What's the most out-of-the-ordinary refusal you've ever gotten?

[abckidsmom]

I went for a guy in anaphylaxis the other day. He'd been stung on the eyelid by a wasp, and was swollen up like a balloon, with difficulty breathing, a little stridor and hives. I gave him epi and benadryl immediately when we got there, and then he started saying that he was absolutely not going to the hospital.

He really didn't, wouldn't, and couldn't be convinced. It was a standout call, because I've never really had someone refuse and keep refusing when they had an actual medical emergency. I ended up giving him solumedrol and a liter of fluid on medical command, then leaving him at home with orders to take 50 of benadryl in 4 hours.

What was the sickest person you've had that you didn't take to the hospital?

 

[DesertMedic66]

If we highly feel that a patient needs to go to the hospital and they keep refusing we have the option of calling PD and having that patient placed on a 5150 hold (danger to self). That makes it so the patient doesn't have a say on to be transported or not. They get treated at the hospital and then they are free to go. and the 5150 disappears.

On another note we had a 75 year old male patient pinned to the floor by some heavy boxes for 5 days. We had to make forceable entry into his house. He was AOx4. Super weak and severly dehydrated. All his vital signs were horrible. He refused to go to the hospital. We contacted the hospital and gave them all the info we had and they gave us the go ahead to leave him there (we contact the hospital on all AMA's and refusals, it takes the laibility off of us if something happens to the patient later on). He probably should have gone because a couple days later he coded (not saying it was related).

 

[Shishkabob]

During my medic internship, we were called for a man-down found by his neighbors in a doorway. As we got there, he was still on the ground. Patient was somewhat coherent, HR crap, BP crap, BGL even worse. Complaining of neck/back pain with tingling, and hip pain. He was coherent and awake enough to give oral glucose, which is all he'd let us do, which raised his BGL, but his HR and BP were still crappy, and he just looked like death. He let us move him to the couch as well, but nothing else.

He absolutely refused to go to the hospital. He stated he knew he was going to die soon and did NOT want to die in a hospital. We spent 30ish minutes on scene trying to convince him. In the end, I made sure he had food in his fridge, and I contacted one of his family members that lived nearby, then we left.



As we were leaving, my preceptor said we'd be back in a matter of hours working a code. Luckily we didn't on our shift, but I don't know of the other shifts.




Luckily, MY anaphalyxis patient a couple of months ago let us take him... though the doctor asked why we transported after I gave epi, benadryl, pepcid and solumedrol... I was like "Don't you think he should have access to an Epi-pen...???"

 

[MrBrown]

Declining of recommendation of treatment and/or transport aren't very common here.

One however stands out; had a bloke decline transport only to have him call back seeking transport the following night; he didn't want to go to hospital the previous evening because he was trying to pick up this girl he met down at the bar and it didn't work.

 

[JeffDHMC]

Older gal w/ c/p went unresp during hx 2ndary to VT. Shocked her, she woke up and refused to go. Not exactly a refusal since I talked her into it, but she would have loved to stay home.

Jeff

 

[JPINFV]

If we highly feel that a patient needs to go to the hospital and they keep refusing we have the option of calling PD and having that patient placed on a 5150 hold (danger to self). That makes it so the patient doesn't have a say on to be transported or not. They get treated at the hospital and then they are free to go. and the 5150 disappears.

Err, 5150's aren't supposed to work that way. You're free to be a danger to yourself provided that danger isn't due to mental illness (otherwise let's ban motorcycles and casual sex). If the police are putting anyone who refuses on a 5150, then I'm very surprised that there hasn't been lawsuits over it yet. Especially since a 5150 doesn't "just leave," especially if the individual is a gun owner.

Anyone facilitating (including tacitly standing around) a 5150 simply because the patient is simply refusing care deserves to lose their EMS license or POST certification, become liable for any costs incurred by the patient (including any loss of wages), and prosecuted for battery and kidnapping. The situation, as described, demands nothing less.

it takes the laibility off of us if something happens to the patient later on).

...and people wonder why EMS isn't seen as a profession.

 

[MrBrown]

If we highly feel that a patient needs to go to the hospital and they keep refusing we have the option of calling PD and having that patient placed on a 5150 hold (danger to self). That makes it so the patient doesn't have a say on to be transported or not. They get treated at the hospital and then they are free to go. and the 5150 disappears.

You should be forever banned from practising for that statement mate.

Brown believes very strongly in patient choice for healthcare, if the patient doesn't want it no matter how lifesaving it will be, if they do not want it and can reliably communicate that to the Ambulance Officers then it's not up to us to decide for them.

 

[DesertMedic66]

Err, 5150's aren't supposed to work that way. You're free to be a danger to yourself provided that danger isn't due to mental illness (otherwise let's ban motorcycles and casual sex). If the police are putting anyone who refuses on a 5150, then I'm very surprised that there hasn't been lawsuits over it yet. Especially since a 5150 doesn't "just leave," especially if the individual is a gun owner.

Anyone facilitating (including tacitly standing around) a 5150 simply because the patient is simply refusing care deserves to lose their EMS license or POST certification, become liable for any costs incurred by the patient (including any loss of wages), and prosecuted for battery and kidnapping. The situation, as described, demands nothing less.

