How Assertive Are You On Calls?

spnjsquad

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Hey guys, I ran into a situation today with a patient. He's a frequent flyer and refused when we told him to sign our refusal form (he always calls then refuses care). My partner kept (in my opinion) being soft with him saying over and over "it's a legal document, you have to sign it" which did absolutely nothing to help. A cop walked in and said "did he sign" and the second we said "no" the cop was yelling "sir, either sign this f**king document or you're going to the hospital" and whenever the patient would interrupt the cop would yell "no, shut your mouth and listen to me" which led me to believe; couldn't we have done something as simple as that (without the cursing, of course)? So the bottom line is what limits do you set on how assertive you are towards a patient and how would you have handled this situation?
 
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chaz90

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Hey guys, I ran into a situation today with a patient. He's a frequent flyer and refused when we told him to sign our refusal form (he always calls then refuses care). My partner kept (in my opinion) being soft with him saying over and over "it's a legal document, you have to sign it" which did absolutely nothing to help. A cop walked in and said "did he sign" and the second we said "no" the cop was yelling "sir, either sign this f**king document or you're going to the hospital" and whenever the patient would interrupt the cop would yell "no, shut your mouth and listen to me" which led me to believe; couldn't we have done something as simple as that? So the bottom line is what limits do you set on how assertive you are towards a patient and how would you have handled this situation?

If you're implying that you would have liked to handle it like the cops did, then absolutely not. Seriously, I cannot emphasize that enough. There is no way in hell that is the appropriate way for anyone to treat any patient. I would never treat a patient that way, nor could I tolerate anyone else around me doing something similar.

The cops were wrong here. I know it's "urban" and a "frequent flyer patient" but this is wholly inappropriate, and quite frankly, not even legally accurate. If the patient refuses to sign your refusal and still refuses care or assessment, document it well, get a witness to sign, and clear the scene. Period.

There's a huge difference between being confident and assertive and being a buffon with some type of badge and uniform who uses threats and profanity to get what you want.
 
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spnjsquad

spnjsquad

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I think I worded my post a bit wrong. I mean us, as EMT's saying "listen, it's either you have to sign this refusal or we have to take you to the hospital". I in every way agree that the cop was extremely harsh to the patient. I don't know where you got the idea that you can just have a patient not sign a refusal though. In NJ, as with any state, a refusal is a fully legal document and not signing it can actually be considered an offense to the police. The only time that we may not have a patient sign is when it's an adolescent with no parent around except with contact via phone.
 

AtlasFlyer

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We can document a patient refusal to sign, and with witness signature (preferably a LEO witness). It stands up in court and is all on the PT's shoulders for refusing to sign, just make sure to document well and get at least one, preferably two witness signatures.
 

chaz90

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I think I worded my post a bit wrong. I mean us, as EMT's saying "listen, it's either you have to sign this refusal or we have to take you to the hospital". I in every way agree that the cop was extremely harsh to the patient. I don't know where you got the idea that you can just have a patient not sign a refusal though. In NJ, as with any state, a refusal is a fully legal document and not signing it can actually be considered an offense to the police. The only time that we may not have a patient sign is when it's an adolescent with no parent around except with contact via phone.
Nope. You can absolutely clear a scene without a patient signing a refusal. They're not under any obligation to sign anything just because they or someone else called 911. It makes it easier for us if they agree to, but sometimes they don't. Our refusals have a separate line for "Witness if patient refuses to sign." Even if yours don't, you really have no recourse to say "sign this or we're taking you." Unwillingness to sign a form for whatever reason doesn't constitute grounds for abduction.
 

J B

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I think I worded my post a bit wrong. I mean us, as EMT's saying "listen, it's either you have to sign this refusal or we have to take you to the hospital". I in every way agree that the cop was extremely harsh to the patient. I don't know where you got the idea that you can just have a patient not sign a refusal though. In NJ, as with any state, a refusal is a fully legal document and not signing it can actually be considered an offense to the police. The only time that we may not have a patient sign is when it's an adolescent with no parent around except with contact via phone.

Holy ****, there is no way this is legal. You can't force someone to sign something - the fact that it's a legal document makes it even worse that you're trying to force them to sign it. "It can be considered an offense to the police"? F*** you and f*** the police - I want to talk to a lawyer.

If you pulled this on me I would refuse to sign, go to the hospital and be on the phone with a lawyer while sitting in the waiting room. Probably the only reason your company hasn't been involved in a giant lawsuit is that you only pull this on the drunks? But if they're CAOx4 and not a danger to themselves or others, what right do you have to take them? And if they ARE a danger to themselves, why are you getting a refusal?

It's blowing my mind right now that this is commonplace where you work?
 
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DesertMedic66

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I think I worded my post a bit wrong. I mean us, as EMT's saying "listen, it's either you have to sign this refusal or we have to take you to the hospital". I in every way agree that the cop was extremely harsh to the patient. I don't know where you got the idea that you can just have a patient not sign a refusal though. In NJ, as with any state, a refusal is a fully legal document and not signing it can actually be considered an offense to the police. The only time that we may not have a patient sign is when it's an adolescent with no parent around except with contact via phone.
Well that's a problem. Even if the patient does not want to sign our forum we can not force them to go to the hospital (assuming they are mentally capable).

If they say no to going to the hospital and say no to signing your paperwork but you force them to go that is assult/battery and kidnapping. I would just love for an EMS crew to do that to me. I would file enough lawsuits that I would not have to work another day in my life.
 
