AMA's and definition of a medical patient

[uglyEMT]

Richard sounds like the initial pt contact was by FD. FD EMT asked for the refusal. Seems as though their FD EMTs dont complete PCRs or transport.

Dont know where the OP is from but I know in my neck of the woods FD will always call BLS for any MVA regardless of pt wishes. Not that big of a deal to go out, check the pt, RMA if OK.

Perfect example...

Low speed MVA, no airbag deployment. Pt sitting on the car hood upon our arrival. Stating quiet angerly why were we called, its nothing, blah blah blah. My partner goes over to the patient for a quick once over and imediatly calls me to come over. Points at pts ear, fluid seeping out. Long story short pt had closed skull fracture from a bar fight. MVA had nothing to do with injuries, but the injures caused the MVA. Never hurts to check, no matter how minor the MVA.

Another example of low speed...

My father!! Backing out of the driveway another car comes around the corner and he backs into the other car. No damage to my father's vehicle except some paint transfer, other car had a dent in the door. I run over to see what happened and my father is slouched over in the driver seat saying he can feel anything. I call 911 and while waiting the other guy starts screaming about how my Dad is just trying to get a claim out of him. Make a long story short, Dad damaged the spinal cord at C3,C4,C5 and has been in a wheelchair for the past 5 years as a near quadraplegic. If I didn't witness the accident I would never have believed such an injury can happen at such a low speed.

Edited April 18, 2010 by UGLyEMT

[Lone Star]

My father was in a backbrace for almost a year because he picked up a paperclip. Yeah, it doesn't take much sometimes to injure the spinal cord.

From what I gathered from the original post, it seems that the patient was CAO x 4, and refused medical attention.

That being said, if the patient was unaffected by drugs, alcohol or was not mentally competent; there's not much we can do if they refuse to be treated.

What I'm having a hard time understanding (as is a few others), is why the transporting crew was responsible for obtaining an RMA, when the Fire Department first responders were the ones to initiate patient contact. To me, it sounds like a bad case of "Me too lazy".

[tcripp]

What I'm having a hard time understanding (as is a few others), is why the transporting crew was responsible for obtaining an RMA, when the Fire Department first responders were the ones to initiate patient contact. To me, it sounds like a bad case of "Me too lazy".

So, just thinking out loud here...but is it possible that this FD first responding unit isn't cleared to accept the refusal if the 911 service has been activated? I am aware of that being the case in other areas up to and including not being able to downgrade a call from code 3 to code 1.

[Richard B the EMT]

What I'm having a hard time understanding (as is a few others), is why the transporting crew was responsible for obtaining an RMA, when the Fire Department first responders were the ones to initiate patient contact. To me, it sounds like a bad case of "Me too lazy".

Not necessarily so. Their management may have written the protocols for them, indicating the need for "higher medical authority", I.E. an ambulance crew's EMTs over their own First Responders, for treat/transport decisions. Therefore, it is NOT lazy Fire Fighters, but "allergic to litigation" chiefs of department, writing protocols that field folk like us EMTs and Paramedics, as well as the Fire Fighters, have to follow.

[speedygodzilla]

Every contact is a patient. Many here have had the same argument here where I work. To help the crews with this we have multi contact forms for multiple noninjury patients without a complaint. But we still have to fill out refusals for single pt incidents or my toe hurts etc.

I see both sides of the argument but would rather be safe than sorry. What if you are called to court 5 years down the road on this call. CYA

Where I work the fire dept. does not fill out any sort of patient care report including refusals. Just the way it is.