What gives us the right????

i suppose being a semi-invalid frequent flyer qualifies

oh, they can be Oriented x99, but night after night of those fallen and can't get up ordeals where they say they simply don't care if they're incontinent seems to bother the powers that be enough(and next of kin is just that) to eventually have them hauled off to the fossil home....

~CS~
 
Generally, a competent adult of legal age or meeting the legal requirements for emancipation can refuse treatment at any time regardless of their physical condition. They could be missing an arm, a leg, and one eye, and bleeding to death and if they dont want to receive care or be transported then you really have no grounds to force care. You just have to be really persuasive or wait til their mental status becomes altered from hypoxia and provide care under the law of implied consent. And if you really wanted to debate the issue, does implied consent still apply if a pt. makes their wishes known before they become altered or unconscious from their injuries? Or does it only apply if you find a pt. in an altered or unconscious state?

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Any pt. that is contemplating harm to themselves or others regardless of compency is automatically getting a ride to the hospital cause obviously if they were in a "normal" state of mind they would not want to harm themselves or someone else. The pt. has no choice here.

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Minors only get transported if I cant get ahold of a parent, relative, or legal guardian to come to the scene or give verbal consent for refusal over the phone.

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An area I find scary is when providers release a MVC pt. that is intoxicated to law enforcement. Legally, these pt's. cannot be released to a person of a lesser level of training then you and the pt. obviously cannot decide for themselves to refuse given the intoxicated state. What happens when PD is transporting to the barracks or wherever and the pt. crashs? Who is liable here? I've had this situation and consulted medical command for their ok before releasing to law enforcement.

This is an area of many fine lines and circumstances but Ive always been told and operate under the primise that as long as you do what is in the best interest of the pt, you are gonna be protecting yourself.
 
We have an obligation to protect a patient, even at times, from themselves. If they cannot comprehend their condition and make an informed consent in respect not only to treatment and transportation, but in informed refusal as well, they're ours. If an adult who is their own DPOA is conscious, alert, and oriented, can understand the consequence of refusal of care, that's informed refusal. The most common condition that I can relate to is alcohol/drug poisonings.
 
In my state, any transporting against the expressed refusal of a patient has to be done by LEO. Its called an ITA (Involuntary Transport Authority). I have found that most drunks faced with the choice of riding to jail in the back of a cop car or riding to the ED in the back of our ambulance, generally choose the ambulance.

The ITA is mostly used on pt's with Senior Dementia. If there is no record of the dementia in the Pt's records at the hospital and a family member doesn't have a power of attorney, we need a LEO to document the lack of mental competency.

Legality aside, it generally is more of a sales job than an enforcement issue.
 
It is when a patient is a danger to themselves and others. Here in Santa Barbara Co. the pt.is made a 5150 and the police, sheriff, or CHP can do that. The documentation that goes on the PCR must list everything that the patient states and all actions that lead up to calling the cops to take in the patient. Ask any medic or emt that has had to do that, the charting alone will give you 3 headaches and makes you still wonder about human nature.:wacko:
 
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