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TransportJockey

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I think I worded my post a bit wrong. I mean us, as EMT's saying "listen, it's either you have to sign this refusal or we have to take you to the hospital". I in every way agree that the cop was extremely harsh to the patient. I don't know where you got the idea that you can just have a patient not sign a refusal though. In NJ, as with any state, a refusal is a fully legal document and not signing it can actually be considered an offense to the police. The only time that we may not have a patient sign is when it's an adolescent with no parent around except with contact via phone.
Someone has been lying to you. Here o would have the cop witness that the patient refused to sign and cleared.
 

cprted

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If a patient refuses to sign my refusal, I simply document, "Patient Refused to Sign" where there signature would go and have a witness sign.
 

Handsome Robb

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They don't have to sign anything they don't want to. I'm not gonna be a **** if they don't want to sign it. I'll explain why I want them to sign it, I never tell them to sign it or say they have to, I ask politely. I'll push for a while but in the end they don't have to and if they don't you have no right to kidnap them and take them against their will. If there's fire or PD present I'll have them sign as a witness and fill out the form as refused to sign. You can also have a family member sign as a witness. Be thorough in your documentation and you're fine.

Squad, you're wrong. I'm going to be blunt about t, you need to spend more time or medico-legal and learn your state laws regarding your job before you get yourself into trouble.

Even if you dot have a witness, document thoroughly and you're fine. You cannot force anyone to sign anything in this job and if you talked to me the way you stated the cop talked to the patient or told me if I didn't sign you'd force me to go to the hospital I'd be filing complaints not only with your agency but with the state and/or county department which certifies you.

As someone else stated, there's a big difference from benign assertive and being an *******. What you just said about having to sign it or you're coming with me is basically the same thing as a LEOS abusing their power.

And we wonder why we aren't viewed as professionals...
 

Ewok Jerky

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Ditto the above.

Document that patient refused to sign and have a witness,either LEO or family, and you will have no problem. We do it on a regular basis.

Also if they are AMA we have a base hospital on the phone as well.
 
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spnjsquad

spnjsquad

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You guys don't have to jump all over me. I made a mistake and was taught wrong regarding the protocols for our forms, and I'm going to speak with those who told me this.
 
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chaz90

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You guys don't have to jump all over me. I made a mistake and was taught wrong regarding the protocols for our forms, and I'm going to speak with those who told me this.
Outstanding. I think that's all anyone hoped to hear.
 

LACoGurneyjockey

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You guys don't have to jump all over me. I made a mistake and was taught wrong regarding the protocols for our forms, and I'm going to speak with those who told me this.

They do it out of love...
It's all a learning experience, that's the best thing you can take from this forum...other than DesertEMTs moments of cleverness.
 

Handsome Robb

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You guys don't have to jump all over me. I made a mistake and was taught wrong regarding the protocols for our forms, and I'm going to speak with those who told me this.

The reason you got jumped on is what you were saying could get you into a lot, a lot of trouble. Read: felony trouble.

Also, you might take this as me jumping on yu again but even if you're taught one way it's your responsibility as an EMS provider to make sure you know your job and the laws/regulations that apply to it. Just because someone tells you something doesn't mean it's true. Unfortunately its more often than not that many EMS providers truly don't know what they're talking about and either parrot bad information they were given without vetting it or just tell people things because it's what they think or how they've always done it.
 
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greenmountains

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What is the issue here? The patient refused treatment, then refused to sign. The cop was there and witnessed the refusal, so he could have signed as a witness. Done. Easy run.
 

Handsome Robb

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What is the issue here? The patient refused treatment, then refused to sign. The cop was there and witnessed the refusal, so he could have signed as a witness. Done. Easy run.
The issue is that the OP was under the impression that the patient had to sign otherwise they couldn't leave them on scene.
 

OnceAnEMT

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Same over here, a very good system setup for documenting patient refusals, including when they refuse to sign the AMA. Guidelines from talking to family to a different responder to the MD himself. If you don't want to sign, they don't just give up, but its certainly not forceful.

Now in the ED, it depends on the nurse. If they are leaving AMA and the physician already accepts that fact, then its just about the nurse obtaining a signature. Some will argue for it, some will go "Ok, bye, thanks for coming!". Literally.

Definitely not calling in LEO to get a signature though. Waste of resources.
 

wanderingmedic

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You are working way to hard. If the pt refuses to sign, then just document the pt refused to sign and follow your company's procedure. Its generally bad to argue with pts. If the person you were treating was a frequent flyer and was just being a pain, ask PD what they can do for 911 abuse. Sometimes a citation is enough to get someone to stop.
 
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greenmountains

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"What is the issue here? The patient refused treatment, then refused to sign. The cop was there and witnessed the refusal, so he could have signed as a witness. Done. Easy run."
Click to expand...

"The issue is that the OP was under the impression that the patient had to sign otherwise they couldn't leave them on scene. "
Yes, pretty plain that the guy did not understand the matter, but if for some reason this crucial matter was missed in his training, than his supervisor/squad leader needed to have educated him. Why did he raise it here instead of with his superiors?
I am almost agast that he felt he was imprisoned by the patient..."I won't sign so you have to live here until you are ready for retirement." Or what? Have the cop deliver the patient in handcuffs?
I am not trying to be harsh with anyone but really, this is not advanced stuff. He should have learned this before he took a seat or at the least on his first refusal. It is basic operations.
I understand his frustration at someone that sucks up time that could have been spent with a seriously ill or injured person, but dealing with difficult people and situations is part of the job, right?
I am jumping on no one,attacking no one, but this seems so blatently easy I cannot get my arms around it. This was on a number of my tests during training, including both the mid-term and the final. It was almost word for word the same scenerio in the post above (hmm...I wonder....nah, probably just coincidence...) OK, I suppose he could have got it wrong, maybe is inexperienced, but did no one, even his partner, who was present, clue him in? If I was so out of my depth, I would hope my sideman would help me. I would help him.
 
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