AMA question?

[Just Plain Ruff]

http://www.themissingprotocol.com/site/bookcorner.pdf

http://www.themissingprotocol.com/site/educational_program.htm

Yep that's it.

I think I actually gave away a copy from one of my infamous contests on emt city a while back. Note to self, I have to do another one soon.

That book taught me more than any medic class, documentation class etc. It tells you how to write a legally defensible report. I have never been to court as a defendant based on my reports. I have been asked to clarify soem points but never as a defendant in a malpractice or negligence case. I think this book helped me stay that way.

I recommend to get it.

[ERDoc]

The most important thing to remember is that this is the US, everyone has the right to sue anyone for anything. Should you be sued, you will NOT be judged by a jury of your peers but by a group of people that don't have the first clue about medicine/EMS. Laws vary from state to state but it is not enough to be A&OX3 or 4. A patient has to have the capacity to refuse care. This means that they must be able to understand what is wrong, what your (the provider) concers are and what the ramifications are of refusing treatment. A pateint who is mentally retarted may be A&OX3/4 but they may not have the capacity to understand the consequences of their decision and therefore cannot refuse care. Minors, regardless of their capacity, cannot refuse (there are some exceptions). Due to their age, they are assumed to not understand the consequences of their actions.

As others have stated, the best thing you can do is document. Document your history and physical. Document your discussion with the pt, being sure to include all of the risks that you have discussed with them. Document that you feel they have the capacity to make the decision to refuse care. Even then you will not totally eliminate you risk but you will minimize it. As I said in the beginning, this is America. If I can sue you for pouring hot coffee on myself then I can sue anyone for anything.

[CBEMT]

http://www.themissingprotocol.com/site/bookcorner.pdf

http://www.themissingprotocol.com/site/educational_program.htm

I ordered that book years ago. Never billed for it, never received it.

[zippyRN]

mental capacity and competence are the keys to whether any refusal / self discharge is valid.

If you are unsure about a patient's competency or capacity make it someone else's problem there and then , a supervisor, a police officer or the patient's primary care practitioner ( i.e. Doctor or Nurse Practitioner)... in most settings supervisors and/or the police are most easily accessed.

Partial refusals are an interesting issue , some people maintain they can't exist and it;s 'my way or the highway' ... an example there would by the patient who has mechanism for a potential spinal injury, and you can't / won't fulfill the criteria or a selective immobilisation guideline / aren't allowed use one ... but the patient is adamant they are not going on a long extrication board and do not want the 'cheese wedges' claiming they are claustrophobic...

the 'my way or the highway' camp would say they sign the refusal and don't get transported , the 'partial refusals exist' camp would collar the patient , place the patient careful on the trolley, use sandbags or rolled towels/ blankets to provide the 'reminder' immobilisation and document to hell and back ...

'young people' can be an interesting area to deal with i.e. teens under the age of majority - and it depends on what the law says where you are, for us in the UK it's the Fraser and Scarman rulings in the Gillick case ...

http://en.wikipedia.org/wiki/Gillick_competence

also the stuff around the concept of the 'emancipated minor' and whether it requires a legal course of action to establish the young person as legal competent or whether like the gillick case, competence can be determined 'on the fly'by the practitioner...