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Patient refusal with bad outcome?

Discussion in 'Scenarios' started by mulana, Nov 13, 2017.

  1. mulana

    mulana Forum Ride Along

    I recently had a call that I'm feeling pretty guilty about. My crew was dispatched to an elderly man who tripped while going for a walk. He was alert and oriented and had no loss of consciousness. There was a small hematoma on the side of his forehead, but he did not report any head pain, dizziness, or nausea. His vitals were absolutely normal. The pt expressed that he did not want to go to the hospital, so like I'd done with many simple fall victims before, I allowed my patient to refuse care. Only four hours later, my agency received a call for a stroke victim. It was my patient from that morning and he apparently lost consciousness after experiencing an excruciating head ache. The hospital said he had a brain bleed, most likely due to his fall that morning. I'm definitely feeling horrible about this. I think my assessment could've been much more thorough, and I can't stop thinking about how I could've done something different to prevent his poor outcome. Has anyone else had a refusal call go bad?
  2. DesertMedic66

    DesertMedic66 Forum Troll

    Oh, I’m fairly positive I have had some patients who I signed out AMA who passed away a short time later. I explained the risks or refusing further medical treatment/evaluation by the physician up to and including death. People are allowed to make their own choices about their healthcare. They are allowed to make stupid decisions (not saying hers was initially a stupid decision) for whatever reason they want.
  3. mgr22

    mgr22 Forum Asst. Chief

    I'm with DesertMedic on this. Your job is to follow your system's rules about assessing patients, advising them of risks, possibly involving medical control in the process, then documenting everything. It's not your job to make decisions for patients who are capable of making informed decisions themselves. I'm guessing I've had a few dozen patients who died shortly after refusing transport. Those calls aren't among the ones stuck in my head.
  4. Chase

    Chase Flight Nurse

    When getting a Refusal you should be explaining the risks including an unrecognized condition that could cause serious harm or death and make sure they truly understand. I would also have them verbilize it, more then just saying “yes”.
    Old Tracker likes this.
  5. NomadicMedic

    NomadicMedic formerly DEmedic

    Another reason I think EMS should be wearing body cams. A perfect way to document that adamant refusal and show the paramedic explained the risks clearly.
    EpiEMS and Colt45 like this.
  6. DrParasite

    DrParasite The fire extinguisher is not just for show

    Did you deny transport? No
    When offered transport, did the patient chose to refuse to go to the hospital? Yes
    Did the patient have any obvious sign of a brain bleed? I'm guessing no.
    Are you going to kidnap every fall victim and drag them kicking and screaming to the hospital, because they might have a brain bleed? I hope not

    People are allowed to make stupid decisions about their healthcare. And (unfortunately in some cases), parents are able to make stupid decisions about their kids. At the end of the day, when its their time, you can't do anything about it.

    Even if he had a bleed, even if he had a skull fracture, even if his pupils were unequal (three clear signs of badness), they still have the right to refuse. As long as you did your job, I wouldn't worry about it.
    DesertMedic66 likes this.
  7. E tank

    E tank Forum Captain

    A bad outcome doesn't mean a mistake was made.
    Colt45, DesertMedic66 and EpiEMS like this.
  8. Tigger

    Tigger Dodges Pucks Community Leader

    Through a mental status examination, was the patient deemed capable to understand and accept the risks or refusing transport and further care? If yes, that's how it goes, provided it was documented as such.

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