Full refusal necessary?

trevor1189

trevor1189

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Here is a question for you. You are on standby at a local event. Someone comes up to your ambulance and basically needs a band aid for a small cut. Do you just dress the wound and move on or obtain a full refusal and chart the incident?

Had this scenario today. Was on standby at a H.S. Football game and a person came up to the ambulance who had been sutured for a laceration on his arm. Needed a new dressing. One of our firemen actually took care of it so no charting would have to be done. But say you did it, as an EMT, would you feel the need to document the "incident" as a refusal or just do it off the record so to speak?

I kind of think it is a shame we have to be so worried about litigation, but that is just the world we live in today.

Do you chart anytime you use supplies off of the ambulance or do you think it is unnecessary for little things like this?
 
I've worked events like marathons and walks, and set aside a few items like bandaids and bandages that I consider self-service. It's really a personal call, but I've provided bandages and dressings to the public to treat previous injuries without documenting.

I like to think that I live life on the edge.
 
We charted it as recieved treatment, refused transport and document, document, document. We had a few refusal options. Treated & refused transport (for bandaids, diabetics), refused treatment & refused transport, patient not found, and another for 3rd party false alarm.
 
There was a standby event compay I used to pull extra gigs for and here is how we handled it.

We had a tackle box filled with typical OTC items, such as band aids, triple antibiotic cream, pepto or Imodium tablets, Tylenol, and a few other things of that sort.

The kit was self service and there was a log beside it. Each person was required to read the form which stated all the legal mumbo jumbo that they understood this was self service, not medical advice/treatment, etc and if they agreed they signed and printed their name on the log.

This kit was kept separate from the table the medic sat at...and minor complaints were encouraged to look at that kit before seeing the medic. Therefore the medic was not dispensing or prescribing medications, especially if the guest saw what they needed and helped themselves prior to speaking to the medic. No different than any adult walking into a store to buy what they need...only no store was around.
 
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Eh, I say yes to be on the safe side.
But in reality.. no, I'd just give it to them.
 
Myself, if I do anything on the ambulance I like to chart it. A CYA move. But I'm this case I would have had to radio county that we were on scene with one patient in order to to chart properly. (we need an incident number on our charts). Also technically for a refusal we need to be sure that we do not need to contact med command to approve the refusal. This would require me to take a full set of vitals on someone who just needs a bandaid. Which just seems ridiculous to me, and I'm sure the "pt." would think I'm nuts.
 
Depends on what you agency requires/wants and what medical care you are providing, imho... But for most FA stuff (band aids and such)... NAW... Might come back to bite you in the butt though... that would be my luck...
 
Mountain Res-Q said:
Depends on what you agency requires/wants and what medical care you are providing, imho... But for most FA stuff (band aids and such)... NAW... Might come back to bite you in the butt though... that would be my luck...
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My concern as well. That is why the FF said forget it I'll do it so you aren't even involved and there won't be anything to worry about charting because you didn't provide any care or treatment.
 
When we did standbys we had event run numbers, 5 digits and followed by a letter. So for each run we add our own run numbers and then coordinate with dispatch at the end of that night to get everything entered in.
 
Mountain Res-Q said:
Depends on what you agency requires/wants and what medical care you are providing, imho... But for most FA stuff (band aids and such)... NAW... Might come back to bite you in the butt though... that would be my luck...
Click to expand...

Well, it might. It's really a personal judgment call. I've worked many standby's and there were some where I wrote "millions" of AMA's and others where I wrote none. I base it on what the persons c/o is and what treatment was rendered. I use a loop hole. I hand them the band aid, 4x4's etc and let them do it themselves.
 
I work an event medical job, on a college campus, and for an urban service. My policy is as follows. I will give you a bandaid, ice pack, even an ace bandage, but nothing more, without a PCR/refusal. In that case, I wont look, listen, touch, comment. If you want me to do so, or check your BP, you are getting a PCR. Nothing more, nothing less.
 
When I worked at NSLIJ we would write a PCR for any and every pt contact, even at standbys when we were only giving out band aids and such. We would always be required to go the whole nine yards with a documented refusal of cont'd Tx. My agency would also require the pt to sign a refusal for not wanting a stair chair, O2, C-collar, really anything that we should give that the pt didn't want. CYA to the extreme, but it has prepared me well to fend off any litigation resulting from poor documentation.

Where I am now, when an elderly pt slips out of bet, or otherwise needs a lift assist only, it is toned out as a public service call. If we find that the citizen actually needs medical attention, we'll make them a pt and treat accordingly. If not, we just put them back in bed/chair and go on about our business. Where I used to work, anyone who needed a lift assist would get a full workup regardless.

We also get requests for BP checks at the station from time to time. If I was in NY, we would have to fill out a PCR and a refusal after two sets. Here, we do one set. If it's abnormally high or low, we'll recommend tx/txp, and make them a pt if they allow us to.
 
trevor1189 said:
Here is a question for you. You are on standby at a local event. Someone comes up to your ambulance and basically needs a band aid for a small cut. Do you just dress the wound and move on or obtain a full refusal and chart the incident?
?
Click to expand...

Here ya go - on standy at a race last weekend. A mechanic came up to our truck saying a broken drive chain caught him across the back of the hand. Only injury was a small laceration, less than 1 in, with soft tissue swelling. He did not desire transport just the "wound" dressed. We did just that. Then filled out the full refusal form and got his signature and his friend's as witness.
 
I work PRN doing special events coverage. We have a "patient contact log" we document all patient contacts on.

If it is something minor, like bandaids... we give them bandaids, and complete the log (Name, Age, CC, and treatment provided)

If we "lay hands on the patient" and/or do an assessment... then we need to document and obtain a refusal... and all the info goes on the log, too.
 
I have no problem giving them an dnagage and wipe and saying you ok, for small stuff.


As an asside can ye not "treat and not transport"
 
Jon said:
I work PRN doing special events coverage. We have a "patient contact log" we document all patient contacts on.

If it is something minor, like bandaids... we give them bandaids, and complete the log (Name, Age, CC, and treatment provided)
Click to expand...

The patient contact log is the best way to go when providing band-aid first-aid. It is a great way to track the number of patients seen to confirm a need for such service and to assist the company in negotiating a fair price to cover the cost of freebies handed out to everyone with a blister or paper cut. If you have no documentation for anything, it is hard to justify your salary or presence except for the "what-if" part which could also be handled by 911 most of the time.

As far as the "refusal of care" for these situations, you need to verify your companies policies. If you were to ask the patient if they wanted transport for a papercut or were to explain to them that they are signing a "refusal" form, you may get some questioning the terminology as well as the possibility of having an insurance company questioning you why you transported a paper cut injury as some may take you up on the ambulance ride rather than sign an AMA form. The companies that provide first-aid may have a simple form that covers them for handing out the band-aid and "no transport required" rather than "refusal of care".
 
I got questioned on this very thing a week or so ago. It was a big community event. We were all hanging out at the station for our annual BBQ when someone stopped in. They had a decent sized lac to their thumb that was probably going to need stiches. They wanted to know if they should go in to the local ER and be seen. I looked at it, told him he should probably go get it stitched. I put a 2x2 on it and some kling to keep the skin flap in place until he got to the ER.

A volunteer who has spent more time on probation than actually running calls questioned my not writing a report on the incident. In my perception, this was not 'a call'. I was not dispatched, did not transport and did not even provide EMS only a bit of neighborly first aid. The pt was on his way to the ER POV.

I understand the need to CYA when dealing with the public. But part of the reason that I choose to live in a remote rural area is because that is seldom an issue for us. The day I have to worry about being sued for giving someone a bandaid is the day I hand in my radio.
 
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