Chest Pain - BLS - No Meds - Pt Refusing Care

[jhopper]

No such SOR protocol

 

[Sandog]

Emphasis added.
I would argue yes, as what are you treating if you aren't developing a working diagnosis from a set of differential diagnoses?

You made a believer out of me JP. I read your article, I liked it, and I agree.

 

[18G]

To the OP... it sounds to me like you and your crew members handled the call appropriately. Sometimes patients are just butt heads and refuse to listen to reason. You guys informed the patient of his current condition and what the risks of refusing care and transport were. As long as the patient was conscious, alert, and oriented, and he was enabled to make his decision an informed one, there wasn't anything else you could have done.

And in telling the patient that you thought his pain was from ischemia.... I think that was totally a-ok. It's not hard to get a good general sense of ischemic pain from non-ischemic pain even without a ECG and labs. This guy's history and presentation rings very loudly of ischemia. Sometimes you need to use scare tactics and be very blunt with patients to get them to understand and accept the seriousness of their condition.... I'm not saying lie to them... but choose words that emphasize the immediacy of the situation.

The patient got lucky this time and hopefully he learned his lesson. If you encounter the same patient again or similar cases handle it the same. As someone else suggested you could request ALS even though the patient says he refuses. Perhaps a change in the scene dynamics can persuade the patient to accept transport in a unit that he can see in front of his house and it will show that you tried every thing in your power to get the patient a level of care they needed.

 

[CodyHolt83]

I agree with JPINFIV

 

[zmedic]

If you were on an ambulance, on duty I would call your on line medical control and have the doc speak to the patient, that can really help. Also covers your butt with the refusal "pt continued to refuse care even after speaking to online medical control Dr. X."

You should be really explicit in explaining the risks to the patient and document as such:

"Pt was told that his chest pain could be due to a life threatening condition including heart attack, pulmonary embolism, or damage to his aorta. Pt was told that proper evaluation should happen at a hospital and refusal of care or delay in treatment could lead to serious consequences including disability, cardiac arrest and death. Pt verbalized understanding of risks and that he could call 911 if he changed his mind, signed refusal form and ambulated away without assistance."

 

[CodyHolt83]

"Pt was told that his chest pain could be due to a life threatening condition including heart attack, pulmonary embolism, or damage to his aorta. Pt was told that proper evaluation should happen at a hospital and refusal of care or delay in treatment could lead to serious consequences including disability, cardiac arrest and death. Pt verbalized understanding of risks and that he could call 911 if he changed his mind, signed refusal form and ambulated away without assistance."

That is awesome! As a new EMT, this statement is perfect for me! Thanks for posting.

 

[Sasha]

"pain is caused from ischemia. If it were angina it should abate after rest. Because the pain will not abate this is cause for concern. Your heart is starving for oxygen.

Not to be nit picky, but I hate when people try to use big words like ischemia and angina when talking to patients. In your report, that's fine, but a lot of people don't know these words, and it can be kind of intimidating and confusing for them, which is not going to win them over to your side.

 

[jjesusfreak01]

I would call for an ALS response, and let them try to convince him to at least go for a 12-lead before he left, reminding him that he doesn't get billed unless we transport. Do your best to get them checked out, and if they still leave, thats not your problem.