Refusals

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med109

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Having some refusal issues in my dept. and was hoping for some opinions.
1.Do you write refusals for everything you don't transport? Like a lift assist or where they hit their button on accident. What are the "rules" for what gets a report and what don't?

2. What about auto accidents? You get on scene and there is you, your driver, and firefighters (some are EMT's). You have 2 possible patients, one needs to be transported now, the other is refusing. There isn't time to do an assessment, call the Dr. and do refusal paperwork. SO we let one of the EMT/Fire guys handle the refusal. He turns in a blank refusal signed by the patient. Is this how you would handle the scenario (allowing a EMT/fire to do refusal)? The lack of report seems like a big deal to me, your opinion?

3. ONE more scenario, underage pt. Hit in the face with a ball, no loss of consciousness. Pt. gets loaded for transport when your informed Mom will be there shortly and will take pt. herself. You leave the scene with pt. to meet Mom cause she can't find the scene. She signs the refusal. Report is wrote, but the Dr. wasn't called for a refusal. What do you think? Shouldn't the Dr. be called when you do a patient assessment that results in refusal?

Thanks for all your opinions. I don't want to nit pick my crew to death, but refusals seem so important to me.
 
This will vary greatly depending on protocols.

1. Refusals are only for medical aids. If it was an accidental activation of their "life alert" then we will just document that. No need to do an assessment or have the patient sign anything.

2. Have the fire department remain in charge of patient care for the one who does not want to go. Transport the critical one. If the fire department turns in a bad report it's on them "just remember to document that they were in charge of the other patient".

3. Our docs like us to call on most things involving pedi calls. So in my system I probably would have called but there will be a lot of places where the doc doesn't need to be called for that.
 
You have to call a doc on every refusal?

When do they find time for medicine?
 
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DesertEMT66 said:
This will vary greatly depending on protocols.

1. Refusals are only for medical aids. If it was an accidental activation of their "life alert" then we will just document that. No need to do an assessment or have the patient sign anything.

2. Have the fire department remain in charge of patient care for the one who does not want to go. Transport the critical one. If the fire department turns in a bad report it's on them "just remember to document that they were in charge of the other patient".

3. Our docs like us to call on most things involving pedi calls. So in my system I probably would have called but there will be a lot of places where the doc doesn't need to be called for that.
Click to expand...

Really for #1? I'm not saying it's wrong, but our CES guy told us, AMA sigs for anything we make contact with(basically even visual), for anyone who calls an ambulance or has one called for them(med alarms and such). Were you guys not told that during your mando training last year? I only ask so I can bring it up to our managers.
 
1. It typically ends up being paramedic discretion. Were SUPPOSED to do a refusal for all patient contacts. At car wrecks, if you're not the injured one and you did not request an ambulance, then you are not a patient to me.

2. No can do for me. Second unit gets called. Paramedics write refusals.

3. I rarely call. Im supposed to call to DC an IV on diabetics. No reason too, doc can't make me take them and I can't leave the IV in. Doc usually ask why the hell were calling.
 
We get a refusal signed anytime patient contact is made. If it is a minor and they tell us a parent is en-route to the location we wait till they get on scene and have the parent sign. If one patient needs to be transported and another is uninjured we have one of the med crew get them to sign the refusal or a lot of times we have off duty EMTS or Medics that will also respond and they will take care of the refusal for us. We do not call in for any refusals, what are they gonna do tell you to take them against their will?
 
If a person is identified as being a patient and they refuse, then paperwork must be done. If we contact a person and determine there's no patient, then no paperwork need be done other than to write "no patient found" on the run sheet, no signatures... nada because there's no patient. It would be exactly like getting called out somewhere and not finding anyone there.
 
jgmedic said:
Really for #1? I'm not saying it's wrong, but our CES guy told us, AMA sigs for anything we make contact with(basically even visual), for anyone who calls an ambulance or has one called for them(med alarms and such). Were you guys not told that during your mando training last year? I only ask so I can bring it up to our managers.
Click to expand...

AMAs are only for patients. An accidental activation of a life alert does not mean there is a patient.

"Sir, did you mean to push your help button?"
"Nope. I accidentally rolled over on it during the night".
"Do you need any medical help or anything?"
"Nope."
"Cool. Take care sir".

"Dispatch, medic 104 is clear from the scene. No medical aid needed, accidental activation".

There never was a patient. Same with non-injury TCs.

On the PCR the person is stated as a "subject" and not a patient.
 
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Here is the counties definition of who a patient is.

iii is almost close to making them a patient. However they accidentally set their alarm off. So they didn't really make a request for help (that they know of).

ga7ysege.jpg


Sorry for the horrible quality, Tapatalk wouldn't let me upload a higher definition.
 
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