Refusals

JK773

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Hey everyone,

How do you go about your refusals ? What kind of speech do you give your pts, let's do they hypothetic trauma and non-traumatic. This is what I usually say in the end when I type my narrative if they are A/Ox4 and competently refusing . I live in MA and certain substances have been legalized recently

To the best of my knowledge patient does not appear to be under the influence of any legal or illegal mind altering substances that will cloud his / her judgement. Patient is fully aware of his / her action when refusing treatment or transport and is also aware that this is not an attempt to solicit a refusal from them in anyway. Patient understands that if at anytime they feel any different and need an ambulance or any medical attention to access 911 immediately. Before having patient sign refusal patient is offered transport to the hospital and patient declined transport again. Patient is refusing with Police, Fire, ALS, and EMS and family as witnesses ( I have family sign if they are there as well )

A-? Clear and back in service
 

NomadicMedic

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All of that stuff is on my refusal paperwork. I document that explained the risks of refusal and I asked the patient three separate times.
 

DesertMedic66

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Pretty much what former DEmedic said. Document that the patient is AOx4, GCS 15, able to make decisions for themselves, that they were informed and that the understand the risks of refusing treatment/transport, that they are more than welcome to call 911 back at anytime or go to an urgent care/ED, and that by signing the form it releases our company/providers/hospitals from liability. Make sure to state that treatment/transport was clearly offered and that the patient clearly refused. Have any friends/family/LEO sign the refusal as a witness.

If I contacted the ED I will include the contact incident # for reference. I do make hospital contact on a lot of my AMA's just as another form of documentation.
 

NysEms2117

ex-Parole officer/EMT
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I wrote this in conjunction with a NYS prosecutor at an earlier date.
okay to start off. You need to "do your do diligence". You also need to make sure everything is explained at least 2 times, because in law 2+ points of proof is always better then one. example: finding the gun and the caliber bullet both with fingerprints matching. One can conclude more definitively that person used said gun in said crime. however going back to EMS ->. As an EMT you need to be sure they don't need to go to the hospital in order to even recommend an RMA, im showing you my example for a patient that NEEDS to go, but refuses. My RMA in total is something like this(this will be paraphrased a little bit):

" The patient xyz(name here) understands all the medical issues explained by the EMT/Paramedic(the tech that is "Running the call") and is alert and oriented to the regulations set by the state of ----. At this point in time the patient whose name will be signed below proving that they are in fact xyz, understands all medical risks explained to them up to and including sudden death. The patient xyz has had any prominent medical threats explained to them verbally by the EMT/medic to the best of their ability. The potential other options have been explained to the patient(urgent care, PCP visit within a week, mental heath ect) and the patient understands these. By signing below the patient also removes all responsibility from the EMT/Paramedic at this time, until further dispatched (or something along those lines however you want to word it). The EMT/paramedic has explained all prominent and visible threats to my life, by signing below i acknowledge that i understand all of them and that I am alert to the state regulations set forth by the state of------."

Thats what my RMA looks like, to do your do diligence you need to explain to the patient 2 times that the health risk of not being transported is xyz. You also need to make sure they are AOx3 or 4, whatever your legal standard is.

To break this down sentence by sentence ill do bullet points, you want to cover all your bases
sentence 1: your confirming that the patient understands what you think could possibly be wrong with them, and that they are mentally stable/oriented well enough to comprehend what you are saying.
sentence 2: They understand their health and that by signing below they could have anything happen including sudden death
sentence 3: You as a healthcare provider explained the symptoms and what they could mean/lead to, to the best of your ability(your level of training)
sentence 4: alternatives to the ER have been explained and the patient understands those options
sentence 5: the patient revokes responsibility set on you by the state( when you get dispatched obviously you cant refuse to go), they remove that responsibility until you get dispatched to them again.
sentence 6: you explained their life threats again(to the best of your ability), and that signing below they understand the threats to their life, potential risks of refusing medical care, and that they are in fact alert and oriented to the minimum state requirement.

