Signed refusal, or no EMS?

[sevenball]

Capman,

My apologies, when I said "upon your assessment" I meant the assessment of the situation, not the patient. What I should have said was upon your assessment of the scene, and further interviewing the individuals involved, all people claim no injuries, not requesting your services. It's my belief that if you document it as such, there is no liability in that.

That being said, I stated before that my particular service shows some leniency in situations like this, but would like to see a refusal signed for every contact. I agree with an earlier post that if you play this game, then you best know beyond a shodow of a doubt, that there is no injuries for sure. In that, I mean the tiny fender bender, all parties ambulatory, clearly no problems. Obviously, if there is any significant mechanism involved, or if something just doesn't settle with you, you want to cover yourself.

[JakeEMTP]

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

Welcome to the City.

How can you document canceled call when you checked on scene, made patient contact and made some sort of assessment? We have the ePCR and under treatment there is "No treatment required" option. I believe some sort of documentation like that would be more appropriate. I have them sign a " No Transport form" which is a paper form requiring their name and age. There is certain criteria that has to be met, but for the most part, it is painless and takes just a few minutes to complete. Then I can enter it into the toughbook at a later time allowing us to clear the seen asap and the individual/individual's to carry on their collective way.

[Flasurfbum]

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.

Not trying to split hairs, but someone called 911, who was not that "pt', and they want nothing to do with transport. But since you asked them how they feel, they are your pt, and they need a PCR filled out?

So when you are on duty, and ask the clerk at the store how they feel, you need a PCR for them too?

We are relying on the word of a probably non medically trained provider to asses our pt (the 911 caller who saw someone take a blow after cutting their lawn, and calls in a poss MI)

A call of "no patient found, in service returning to quarters", would be appropiate in that instance.

As for a multi "pt" refusal, have your company make up a multi patient refusal form.

[dougd]

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.

I belong to an organization that does a lot of event coverage (It's actually what led to me becoming an EMT). Our policies are exactly along those lines. If you're handing out a bandaid no report is required, but if you're assessing the patient you should be documenting your findings in a run report.

As usual, common sense should dictate, but it isn't all that common, is it?

[sevenball]

We might be getting away from the original question. I think we all agree that to avoid litigation, we should be obtaining signed refusals. My question was, do YOU think it's right if there are no injuries. Not so much "do you think you should document the call?" or "to CYA, should you get a refusal?", but, do you believe that you should have to get a signature if the patient does not have any complaints. Documentation aside, what is your person feelings on the matter. If your service told you tomorrow that it is completely up to you if you want to obtain signatures for refusals, as long as there are no injuries, would you?

[mshow00]

We might be getting away from the original question. I think we all agree that to avoid litigation, we should be obtaining signed refusals. My question was, do YOU think it's right if there are no injuries. Not so much "do you think you should document the call?" or "to CYA, should you get a refusal?", but, do you believe that you should have to get a signature if the patient does not have any complaints. Documentation aside, what is your person feelings on the matter. If your service told you tomorrow that it is completely up to you if you want to obtain signatures for refusals, as long as there are no injuries, would you?

Calling a tomato a potato does not change it. If my company came to me and told me my choice, guess what I will still do a PCR (we are stone age pen and paper) and a signed refusal. It only takes a few minutes to do (generally plenty of down time to complete it), and it will only serve to save my company and I from some sue happy "non-pt". I live in the sue captiol of the world. Aside from the legal stand point, if you don't spend at least a few seconds talking to the "non-pt" then how do you know if they truly are ok?

[PatrickW]

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.

Of course I can't be sure that there isn't anything wrong with them, but I can't thoroughly assess everyone that is involved with any call. How do I know that the family member of the full arrest I'm working isn't going to stroke out from the hypertension associated with the event? If they don't ask for us and they don't want us, I'm not going to sit there and do a detailed history and physical, including vital signs, and then suggest that they be taken to the hospital regardless of my findings.

I can't police the community for illness and injury, assessing everyone I come across or everyone involved in an event I'm called for.

If I get called to an MVA and a pedestrian jumped out of the way to avoid it, do I need to get a refusal from them if I ask them if they're ok? How about a school bus that brakes quickly, one patient complaining of neck pain. I have to obtain histories, physicals, and refusals from all the other children and their parents? That's ridiculous.

The 911 service I work for does have a transport policy, and we are able to treat and release some patients if they do not meet our transport criteria and both crew members are comfortable doing so. "You call, we haul" is ridiculous.

[PatrickW]

Calling a tomato a potato does not change it. If my company came to me and told me my choice, guess what I will still do a PCR (we are stone age pen and paper) and a signed refusal. It only takes a few minutes to do (generally plenty of down time to complete it), and it will only serve to save my company and I from some sue happy "non-pt". I live in the sue captiol of the world. Aside from the legal stand point, if you don't spend at least a few seconds talking to the "non-pt" then how do you know if they truly are ok?

How does a refusal only take a few minutes for you? Do you not take two sets of vital signs? Is the refusal you're obtaining just a signature, or is it an informed refusal following advising the patient of the risks involved with refusing (which I'm not sure what they are for someone who says they aren't hurt or ill and don't need EMS)?

