Ethical Question: Refusals versus Not Needed

[spenac]

but if that fractured toe throws a marrow emboli to the lungs and the patient dies, what happens then? hey it could happen.

LOL. More likely we load up stub toe and get in a wreck and stub toe dies from wreck than that. Then instead of 1 lawsuit there are many.

Also crotch if patient decides they do not want to go their signing a refusal is not unethical. They decided. Now if we deny transport then need different statement signed.

[stcommodore]

Real life case...

Called for an "assault" and find a 30's female who had a few minor abrasions on her hands from getting in a fight with a roomate and being cut by a glass bottle. Patient had no active bleeding, and no real emergency condition. Police on scene have the roomate, and somehow ems was called into the situation.

I say "you really don't need to go to the hospital for a few cuts on your hand"

and she says "but I'm a diabetic and I'm afraid I'm gonna fall out if I take my medicine"

me "do you fall out everyday you take your medication?"

"no..." her

me "then your not going to fall out today"

her "well I'm feeling dizzy now"

me "fine, lets go"

Did this patient need to go to the hospital?

We have no offical "ems refuses transport" but the loop hool would have been to call this call "handled by police" or "no services needed" and for better or worse that would have been the end of it.

[crazyemt5150]

Where I work we can not legally tell a pt, that they do not need to go to the hospital and or need an ambulance, If they ask us if they need to go, In our professional medical opinion we think they should go. If they say I will just go to my doctor we say ok. But we will have them sign an ama form. They called for a reason there for something is wrong. I have rarely ran into calls were they don't have a complaint, and if they don't we will just cancel as no medical aid needed

[crotchitymedic1986]

Just to clarify crazy: You respond to a construction site where a worker has accidentally shot a staple into his index finger. Bleeding is under control, and all vitals are stable, he will probably need a tetanus shot, but no stitches. You are on an ALS ambulance. Do you transport him or not ? If he is willing to let a coworker drive him to his doctor or local doc-in-a-box, do you tell him that he shouldnt and beg him to let you transport ? If not, do you still get him to sign AMA ?

[crazyemt5150]

Just to clarify crazy: You respond to a construction site where a worker has accidentally shot a staple into his index finger. Bleeding is under control, and all vitals are stable, he will probably need a tetanus shot, but no stitches. You are on an ALS ambulance. Do you transport him or not ? If he is willing to let a coworker drive him to his doctor or local doc-in-a-box, do you tell him that he shouldnt and beg him to let you transport ? If not, do you still get him to sign AMA ?

In that scenario, I would check everything out and if vitals are stable gcs of 15 , and he doesn't want us to take him to the hospital, I can't force him to go that's kidnapping. Since he is injured I would have him sign an ama, If he wanted to go with us, I wouldn't try to convince him not to go. Its easier just to transport and take whomever to the hospital that it is to convince someone not to go and have them sign an ama. You will have the same paperwork regardless

[Just Plain Ruff]

Our town police used to have a zero tolerance on ambulance abuse. Our service also used to have a zero tolerance.

I had a woman who called 911 for chest pain. When we got there she met us at the ambulance with her purse and she was made up like a 4 dollar you know who.

She refused any care, she just got in the ambulance and got on the cot.

We arrived at the hospital and took her in to the ER. She immediately got up and walked out. I followed her over across the street all the while having PD arrive. She walked in the local drinking establishment. The officers walked in behind her, cuffed her and arrested her for 911 abuse.

She went to jail.

plain and simple as that, abuse 911, go directly to jail.

[CBEMT]

but if that fractured toe throws a marrow emboli to the lungs and the patient dies, what happens then? hey it could happen.

Oh. My. God.

[Just Plain Ruff]

I hope you saw the sarcasm in that post CB

[CBEMT]

I hope you saw the sarcasm in that post CB

............And fail. :oops:

[Just Plain Ruff]

are you in a bad mood CB?