Pt refusal

[Tigger]

What about 3rd party callers? Looky-Loo's who call in a cardiac arrest without even slowing down their air conditioned Lexus that turns out to be a napping sunbather in their yards? That has to be a refusal too?

For us that would probably fall into "no EMS needed." No refusal needed for that sort of call.

 

[bahnrokt]

What about 3rd party callers? Looky-Loo's who call in a cardiac arrest without even slowing down their air conditioned Lexus that turns out to be a napping sunbather in their yards? That has to be a refusal too?

For a sunbather called in as a code I would write it as "No patient found" and get a responding FF or LEOs name on the pcr.

 

[CANDawg]

About 50% of the time, when the LEOs hear us go to an SNF, they will tag along and someone will explain to the nurses that if we were to take the patient even though eh doesn't want to go, the LEOs would follow us in to the hospital and once we cleared, would arrest us for assault and kidnapping. After having done this for awhile, unless there is new staff at the SNF (which is actually a lot more often than you would think) we usually don't have these issues.

Isn't that a problem? The police haven't been formally called, and at that point there is not even close to enough suspicion of a crime to warrant their presence. That means that they are entering non public property (a patient's room at an SNF), and purposefully exposing themselves to confidential health information that they have no privy to without a warrant.

The only way they could immediately arrest you at the hospital (without the patient making a complaint) is by being in the SNF room when the conversation is taking place. I smell a HIPPA violation, at minimum.

 

[Tigger]

Isn't that a problem? The police haven't been formally called, and at that point there is not even close to enough suspicion of a crime to warrant their presence. That means that they are entering non public property (a patient's room at an SNF), and purposefully exposing themselves to confidential health information that they have no privy to without a warrant.

The only way they could immediately arrest you at the hospital (without the patient making a complaint) is by being in the SNF room when the conversation is taking place. I smell a HIPPA violation, at minimum.

It is not a problem in the slightest. There are many, many places where the police respond to every 911 call no matter what the complaint is. In many places they don't need to be formally called if it is a fire or EMS call, they can add themselves to the incident if they believe it be necessary. It isn't like it is illegal for a police officer to enter onto private property, are they not allowed to get coffee either because they have no warrant to be on Dunkin Donut's property either?

There is no HIPAA (not HIPPA) violation here. How would there be? The cops aren't writing down demographics, billing info, or medical history. It's not even likely that they are listening to the conversation at hand. Even if they were, HIPAA explicitly allows for incidental exposure of medical information. Ever seen an ER where the beds are separated only by curtains?

Most officers end up on scene because they are supposed to, but they know their usefulness is limited unless the EMS crew asks for assistance. And in this case, there is no need for confidential information to be shared for the officer to make his point. It doesn't matter what is wrong with the patient, if they are competent and don't want to go and you take them, the officer is correct, that is a crime.

 

[Bullets]

What about 3rd party callers? Looky-Loo's who call in a cardiac arrest without even slowing down their air conditioned Lexus that turns out to be a napping sunbather in their yards? That has to be a refusal too?

Technically, yes, however if spoke to the person and they denied calling 911 and there was no complaint, i would probably fill out my chart as "service not needed, passer-by called 911 in error." and clear off that

Now if the police department gets there first and sees that it was called in error, and there is no request by the "patient" for medical attention, i can talk to the cop and get a cancel.

At MVCs i ask everyone if they are hurt or have pain, those that decline any pain or injury do not have to sign the RMA, because i am not recommending them to see higher care nor am i treating them as a patient

It is not a problem in the slightest. There are many, many places where the police respond to every 911 call no matter what the complaint is. In many places they don't need to be formally called if it is a fire or EMS call, they can add themselves to the incident if they believe it be necessary. It isn't like it is illegal for a police officer to enter onto private property, are they not allowed to get coffee either because they have no warrant to be on Dunkin Donut's property either?

In my home town where we do get cops, they take the patients name, dob, address, and phone, sometimes a SS#.

A request by a SNF for an ambulance is an indicator of some form of medical emergency, whether or not you and i know it generally isnt "Emergent", this request for emergency resources is sufficient enough to give the police department probable cause to enter a residence. There may be a life safety issue at hand.

 

[Bullets]

disregard

 

[Aussie_Medic_Girl]

So you guys either transport or have the patient sign a refusal?

What about the 3rd option, 'transport not required'.

We actually have that as an option on our ePCR. People call us because they are scared, unsure of what to do or just plain want a mobile medical assessment of some kind. If we don't transport here we don't have to have a refusal, because we are not offering transport hence the patient isn't refusing anything.

We are a state run service and if people insist on going to the ED for minor stuff we take them. I try to educate the patient about what they might be suffering from, what the ED could do for them or what on the community option might be better for them. Obviously you guys are more litigious over there but it seems silly to either 'be transported' or 'refusing medial care/transport'.

Hopefully pre-hospital care will evolve more to allow us as clinicians to be 'mandatory' transport to hospital.

I'm lucky to be with Negro here. I'm lucky enough to be able to determine that someone doesn't actually require tx although if they still insist it's debatable as to whether or not we can refuse to tx them and I personally will not take that risk. Instead I take them...and then escort them to the waiting room after triage.

As for nursing homes, as a student I had a pt refuse to go to hospital. The home had called as she was "dehydrated" due to "gastro" and the Dr wanted her to go to hospital. Her assessment was fine-all VSS fine, good skin turgor, normal mucous membranes. She had been drinking water and keeping it down, hadn't vomited for hours and had only had 3 small bouts of diarrhoea over 8 hours. After assessment she still refused to go so we said "No worries have a nice day.". Nurse was fuming but we stood our ground and said that based on our assessment and the hx given to us by nursing staff pt had the capacity to refuse and we could not force her to come. Topped of with the fact that she didn't really need to go.

As for nursing staff coercing the pt to go...that would break our refusal validation. We work on a VIRCA concept:

Voluntary-Pt voluntarily refused tx (ie. was not coerced)
Informed-pt was informed of the risks of non tx
Relevant-pt's refusal was relevant to their current condition
Capacity-pt had the capacity to refuse tx
Advice-pt was provided with sound discharge advice

 

[DrParasite]

Patient is A/Ox3 and understands the risks of refusing? Sign here, press hard, 2 copies, have a good night.

while normally I would agree with you, with EMTs being fired by their companies because the SNF complained (since you didn't transport the patient). with EMTs being fired by their companies for not completing a transport that they were called for.

As has been discussed before, there is right, what is legal, and what your crappy private IFT boss will fire you for for losing the money he or she would have made from the transport.