~~Andrew
 

NPO

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Sign here.
Your chances of dying are 100%. Youre signing in agreement of that, and that if it happens sooner than later, it's not our responsibility.

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NomadicMedic

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If your patient is signing a refusal form that had been vetted by your department' attorney, you're fine. In fact, all of the boilerplate crap that people write in their narrative will only jam them up in a deposition. Wait til the patients attorney, who makes a living ripping up medical records, decides to have you explain, in great detail, each part of your narrative. You'll quickly go back to something simple like,

"The patient was found to be conscious, alert and oriented and refused any EMS evaluation and treatment or transport. The patient was explained the risks of refusing EMS treatment or transport. The patient stated that he was aware and accepted the risks. The patient was shown the refusal paperwork and again explained the risks. The patient again stated that he was aware of the risks and signed a refusal paperwork. Prior to clearing the scene the patient was asked for a third and final time if he wished to be treated and or transported by EMS. The patient again refused."

That is seriously all you need. If you start to put things in your report like, "The patient did not appear to be under the influence of any drugs or alcohol" You will get ripped to shreds. Especially if you don't have any training to determine what patients are under the influence of drugs or alcohol.

Keep it simple. Use the refusal paperwork for all of your boiler plate, simply document that you offered to treat and transport the patient three times and get it signed by a LEO and family members.

And if you haven't taken a workshop on defensible EMS documentation, I highly recommend it. They do seminars at all of the EMS conferences and many agencies have them come in to teach their documentation course.

These guys are the experts in documentation and their methods can keep you out of trouble. https://www.pwwemslaw.com/
 

DrParasite

The fire extinguisher is not just for show
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If your patient is signing a refusal form that had been vetted by your department' attorney, you're fine. In fact, all of the boilerplate crap that people write in their narrative will only jam them up in a deposition. Wait til the patients attorney, who makes a living ripping up medical records, decides to have you explain, in great detail, each part of your narrative. You'll quickly go back to something simple like,

"The patient was found to be conscious, alert and oriented and refused any EMS evaluation and treatment or transport. The patient was explained the risks of refusing EMS treatment or transport. The patient stated that he was aware and accepted the risks. The patient was shown the refusal paperwork and again explained the risks. The patient again stated that he was aware of the risks and signed a refusal paperwork. Prior to clearing the scene the patient was asked for a third and final time if he wished to be treated and or transported by EMS. The patient again refused."

That is seriously all you need. If you start to put things in your report like, "The patient did not appear to be under the influence of any drugs or alcohol" You will get ripped to shreds. Especially if you don't have any training to determine what patients are under the influence of drugs or alcohol.
what he just said... Don't over complicate it, you will get yourself jammed up.

Don't believe me? Find a lawyer who specializes in medical malpractice to look over your RMA fluff, and ask how they would not only tear it to pieces in court, but make you look like an incompetent bafoon on the witness stand

And if you haven't taken a workshop on defensible EMS documentation, I highly recommend it. They do seminars at all of the EMS conferences and many agencies have them come in to teach their documentation course.

These guys are the experts in documentation and their methods can keep you out of trouble. https://www.pwwemslaw.com/
Quoted for truth
 

NysEms2117

ex-Parole officer/EMT
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I would also like to add on to Dr.P's post, if I may. Court is a whole new animal and I think I said this in another thread, but let legal people do legal things, don't think for even a second you can hold your own in court. Young parole officer me learned that very very early. I would also very strongly recommend getting a prosecutor to tell you "what will you attack in court" and write your Rma off of that. I would also suggest a documentation workshop/lecture.


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Ensihoitaja

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Prior to clearing the scene the patient was asked for a third and final time if he wished to be treated and or transported by EMS. The patient again refused."
Jesus said:
"This very night, before the rooster crows, you will disown me three times."
Seriously, though, my refusals aren't particularly different from yours.

Patient refused treatment/transport
The patient is clinically sober and has decision-making capacity
The patient understands risks, including: worsening of symptoms, undetected medical condition or injury, etc, etc

And, of course, I make sure that the rest of my narrative supports the clinically sober and decision-making capacity parts/
 
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