How do you justify that in court if the patient is AOx4 with a GCS of 15? I can understand if they aren't, but if they are wouldn't that legally still be kidnapping ?
Back on topic, I'm starting to think that a requirement for BLS crews to do patient refusals should be contacting med control.
Well, for starters, we use the ePCR. We have a refusal form on there that we have the pt sign. It goes on to say things like we're not doctors, and our care is not a substitute for that of a doctor. At the bottom, right above the "accept" checkbox that sends the pt to the signature page, the form says a line about the pt refusing treatment and transport, and it says "and I do so unimpaired by drugs or alcohol." Furthermore, our OMD and our protocol manual both point out that the pt must demonstrate acceptable decisional capacity as well as being A&O4. The manual states that impairment by ETOH and/or drugs affects the pt's judgment and decisional capacity. I wouldn't count two drinks as impairment, but I would certainly question their decisional capacity if they're inebriated enough where they're showing signs of intox, such as slurred speech, ataxia, nystagmus, irrational behavior, sleepiness, etc. Matter of fact, in NY we responded to a lot of drunks on the street, dispatched as unconscious (asleep, typically). Should we get a refusal from them and then they get hit by a car, it's our jobs.
Regarding devisional capacity, the pt has to fully understand the risks/consequences of their refusal, the differentials regarding their presentation, etc. Repeating " I don't wanna go to the hospital" without a good reason why isn't good enough for me, and shows that they don't understand their situation fully. Now, even though we would most likely be covered by the decisional capacity clause, I will still punt and get the EMS Capt involved, the med director if available, and/or the local Magistrate for an emergency detention order. That way, I'm covering my crew and the pt, and I've also succeeded in shifting any liability onto others. If we're to accept the refusal, it will be by order from a higher authority, thus protecting us legally.
Now, for 46 Young's street tip: If you have an intox, possibly belligerent, and you're sure it's in fact ETOH and not some other underlying cause, they may wish to refuse. You can find a tactful way to let them know that if they just up and leave the scene, you can't follow them and detain them. You just advise and document that the pt refused treatment, refused to speak with and be evaluated by EMS, and left the scene by foot. In NYC it's called a 10-93 refused all. It's quite common, actually.
h34r: