Question about Refusing Care

[newEMT]

I'm a new EMT, and I was wondering what to do in the following scenario.

Dispatched for vehicle accident. When arrive, there is 1 patient in the vehicle with no apparent injuries. Patient states that they want to refuse care. Do you have to stabilize their C-spine while you're checking to see if they are competent to refuse care?

 

[Ridryder911]

Okay, they refuse to be treated, and your doing what? Remember, before you are to touch someone (if they are awake) you ask to help them (consent?) If they refuse treatment ask the simple questions to obtain they are competent and orientated enough to make decisions. Advise, risk, alternatives, and sign refusal, get witness if possible.. then by-by to another call.

R/r 911

 

[NJN]

Textbook side of me says yes, always suspect c-spine until you rule it out, even if they are going to RMA. I would hold c-spine until you have completed your assessment and they are competent and understand risks of RMA-ing, and once they officially refuse care then i would let go.

Real world side of me says that it depends on what your scene size up is, how is the car damaged, what appeared to have happened, was the driver wearing a seat belt and did they appear to hit their head on anything. If its a small fender bender, minimal damage, and they aren't complaining of any pain and are competent to refuse, then most likely wouldn't.

This is all done if they consent to be at least assessed.

 

[newEMT]

I would have to get vital signs though according to our protocol. How would you deal with a patient who didn't want you to even take their pulse or BP? Sorry, these are really basic questions but we never really talked about these issues in EMT class and I don't want to screw up.

 

[MMiz]

First, welcome to EMTLife!

An alert, oriented, and informed patient has the right to refuse care. I usually initiated patient care with:

"My name is Matt, I'm an EMT with xxx, I'm going to...". If the patient refuses care or contact, I would:
1. Confirm that they were AOX3 (or x4 depending on service)
2. Check for obvious head injury
3. Check to see if I see any drugs or smell drug/alcohol use
4. Inform patient of possible consequences of not receiving care, and how to receive care should in the future if needed.

If a patient was clear that they didn't want treatment prior to c-spine, then I would not initiate any further treatment.

 

[NJN]

I would have to get vital signs though according to our protocol. How would you deal with a patient who didn't want you to even take their pulse or BP? Sorry, these are really basic questions but we never really talked about these issues in EMT class and I don't want to screw up.

These are things that really should have been covered in your class. RMA by action is when their actions clearly state they do not want to be treated by you, ex: getting violent or running away. It would be a RMA by action if they refuse to let you near them even though you informed them that it is necessary to obtain vitals for a proper refusal. You would document this to your best abilities.

 

[MMiz]

I would have to get vital signs though according to our protocol. How would you deal with a patient who didn't want you to even take their pulse or BP? Sorry, these are really basic questions but we never really talked about these issues in EMT class and I don't want to screw up.

That can't be true. You can not force an assessment on a patient. I would ask that patient if they wouldn't mind me taking their vital signs so that I could put the information on my refusal form. If they refused, I'd note their respirations, pupils as best I could, skin condition, and any other apparent vital.

 

[ffemt8978]

If they're CAO and competent to refuse care, you can NOT touch them, even for vital signs, without their consent. You need to explain to them what you want to do, but if they continue to refuse, then that's it. Sign here, press hard, multiple copies and be on your way. To CYA, you can always call medical control and explain the situation to them, and they may or may not be able to convince the patient to change their mind.

Even taking a blood pressure without consent can be construed as assault, if they want to press the issue.

 

[vquintessence]

I'm a new EMT, and I was wondering what to do in the following scenario.

Dispatched for vehicle accident. When arrive, there is 1 patient in the vehicle with no apparent injuries. Patient states that they want to refuse care. Do you have to stabilize their C-spine while you're checking to see if they are competent to refuse care?

In a test... yes? Real world? No (assuming it's a minor MVC and the pt refusing isn't altered from medical/trauma issues --- even in pts who do want transport... usually c-spine is forgone unless it's a serious mechanism of injury or suspicion).

Just document to CYA. MVA's are the biggest pain in the explitive; most of the time the pt is pissed off and wont want to seek medical attention. To protect yourself: Mention the extent and location of damage to vehicle (INCLUDING if glass is intact or not), that pt denies complaints (pertinent negatives are crucial [ex: -LOC, neck pain, -N/V, -pain]) pt refused physical exam, mention airbags deploying/not, seat belts used/not, try to get vitals and if pt refuses, state that as well. It's all about pertinent negatives and findings in this instances.

On an off note, pay attention to whether or not the pt has a "bad headache." Our medical director has been beating his shoe on the podium lately on this issue (pt refusals involving MVC's and headaches). We had a refusal for a decent MVC that came back and bit one of the EMTs on the explitive. The person signed a refusal and the paperwork was very lack on the EMT's part... but the EMT mentioned a headache. Well, the person was picked up hours later for altered LOC (pt was in 20's). Turns out the poor fella had sustained a subarachnoid bleed, supposedly after the MVC. Well now the EMT's are under state investigation. No lawsuits mentioned yet. Just my $0.02.

 

[daedalus]

Textbook side of me says yes, always suspect c-spine until you rule it out, even if they are going to RMA. I would hold c-spine until you have completed your assessment and they are competent and understand risks of RMA-ing, and once they officially refuse care then i would let go.

Real world side of me says that it depends on what your scene size up is, how is the car damaged, what appeared to have happened, was the driver wearing a seat belt and did they appear to hit their head on anything. If its a small fender bender, minimal damage, and they aren't complaining of any pain and are competent to refuse, then most likely wouldn't.

This is all done if they consent to be at least assessed.

A. Thats assault with battery
B. Holding C-spine is a myth
C. Your going to hold it only to later let go?

 

[NJN]

A. Thats assault with battery
B. Holding C-spine is a myth
C. Your going to hold it only to later let go?

A. Read my last line, only if they consent to at least being assessed
B. I learned to hold C-Spine in class, the state tells me to, so i do, myth or not.
C. And i never said i would, that is just what i would do if i were to follow my poorly written protocols to the letter.

That conclusion was based upon ONLY what was discussed in my EMT class. Which just shows that the EMT-B should be eliminated or the class should be expanded. The real street is a lot different than class and i recognize that.

 

[rescuepoppy]

Refusal

I would have to get vital signs though according to our protocol. How would you deal with a patient who didn't want you to even take their pulse or BP? Sorry, these are really basic questions but we never really talked about these issues in EMT class and I don't want to screw up.

Protocols are made to be followed, they are there partly to cya, but if the patient refuses treatment that also means assesment. If the patient won.t let you check vitals it doesnt matter what your protocols say. They are there for you to follow not rules for the patient. In this case be sure to explain to your patient about the possible risks of refusing treatment. Then make sure eveything is documented. If they refuse all treatment that is all you can do.

 

[KEVD18]

lay one finger on a person wihtou there consent and you have assualted them. i assualt my patients about as often as i kidnap them, and i never kidnap patients.


the first lesson you need to learn is that you cant save everyone. as soon as you get that one, your career will instantly become easier.

 

[Code 3]

lay one finger on a person wihtou there consent and you have assualted them.

That's actually battery. Assault is only the intent or threat of inflicting harm.

 

[daedalus]

The clever lawyer-folk can make easy arguments for both assault and battery. They can pretty much make you fit into any category of crime. I have heard that they even like to pretend children are adults to get bigger sentences.

I meant no offense by the way to NJNewbie. My post was really directed at the futility of this discussion.

 

[KEVD18]

That's actually battery. Assault is only the intent or threat of inflicting harm.

great, you've bested me in the legaleese but my point is still valid.

 

[Shishkabob]

That's actually battery. Assault is only the intent or threat of inflicting harm.

Depends on the state actually.

In Michigan, assault is the threat of, while battery is the commission.

In Texas, assault is everything from verbal to sexual to physical.

 

[Code 3]

great, you've bested me in the legaleese but my point is still valid.

I was merely making a simple correction. I think it's particularly important to relay accurate information regarding assault vs battery since it's discussed in the beginning chapters of a lot of text books. This site is used as a resource and citing correct terms should be a priority.

 

[Shishkabob]

I was merely making a simple correction. I think it's particularly important to relay accurate information regarding assault vs battery since it's discussed in the beginning chapters of a lot of text books. This site is used as a resource and citing correct terms should be a priority.

Which you still got wrong depending on peoples location... sooo.....

 

[Code 3]

Which you still got half wrong... sooo.....

Maybe I can't read, but BRADY states that assault is considered placing a person in fear of or immediate bodily harm, while battery is touching unlawfully.