# Non-English Patient Consent



## sop (Jan 25, 2011)

If you have an adult patient who does not speak English, and he or she is showing possible signs of labored breathing. You cannot find a translator, and you do not know this person's language. How would you find out whether you have the patient's consent to treat him or her? Would you assume that you automatically have expressed consent?


----------



## medicdan (Jan 25, 2011)

Especially when a patient is in distress, consent can be achieved non-verbally. Use gestures, language cue cards, etc. Where you begin to have trouble is in your assessment in learning more about the HPI and associated symptoms.


----------



## HotelCo (Jan 25, 2011)

Honestly? Just go in to assess/treat. If they turn away, push, or do something else to show they don't want treatment, then I'd stop. 

Don't use that answer on a test, use Dan's. But in real world, its what I do when they're in distress.

.


----------



## Aprz (Jan 25, 2011)

If he's showing signs of respiratory distress, he could already be altered from the lack of oxygen. Treat on expressed consent and chart why you think they are in respiratory distress and your attempts to communicate with them.

Cautiously approach and treat, make all efforts to communicate with him. You do not want to further agitate him and aggravate his breathing.

Can you imagine leaving this guy at home by himself in respiratory distress because he shooed you away when you made gestures at him indicating you wanted to help? That's gonna fly with everybody. How do you know he understood your gestures? How do you know he understood the possible consequences of you not treating? How do you know his mentality is in check? You're not leaving unless a greater force makes you, he's coming with you, he's leaving in another ambulance, or you get a translator (that's another scenario though).


----------



## nakenyon (Jan 25, 2011)

Implied consent until he otherwise shows that he doesn't want help. If you try to help and he pushes you away, then you stop. At that point it's just a matter of waiting. If they can't speak your language, they can't very well sign a refusal. So if they are really in respiratory distress, eventually they will lose consciousness and you can start treatment then. Not ideal, but the best option in my opinion.


----------



## Veneficus (Jan 25, 2011)

EMSJunkie91 said:


> So if they are really in respiratory distress, eventually they will lose consciousness and you can start treatment then. Not ideal, but the best option in my opinion.



:wacko:

Nevermind the trouble with the first part of the statement. You really think letting a patient deteriorate to unconsciousness from respiratory distress is ever the best option???


----------



## Aprz (Jan 25, 2011)

I meant implied consent, hehe.


----------



## TransportJockey (Jan 25, 2011)

Or if oyu have a droid phone and can figure out what language they're speaking Google Translate is a wonderful thing. Simple yes or no questions work great


----------



## nakenyon (Jan 25, 2011)

Veneficus said:


> :wacko:
> 
> Nevermind the trouble with the first part of the statement. You really think letting a patient deteriorate to unconsciousness from respiratory distress is ever the best option???



Ok. That didn't read quite the way I wanted it to. Letting the patient deteriorate is not a good scenario   under any circumstances, but if I attempt to treat someone and they push me away or start swinging at me. Then I'm not going to be able to really render any meaningful care.

So in clarification...My first option is to treat the patient. Someone obviously called 911. So it's safe to assume that the patient or someone close to them wanted them to get help. However, if I'm being rebuffed by the patient through physical gestures, I might try for orders to restrain the patient, but my OLMC doctors don't like to hand that out to me. At that point, I'm not sure what else I could do.


----------



## LucidResq (Jan 26, 2011)

I don't think it would be necessary when obtaining consent (the above answers will cover most situations), but does your dispatch center have access to translator services by phone? There's a chance they do especially if they field 911 calls... we often have police, fire and EMS call us up so we can connect them with a translator. 

Our fire dept also puts out a little booklet that covers several different languages common in our area... the only downside to it is that your patient has to be able to read their language. You basically point to the phrase or question you want to ask or say and the pt can point out responses to you as necessary.


----------



## firetender (Jan 26, 2011)

The only thing you have to work with is their resistance. 

You do what you're supposed to do and if prevented, stop.

But don't quit, do something else that will lead you back in to what you were initially refused. My point is what you did may not have been incrementally appropriate for the patient; basically, it's likely you did not establish enough trust.

Trust in emergencies is something that needs no language. It lives in your hands and eyes and the ways you approach your patient and, VERY MUCH how you honor their need for space. 

You don't need non-English speakers to practice with. Try it with all of your patients. Try silence until you must speak. Learn how to move you and your energy around them to ESTABLISH the confidence in you that will carry through the rest of the call.


----------



## akflightmedic (Jan 27, 2011)

sop said:


> If you have an adult patient who does not speak English, and he or she is showing possible signs of labored breathing. You cannot find a translator, and you do not know this person's language. How would you find out whether you have the patient's consent to treat him or her? Would you assume that you automatically have expressed consent?



I have found talking very loud (almost yelling) and exaggerating my syllables truly helps when one does not speak English.


----------



## akflightmedic (Jan 27, 2011)

firetender said:


> The only thing you have to work with is their resistance.
> 
> You do what you're supposed to do and if prevented, stop.
> 
> ...



Aside from my perfect advice already given , the above is true with my previous experiences as well. Well done FT.


----------



## Bieber (Feb 1, 2011)

I would operate under implied consent.  Unless I can hear and understand them when they tell me they don't want to go to the hospital and can prove to me that they're competent to make their own decisions, I simply cannot justify leaving them on scene.

Something a paramedic I worked with said to me, that I've been keeping in the back of my mind when I work, is to always imagine how a news headline or article would read regarding your actions if you're unsure about them.

"Non-English speaking man in respiratory distress left on scene by paramedics who state they thought he didn't want to go the hospital because he fought against their efforts to provide treatment.  Expert witnesses state combativeness is a sign of hypoxia and also state that paramedics must be assured that a patient is competent to make their own decisions in order for them to refuse treatment.  The man later died, and the service in question is being sued by the family for abandonment."

Versus:

"Non-English speaking man in respiratory distress was taken to the hospital against his will by paramedics who state that, when in doubt, they must transport.  They explained to Generic News that they always err on the side of caring for the patient and state that unless they are sure that the patient is competent to make their own decisions, they must assume implied consent.  Man treated and released from hospital."


----------



## Ghando14 (Feb 5, 2011)

I've found that it's not getting consent that's the big problem, it's figuring out what's wrong. I had a car accident happen outside my house, involving a car with three non-english speaking pt's, and a english trucker. Of course I was the first on scene. The car was torn a part pretty good, and the three occupants inside were conscious getting out from the truck. 

Do you have any idea how hard it is to get someone to stop moving their necks when you can't understand each other. Or ask them the questions and such? Even when I had a translator, when you're one guy trying to control a situation with four people on the side of the highway out here, in the middle of the day, it still sucks. Ha ha.


----------

