs would worsen dyspnea; restraining him is inappropriate and unnecessary here; and allowing him to refuse care isn’t appropriate when his ability to make informed decisions is compromised.