Refusal v No EMS with behavioral

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johnhenry

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Got spoken to by a supervisor saying I should’ve gotten a refusal rather than clearing ‘no ems’ dispatched to a psych eval; on scene patient wouldn’t let us enter his house but talked to us he was fully AOx4, denied SI or HI, and said he was doing okay and didn’t want us there. I cleared ‘no ems’ and I got spoken to saying that the patient called and said he was going to kill himself and I should’ve gotten a refusal. First, if the patient is telling me that he’s fine, not suicidal, and doesn’t want us there, why would I collect a refusal? and if he actually is suicidal, technically I can’t even allow him to sign a refusal, I would have to force him to go. Only thing I think I could’ve done differently would be to call the med control doctor and see if he wanted to have the patient sectioned, but I don’t understand when he’s answering all my questions appropriately and says denies all those claims why I should’ve gotten a refusal. Also, it was unclear whether or not the dispatch said SI party, I just heard psych eval. What’s everyone’s thoughts on this? Anyone have similar situations?
 
What is your company’s policy regarding this? My company has a policy of all calls that we arrive on scene to get either transported or a refusal. We arrive on scene of a 2 vehicle MVC with no injuries? Company wants refusals on all patients. Arrive on scene for a possible psych patient? I’m going to get LEO on scene to do a mental health assessment and determine if a 5150 hold (72 hour psych hold) is needed, if it’s not then the patient will get a refusal. If they refuse to sign a refusal form then I will will out a “refused to sign the refusal form”. Do I agree with it all? Nope. Do I do it? Yes, it is company policy and I am employed by that company.
 
DesertMedic66 said:
What is your company’s policy regarding this? My company has a policy of all calls that we arrive on scene to get either transported or a refusal. We arrive on scene of a 2 vehicle MVC with no injuries? Company wants refusals on all patients. Arrive on scene for a possible psych patient? I’m going to get LEO on scene to do a mental health assessment and determine if a 5150 hold (72 hour psych hold) is needed, if it’s not then the patient will get a refusal. If they refuse to sign a refusal form then I will will out a “refused to sign the refusal form”. Do I agree with it all? Nope. Do I do it? Yes, it is company policy and I am employed by that company.
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Yeah my company doesn’t really have a policy, we use refusals for usually all MVAs, and sometimes if we think it’s medically warranted, but if we get called and it’s nothing we can clear with, No EMS, lift assist, public assist, etc. and LEOs were on scene but in my city it’s EMS job to evaluate psych patients. Other long time BLS/ALS providers in the city said I made the right call (also this patient dials 911 frequently but it was the first time I went to his residence. In the past I’ve gone to similar calls and have gotten no backlash, not really sure what made this so different
 
DesertMedic66 said:
Arrive on scene for a possible psych patient? I’m going to get LEO on scene to do a mental health assessment and determine if a 5150 hold (72 hour psych hold) is needed
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So glad I work where mental health is assessed by medical and psych providers and not law enforcement.
 
What do your protocols say? Do you have county/state protocols on refusals?

I would have needed to get a refusal. I'd need to get witnesses to sign the refusal form if the patient wouldn't.

I know that many are moving away from involving LEO on these types of calls. I'll be interested to see what others suggest.
 
DesertMedic66 said:
What is your company’s policy regarding this? My company has a policy of all calls that we arrive on scene to get either transported or a refusal. We arrive on scene of a 2 vehicle MVC with no injuries? Company wants refusals on all patients...
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How do you determine who a patient is? If a bystander calls and no one in the accident called are they still considered a patient? They didn't ask for help. Do you make them give you name and demos? What if they refuse to give you any information? Just curious.

To answer the OP's question. Follow your organizations policies. My agency would have had pd attached because they called saying they were suicidal. And that would have probably ended up being a mandatory hold. But that's with what I can guess with the little info you have provided.
 
PotatoMedic said:
How do you determine who a patient is? If a bystander calls and no one in the accident called are they still considered a patient? They didn't ask for help. Do you make them give you name and demos? What if they refuse to give you any information? Just curious.

To answer the OP's question. Follow your organizations policies. My agency would have had pd attached because they called saying they were suicidal. And that would have probably ended up being a mandatory hold. But that's with what I can guess with the little info you have provided.
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My county and company both have definitions on what and who a patient is.

We attempt to obtain any information from them that they are willing to provide. If they refuse then they are listed as John Doe/Jane Doe and we document what we saw and that they refused to sign.
 
This is a policy question as well as a protocol question. Your safest bet is to follow the strictest of the two.
 
johnhenry said:
on scene patient wouldn’t let us enter his house but talked to us he was fully AOx4, denied SI or HI, and said he was doing okay and didn’t want us there. I cleared ‘no ems’ and I got spoken to saying that the patient called and said he was going to kill himself and I should’ve gotten a refusal.
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Aside from the obvious follow your agency policy and protocol, sounds like you made patient contact, and it should have been a refusal. You can argue that it was a refusal by action, but the fact that you assessed the patient enough to know they were AOx4 and no SI/HI makes me think you should write something down about the patient; clearing with "No EMS" would look really bad when PD breaks down to the door on a welfare check 48 hours later and find the patient killed themselves. Even worse when 2 days ago, your crew was sent, the neighbors saw you talking to him, and you just left, with no documentation about what happened. Can you imagine the optics?

On the topic of who is a patient at MVAs, we only go to MVAs with injuries; otherwise, it's a LEO matter. how do you determine who is a patient? ask them. if they have an obvious injury, or are complaining of something, they are a patient. if not, they are not a patient, and have law enforcement document that in their report.
 
Well to the original post you made patient contact long enough to determine AOx4 etc so they should have signed a refusal if they wouldn’t document it and your covered either way. As for accidents we usually are recalled by police if they do not need or want Ems. Our police ask and if they say no we get cancelled if we do end up on scene for someone and another patient refuses etc we obviously have them sign a refusal.
 
Yea we get that a lot at my PT job: someone calls 911 due to someone laying down on a sidewalk, or in the parking lot, and by the time we get there, no one is laying down: but management wants patient information: What patient.
 
johnrsemt said:
Yea we get that a lot at my PT job: someone calls 911 due to someone laying down on a sidewalk, or in the parking lot, and by the time we get there, no one is laying down: but management wants patient information: What patient.
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i Would be tempted to put he walked in first name and away in last name lol
 
johnrsemt said:
Yea we get that a lot at my PT job: someone calls 911 due to someone laying down on a sidewalk, or in the parking lot, and by the time we get there, no one is laying down: but management wants patient information: What patient.
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Call is either unfounded or gone on arrival. Have dispatch do a call back for additional. If nothing further, go back in service with no chart needed (or a single word chart if you need a chart for every call)
 
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