When to discourage transport

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bdoss2006

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I asked this in a series of questions a few days ago, but I want to get some more insight on this particular topic. When can you suggest a patient not go to the hospital? Of course you can for the stupid stubbed toe calls, but where do you draw the line? With the slightly more serious things I don’t feel comfortable saying don’t go to the hospital. We don’t have protocols for refusal, so I can’t refer to that.
 
How do you not have protocols for refusals? Are you saying no agency protocols or no state protocols for refusals?

Here in NYS, we have a 2 page statewide protocol that gives guidelines on when to consider medical control, when a CFR can cancel a transporting unit and what an EMT or higher should address before accepting a refusal. My agency (and most other agencies) has additional policies above that based on our medical director.
 
At this point you have to be trolling us. Please stop.

Follow your protocols. You have protocols.

If you seriously don't have your protocols, please message me and I'd be happy to send you digital copy. We were required to keep a copy with us at all times while working.

Your protocols state who may refuse treatment, what EMS needs to do to educate the patient of possible risks and dangers associated with not accepting medical, and will likely suggest contacting medical control if you're unsure about something. They will also provide specific details on what needs to be documented.
 
never. seriously.

back in the day, I used to discourage people from going to the hospital, but as I look back on my career, when the patient wants to go, my boss wants them to go, my employer wants them to go, it's not worth trying to convince someone not to go. If they want an expensive taxi ride, I will give them one with a smile on my face.

COVID might have changed things a bit, but to me, it's not worth the personal liability. If the patient doesn't want to go, sign a refusal. if I think they really should go, call someone else to try to convince them that it's in their best interest, but at the end of the day, people have the right to make stupid decisions regarding their health care.

Now, if a patient doesn't want to go to the hospital, I will always recommend (and document) that they follow up with their personal doctor at the soonest available appointment.
 
Your service or protocols should have a very well established/documented process for when patients want to refuse transport or sign out “AMA”.

What your system probably does not have is guidelines for when you should tell a patient they do not need to go to the hospital. There are some systems in the US that do have a process for “EMS initiated refusals” or similar wording however those services are going to be very small in number.

Assessing a patient and them saying “I don’t want to go to the hospital or go by ambulance to the hospital” is a very different beast than an EMS crew saying “even though you want to go to the hospital we are not going to take you”. I’m not a legal expert by any means but I’m fairly confident the later is going to open up a company/provider/system to a lot more liability than the former.

It is likely your system/company doesn’t have a policy on you discouraging transport to the hospital because they do not want to open themselves up to that liability.

Here is a good story about an EMS crew telling family they don’t need to take their kid in for evaluation and what ended up happening.

What I have always done is to be completely honest with the patients who are stable and usually say something along the lines of “I will gladly transport you to the hospital by ambulance if you would like. There is nothing that I am going to do for you in the ambulance and once we get to the hospital there is a pretty good chance you will go straight to the waiting room. So all I am going to act as is an expensive Uber that may or may not be covered by your medical insurance”.
 
FredG said:
How do you not have protocols for refusals? Are you saying no agency protocols or no state protocols for refusals?

Here in NYS, we have a 2 page statewide protocol that gives guidelines on when to consider medical control, when a CFR can cancel a transporting unit and what an EMT or higher should address before accepting a refusal. My agency (and most other agencies) has additional policies above that based on our medical director.
Click to expand...
My agency protocols have nothing referencing refusals. Neither do the regional protocols.
 
MMiz said:
At this point you have to be trolling us. Please stop.

Follow your protocols. You have protocols.

If you seriously don't have your protocols, please message me and I'd be happy to send you digital copy. We were required to keep a copy with us at all times while working.

Your protocols state who may refuse treatment, what EMS needs to do to educate the patient of possible risks and dangers associated with not accepting medical, and will likely suggest contacting medical control if you're unsure about something. They will also provide specific details on what needs to be documented.
Click to expand...
My agency protocols have nothing referencing refusals. Neither do the regional protocols. I can send you a pdf of my regional protocols if you do not believe me. My agency protocols are only on paper, so I can’t easily send them.
 
bdoss2006 said:
My agency protocols have nothing referencing refusals. Neither do the regional protocols. I can send you a pdf of my regional protocols if you do not believe me. My agency protocols are only on paper, so I can’t easily send them.
Click to expand...
In what state are you riding?
 
