Signed refusal, or no EMS?

[zippyRN]

event cover needs it's own guidelines as to what can be discharged at scene and by whom without needing a 'refusal ' and a suitable PRF needs to be in place rather than a transport/911 oriented one ...

[Mateo_1387]

At one of my agencies, we are allowed to leave the patients on scene without them signing a refusal of care. They did not need any care, so why make them sign a refusal of patient care. In the other agency, they just play the CYA game and make you get a refusal for each and everyone.

Personally I think that if they patient has no complaints, and they do not want any care, then no refusal is needed. Documentation is needed for the call, but not a refusal form. If care is started, or the patient looks like they need emergency care, then get a refusal.

[PatrickW]

The replies here really puzzle me.

In the hypothetical situation of an MVA with no injuries, what would the people with no injuries be refusing? Transport for no injuries? Is that implying that you, as the healthcare provider, are suggesting that these people be transported to an ER, even though they have no complaints?

In my system, a refusal means that the patient meets transport criteria and the patient should be transported to an ER. To obtain a refusal, we have to inform the patient of the possible consequences of refusing transport (for example, for neck pain we would warn them that if they have a spinal injury and refuse transport, they could become paralyzed and die), and by signing the refusal they acknowledge that they accept these possible consequences to refuse. I can't imagine doing a refusal on someone who has no complaints. What would I tell them the refusal means?

With few exceptions, anyone who denies injuries on an MVA is not a patient. They are a person involved in an MVA who isn't hurt and doesn't need EMS. There would have to be extenuating circumstances for me to assess someone who claims they aren't hurt and don't need an ambulance, and tell them that they need to go to the hospital.

[Capman]

I'm not so much talking about documenting pt. contact. I'm saying should you get a signed refusal? If your pt. doesn't have a complaint of injury, are they considered a patient at all?

Yes!

If you asked that person how they feel... It's an assessment, and they become a patient!

Now, that you initiated "Patient" contact. No matter how the patient refuses, it is now a refusal of "Patient" care.

It should be documented as such. Not doing so could leave you and your service in a heap of trouble. I shouldn't have to explain why.

[fallout]

I frequently go back in as "no EMS care" required off of MVCs.

Namely, we get tons of bystander calls on every little fender-bender. So, we arrive on scene and the people state "I don't need an ambulance" and "I just want to make a police report." To me they were never patients. They didn't want my services and I can't really thrust my services on them. It is one thing if it was just a documentation issue, but we also send people a $50 response bill when they do not want our services.

Now, if we get there and they have a complaint or mechanism is suggestive of potential injury, then it becomes a patient refusal.

[lonewolf_6491]

if no injuries then no sig needed it is logged as a cancelled call

[mobey]

if no injuries then no sig needed it is logged as a cancelled call

Is that policy or opinion?

Do you feel this way of doing refusals results in you being liable?

Welcome to the city!!

[CBEMT]

Our event detail crews ask this question frequently. I tell them that if they hand out a bandaid, I don't see the point. If they feel the need to ASSESS the patient, they should document that contact.

[Capman]

Namely, we get tons of bystander calls on every little fender-bender. So, we arrive on scene and the people state "I don't need an ambulance" and "I just want to make a police report." To me they were never patients. They didn't want my services and I can't really thrust my services on them. It is one thing if it was just a documentation issue, but we also send people a $50 response bill when they do not want our services.

Here's a situation for everyone to ponder. You are called to the scene of a MVC. Upon your arrival you find multiple patients all ambulatory and in no apparent distress. Upon your assessment, each individual states that they are unijured and wish no treatment or transport. If you continue to question them as to the nature of injury, for example, you state "You're uninjured, no pain, cuts, scrapes, bumps, bruises, nicks or stiffness?" If they state no to all questions, should you obtain a refusal of care and transport, or should you not classify them as a patient, and document as "no ems needed"?

Totally not the same situation fallout!

I quote sevenball "Upon your assessment...". Since when do we assess "non Patients"???

What you are describing fallout, is showing up and instantaneously deeming everyone a patient. That is not what Sevenball is asking. He is asking after an "assessment" can you deem someone a "non patient".

I'm sorry if I sound like a jerk here, but...

If any EMT wants to put their ass on the line by assessing a person that wishes to refuse treatment or transport (whether EMT's feel it's warranted or not) without having a patient sign the form that releases them and their service from any liabilities that may arise from not treating or transporting that person/patient, then go right ahead.

When your ass gets taken to court by a patient who now wants to sue or make waves because they collapsed an hour later after you assessed them and deemed them "not a patient" following an MVA, their signature on the document that releases you and your service from liability, which you failed to have signed, could be the only thing that proves they refused your services!

Remember that classic phrase...

If it isn't documented, it never happened.

If I sound rude, I apologize; but I can not believe that some EMT's would put themselves out there like that!

[mshow00]

The replies here really puzzle me.

In the hypothetical situation of an MVA with no injuries, what would the people with no injuries be refusing? Transport for no injuries? Is that implying that you, as the healthcare provider, are suggesting that these people be transported to an ER, even though they have no complaints?

In my system, a refusal means that the patient meets transport criteria and the patient should be transported to an ER. To obtain a refusal, we have to inform the patient of the possible consequences of refusing transport (for example, for neck pain we would warn them that if they have a spinal injury and refuse transport, they could become paralyzed and die), and by signing the refusal they acknowledge that they accept these possible consequences to refuse. I can't imagine doing a refusal on someone who has no complaints. What would I tell them the refusal means?

With few exceptions, anyone who denies injuries on an MVA is not a patient. They are a person involved in an MVA who isn't hurt and doesn't need EMS. There would have to be extenuating circumstances for me to assess someone who claims they aren't hurt and don't need an ambulance, and tell them that they need to go to the hospital.

Just a quick question: can you be definitively positive that your pt is not hurt? I mean just because at the scene they don't have any complaints does not mean that will be the case later(after they talk to a shark or not so nefariously the sympathetic nervous system starts to relax). In the case of them talking to a lawyer not only may they have a claim against the other driver, but you and your company are screwed. So where I am concerned the Pts with "no complaint" get the most thorough assessment and documentation I can do, and I make them sign.