[mshow00]

PatrickW, I am not talking about assessing everyone we cross on the streets, but if I am called to a scene I do a refusal save when the local FD/PD disregards me. Anytime I make Pt contact (talk to them) and they don't want to be transported (note I say nothing about treating) I fill out a refusal. Being totally honest, a refusal does not take all that much time. That's a pt interview, assessment, two sets of vitals, treatment (if needed), and education: knowledge needed to make an informed decision. Those are the people I am talking about.

Since you brought it up: "How do I know that the family member of the full arrest I'm working isn't going to stroke out from the hypertension associated with the event?"

you don't. But according to any of our textbooks (and my personal ethics/morals) they are our pt too(regardless of the current condition). I suppose that is a personal call.

"I can't police the community for illness and injury, assessing everyone I come across or everyone involved in an event I'm called for. "-PatrickW

Neither do I, not the witnesses, not the by-standers. But the people involved yes I do. Again CYA, how do you know they won't have some pain later? How do you know that they won't go home and get hurt and blame it on the call you did not document? How do you know they won't talk to some slime ball lawyer (or even a damn good lawyer)? Then what? if they push it your career is over. They have you for neglect and abandonment. You were called to the scene for them, and you did not treat them in any way. Your word vs their's, they are hurt and you have money(at least your company does). It was nice to know you.

"If I get called to an MVA and a pedestrian jumped out of the way to avoid it, do I need to get a refusal from them if I ask them if they're ok? How about a school bus that brakes quickly, one patient complaining of neck pain. I have to obtain histories, physicals, and refusals from all the other children and their parents? That's ridiculous. " -PatrickW

Ridiculous or not, the point is if you are required to get them do, if its your choice then its your choice. I would do it. Bottom line. No harm can come from me doing it. So it takes time to do an entire school bus full of kids. So what. Lame lame lame excuse. Not to be offensive here, but it sounds like you are just lazy.

"The 911 service I work for does have a transport policy, and we are able to treat and release some patients if they do not meet our transport criteria and both crew members are comfortable doing so. "You call, we haul" is ridiculous."-PatrickW

With that we are in TOTAL agreement. I don't transport everyone, but I do get refusals on them. If there is a difference in opinion between "us" and "them", well thats what medical control is for.

[PatrickW]

PatrickW, I am not talking about assessing everyone we cross on the streets, but if I am called to a scene I do a refusal save when the local FD/PD disregards me. Anytime I make Pt contact (talk to them) and they don't want to be transported (note I say nothing about treating) I fill out a refusal. Being totally honest, a refusal does not take all that much time. That's a pt interview, assessment, two sets of vitals, treatment (if needed), and education: knowledge needed to make an informed decision. Those are the people I am talking about.

What does your physical assessment involve if the pt has no complaints? Detailed head to toe? What do you tell them the risks of refusing transport are for someone with no complaints? What do you tell them when they ask why you, the healthcare provider, think they should let you transport them?

Since you brought it up: "How do I know that the family member of the full arrest I'm working isn't going to stroke out from the hypertension associated with the event?"

you don't. But according to any of our textbooks (and my personal ethics/morals) they are our pt too(regardless of the current condition). I suppose that is a personal call.

Since they are a pt, what does your treatment and transport of them usually consist of? Do you call for a second ambulance while you work the full arrest?

I agree they need emotional support, however if they do not have a medical complaint or ask for EMS for themselves we aren't going to transport them as a patient.

"I can't police the community for illness and injury, assessing everyone I come across or everyone involved in an event I'm called for. "-PatrickW

Neither do I, not the witnesses, not the by-standers. But the people involved yes I do. Again CYA, how do you know they won't have some pain later? How do you know that they won't go home and get hurt and blame it on the call you did not document? How do you know they won't talk to some slime ball lawyer (or even a damn good lawyer)? Then what? if they push it your career is over. They have you for neglect and abandonment. You were called to the scene for them, and you did not treat them in any way. Your word vs their's, they are hurt and you have money(at least your company does). It was nice to know you.

I don't know that they won't have pain later, and I don't know that they won't contact some lawyer. What I do know is that the person did not request EMS or want EMS, they claimed that they did not need EMS because they were not injured, and I will document that. Is there some case that you can cite where leaving someone with no apparent injury who stated they don't need EMS was considered abandonment, or are you just trying to use scare tactics?

"If I get called to an MVA and a pedestrian jumped out of the way to avoid it, do I need to get a refusal from them if I ask them if they're ok? How about a school bus that brakes quickly, one patient complaining of neck pain. I have to obtain histories, physicals, and refusals from all the other children and their parents? That's ridiculous. " -PatrickW

Ridiculous or not, the point is if you are required to get them do, if its your choice then its your choice. I would do it. Bottom line. No harm can come from me doing it. So it takes time to do an entire school bus full of kids. So what. Lame lame lame excuse. Not to be offensive here, but it sounds like you are just lazy.

I don't know about your system, but taking a truck (or however many it would take to do a whole school bus full of kids) puts a major strain on the entire system and delays response times for true emergencies from people who want EMS. Yes, there is harm done.