Though you never messaged me, here are your protocols.

From that document, here is the refusal process:

REFUSALS

The narrative should include:
  • The patient’s reason for refusal
  • Evidence of decision making capability Patient alert and oriented x 4 (Person, Place, Time and Event)
    • Patient understands and answers questions appropriately
  • The exact ramifications that were explained to the pt. (the worst thing that could happen)
  • Alternatives to care (suggest contacting your physician immediately, etc.)
  • Signature by patient or legal guardian
    • A wife/husband is not a legal guardian unless the courts have appointed them.
    • Durable Power of Attorney for Health Care
    • Document who you spoke with.
  • A physical assessment (if the patient refuses these, document it)
  • Events leading up to 911 call, mechanism of injury or nature of illness
  • Signatures
 
MMiz said:
Though you never messaged me, here are your protocols.

From that document, here is the refusal process:

REFUSALS

The narrative should include:
  • The patient’s reason for refusal
  • Evidence of decision making capability Patient alert and oriented x 4 (Person, Place, Time and Event)
    • Patient understands and answers questions appropriately
  • The exact ramifications that were explained to the pt. (the worst thing that could happen)
  • Alternatives to care (suggest contacting your physician immediately, etc.)
  • Signature by patient or legal guardian
    • A wife/husband is not a legal guardian unless the courts have appointed them.
    • Durable Power of Attorney for Health Care
    • Document who you spoke with.
  • A physical assessment (if the patient refuses these, document it)
  • Events leading up to 911 call, mechanism of injury or nature of illness
  • Signatures
Click to expand...
That is for tidewater region. I am in the southwest region. Our protocols have no sections for refusals.
 
bdoss2006 said:
That is for tidewater region. I am in the southwest region. Our protocols have no sections for refusals.
Click to expand...
Cool. So take anyone and everyone to the hospital even if they don't want to... Since they can't refuse. Don't ask us what to do. Ask your agency. You obviously don't care what we have to say.
 
bdoss2006 said:
That is for tidewater region. I am in the southwest region. Our protocols have no sections for refusals.
Click to expand...
I just looked at the Virginia state EMS page and it is abysmal. I now understand your frustration.

Look at many other states BEMS pages...many have direct links to statewide BLS protocols and policies. In NYS, we are even given access to a mobile app for protocols that is updated regularly and, if the regional councils participate, have the regionalized modifications to the statewide protocols.
 
bdoss2006 said:
That is for tidewater region. I am in the southwest region. Our protocols have no sections for refusals.
Click to expand...

Have you tried going through the state as I suggested above? If not, here's some of what you could have learned:

​

In Virginia, EMS patients have the right to refuse care, but there are specific protocols that must be followed. Here are the key points:

Documentation: Any decision not to treat or transport a patient must be fully documented on the prehospital patient care report1.

Assessment of Capacity: EMS personnel must assess the patient's decision-making capacity. If there's any doubt, they should consult a Medical Command Physician2.

Explanation of Risks: EMS personnel must explain the possible risks and dangers associated with refusing medical intervention to the patient or their authorized representative2.

Legal Guardians and Minors: Legal guardians can refuse care on behalf of minors or incapacitated individuals. Emancipated minors must show proof of emancipation to refuse care2.

These steps ensure that patients' rights are respected while also safeguarding their health and well-being.

Source(s)
1. 12VAC5-31-1090. Refusal of care. - Virginia Law

2. Policies and Treatment Protocols Special Operational 9208

3. Virginia Administrative Code, Article 5, Section 12VAC5-31-1090 ...

I generated this with Microsoft's Copilot. If you don't have that or another AI tool, you can get less-polished information that's almost as useful using a search engine.
 
No matter what you post, OP is going to keep questioning it. All its posts are trolling in nature.
 
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