We get alot of people on 5150 holds that don't have any kind of mental illness. 5150 are for danger to self and or danger to others. The police view it as if someone is refusing to go to the hospital and they really need to then they are a danger to themselves. Its not done too often since most of our patients are fine with getting transported. My medic and I have had to do it once.

After the patient gets let out from the hospital the police have another form to get rid of the 5150 (talked to several cops about it).

 

[JPINFV]

We get alot of people on 5150 holds that don't have any kind of mental illness. 5150 are for danger to self and or danger to others.

"5150. When any person, as a result of mental disorder, is a danger to others, or to himself or herself, or gravely disabled,"
Emphasis added
http://www.leginfo.ca.gov/cgi-bin/displaycode?section=wic&group=05001-06000&file=5150-5157

5150s are only for people who are a danger to self, others, or gravely disabled due to mental illness. Anything else is a complete and total unjustified use of WIC 5150.

The police view it as if someone is refusing to go to the hospital and they really need to then they are a danger to themselves. Its not done too often since most of our patients are fine with getting transported. My medic and I have had to do it once.

...and the police are fond of the 'ignorance is no defense for breaking the law' line, hence every single one of them should be in prison over the practical effects misusing this statute. The police don't get to rewrite language that is clear with an unmistakable interpretation because it makes their job "easier." Any EMS provider who requests the police simply due to the patient refusing care has no place treating patients and deserves to be in jail just as much as any officer that writes a 5150 on those grounds.

 

[DesertMedic66]

You should be forever banned from practising for that statement mate.

thats going to open up alot of jobs then. There are alot of medics and EMTs that do it here.

It doesn't limit it to only an ambulance transport. The police can also transport them depending on how stable they are.

IMO people should be able to choose what they want done up to a point. There is a point where honestly some peoples choices are well stupid.

 

[JPINFV]

There is a point where honestly some peoples choices are well stupid.

So? Who gets to make that choice? The police? EMTs and paramedics? I find riding motorcycles without a full set of protective clothing to be stupid. Can we ban that? I think people having sex before marriage is stupid and dangerous due to the risk of unwanted pregnancy or the spread of STDs. Can we ban that as well? I think drinking alcohol to the point of being drunk is stupid. Can we ban that as well, not just being drunk in public?

Once that path is started down, where does it stop?

 

[DesertMedic66]

I think this can be a really good thread so I don't want it to get closed for going off topic. If anyone wants to continue about why we do what we do then feel free to send me a PM.

 

[Anjel]

Or what about religious reasons.

If the only thing that would save that person is a blood transfusion. And they refuse. Are you gonna make them?

 

[JPINFV]

Or what about religious reasons.

If the only thing that would save that person is a blood transfusion. And they refuse. Are you gonna make them?

[troll]Why yes. Religion is simply a mental disorder, therefor they would qualify as being a 5150 patient and should be given blood products for their own good, forcefully if need be. After all, health care providers know what's best for you. [/troll]

 

[Sasha]

People who are competent have the right to refuse medical care. The police in your area are violating their rights by forcing it on them.

 

[Epi-do]

And now back to your original programming...

While in medic school, I had a lady that was exhibiting all of the classic signs and symptoms of a stroke - facial droop, slurred speech, unsteady gate, HA. He BP was through the roof, she was finding it difficult to use one side of her body, and she was scheduled to go in and have her carotid arteries roto-rootered in the next few days. According to her family, one of them was somewhere around 50% occluded and the other one was something like 85-90% occluded. She flat out refused to let us take her, and was furious with her family for calling us. We were able to coax her into getting on our cot, thinking we would then be home free since most people will agree to go once they get there, but no dice. Got the doc on the radio and let her talk to him. Both the doc and we stressed just how potentially devastating her decision could be. He family was also trying to talk her into going. It finally reached the point where we just had to leave. I don't know if she ever went in and got checked out or not.

Of course, I also knew this EMS chick that had an anaphylactic reaction to an antibiotic, and she refused to let her husband call for an ambulance because she didn't trust the service that would respond to her house. Instead, she made him half drag, half carry her to the car and take her back to the ER himself. Fortunately for her, things turned out ok.

 

[NomadicMedic]

27 year old female. SVT @ 220, with hx of the same. 12mg adenosine. Converted to NSR. Refusal.

Nobody could talk her into going. (and I'm the master at convincing balky patients to come with...)

 

[mycrofft]

Sober or drunk or avoiding arrest?

Look back at the snakebite thread.
http://www.emtlife.com/showthread.php?t=13891&highlight=rattlesnake

We had a guy actually RUN away AMA twice (a few days apart) while his forearm was rotting off from a rattlesnake bite. He was afraid of needles.

 

[MrBrown]

27 year old female. SVT @ 220, with hx of the same. 12mg adenosine. Converted to NSR. Refusal.

Nobody could talk her into going. (and I'm the master at convincing balky patients to come with...)

For something like that Brown wouldn't feel too bad about leaving her at home, it's clearly something she has a history with and its not like the hospital are going to do a great deal (if anything) for her.

 

[JPINFV]

Religion is simply a mental disorder

Sweet!