Thought provoking article in JEMS re: Patient refusals

[Dustdevil]

I do like the extrapolated conclusion of the piece, which is basically, a refusal should generate so much patient assessment and documentation work that it becomes no easier to no-ride them than it is to simply transport them. Since the rationale for medic initiated refusals is usually laziness, this takes the incentive out of no-riding people, and consequently, the no-ride ratio drops dramatically.

[UMSTUDENT]

UMSTUDENT I think you have too much anger to be in the field of Emergency Medicine.

Replace anger with common sense. Your comment is probably more warranted for the lawyers who find it necessary to sue every EMS provider out there. I love how our profession associates a little self-confidence in ones abilities as anger. Not everyone needs transported to the ER.

I also agree with Dust on the documentation issue. Document every single detail about that refusal. Refusals shouldn't be easy so much as they should be used to lessen the burden of the entire medical system.

[Ridryder 911]

Although I agree with most post, let's be realistic as well too. For those that actually have field experience also realize the stressors of the scene, getting the unit available for the next available call etc...

I will warn of potential dangers etc.. but to do an actual lung sounds, abdominal assessment on a lacerated hand ... no I don't and yes I will write deferred to patients c/c or briefly explain reason as such. There are too many times the person does not want you there.. or take their time, your presence or by any means mess with them. Touching or assessing them will either aggravate them or get me assaulted. Those who that do not understand what I am discussing, either has never worked in the field or dealt with people.

The same in ER, once the patient makes it known that he/she does not want care .. vital signs and warning of risks, ask if they would like to talk to physician etc.. then I gladly open the door for them or point the way.

It would be nice to live in a Utopia where everyone could be assessed, totally informed of all potential risks of every procedure, etc.. But realistically, there are 20 patients waiting for the single empty ER bed, and 2-3 calls waiting for that EMS unit. Again sure it would be nice to have a system that has so many trucks and so many beds it does not know what to do.... but, with the aging population this will never happen again.

Before all the rant ... we all can talk what we try to do.. and then what we really do.. Each time before you start and I.V. , you inform the patient all the risks.. i.e phlebitis, infection, pulmonary embolus,before starting the line ? Or when you administer oxygen you totally inform the risks as well.. (it is a drug) you really are supposed to.

So we are all human.. we try to improve on each call. So yes, proper documentation as usual to CYA and assess as much as possible .. I may discourage, but never refuse transport.

Be safe,

R/R 911

[mediccjh]

And what about those who need to go to the hospital, and adamantly refuse, even after you and a doctor tell them that you will die?

Wanna hear thoughts on this one. I sat on scene w/a gentleman Friday night CAO x 3, who adamantly refused, even though I kept telling him he would probably die.

Personally, if someone doesn't want to go to the hospital, it is their God-given right, even if I believe they will die if they don't go.

[Dustdevil]

I sat on scene w/a gentleman Friday night CAO x 3...

Just out of curiosity, which parameter was he not oriented to?

[Ace844]

Just out of curiosity, which parameter was he not oriented to?

He more than likely wasn't oriented to any of the three, thus the refusal... :!: :!: :?: :!: :arrow: :wink: :shock:...bet what followed sounded like this, "what do you mean I can't refuse becuase I been drinkin...well, Doom on you!! You can't make me do stuff!" (EMT) "Sir, you're intoxicated and sluuring your speech, your not cumpetent to refuse...err I mean competent..." Well, oh yeah!! I'm leaving!" (EMT) "Ok, if you insist, have a nice night! Be careful and try not to pass out on the sidewalk in plain view next time!!" :roll: :shock: 8)

out here,

ACE844

[fanbuffett]

You had 911 when you were a kid? :shock:

You're younger than I thought!

When I was a kid, if you had an emergency you had to saddle up and ride into town and find the sheriff.

AND WE LIKED IT!!!

Dust i am Glad someone made you smarta$$ of the forum. i enjoy your twisted since of humer

[fanbuffett]

I personally think if they call 911 they should go to the hospital in a ambo. But the reality is alot of people just want to be comforted and told everything is going to be alright. anytime I don't transport someone I explain the risk and that i am not a Doctor and only have limited resources, and have my partner explain also and if there are any family there i make sure that they hear that i say and even get them to witness on refusal. haven't been sued yet maybe i am just lucky are haven't not transported the right person.

I know it sucks sometimes but its the world we live in and we have to cover our butts

[mediccjh]

Just out of curiosity, which parameter was he not oriented to?

I always put 3 instead of 4. Conscious, Alert, Oriented x 3. Person, place, time/event.

[Dustdevil]

I always put 3 instead of 4. Conscious, Alert, Oriented x 3. Person, place, time/event.

So, if he is only oriented to person, place and time, but not event, what is that? x2½?