Signed refusal, or no EMS?

[Don1977]

Here's a situation for everyone to ponder. You are called to the scene of a MVC. Upon your arrival you find multiple patients all ambulatory and in no apparent distress. Upon your assessment, each individual states that they are unijured and wish no treatment or transport. If you continue to question them as to the nature of injury, for example, you state "You're uninjured, no pain, cuts, scrapes, bumps, bruises, nicks or stiffness?" If they state no to all questions, should you obtain a refusal of care and transport, or should you not classify them as a patient, and document as "no ems needed"?

Refusals.........

[CBEMT]

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)?

So it is your assertion that someone who says they are not injured and does not want my services needs a full-body trauma survey and two sets of vitals? I can see it now...

"Is anyone hurt?"

"No thanks, we're fine, we're just waiting for the police."

"Sorry, but I made it to the scene without being canceled, so that means I need to feel both of you up for injuries and take your vitals right now and then again in a few minutes. I'll also need all of your personal information like address and phone number, medical history, medications, and allergies. Then I need you to sign this form."

"Dude, I told you. We don't need you."

"Sorry, but my EMS instructor, who has no legal education other than the one he got from his EMS instructor who has no legal education, told me that you might try to sue me later. Now if you'll just hold still..."

NOW you're talking a lawsuit, but one that YOU created by sacrificing your common sense on the alter of legal hysteria.

Not to mention the people who actually NEED an ambulance and aren't getting one because you're doing a half-dozen or more sets of vitals and paperwork on the side of the road off of people who didn't want you in the first place.

[Just Plain Ruff]

Patrick, take this from someone who has put their foot in their mouth several times here on this board, just quit while you are ahead right now.

If you expect me or anyone of us to get two sets of vitals and a full trauma assessment on a patietn that says they are not hurt then you have more issues to get over.

If a patient says I'm not hurt, I turn the report over, have them sign a refusal, and then write it up the way I found it.

[zippyRN]

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.

the issue arises as thereis apresumption in a 999/911 orientated system that people ring because they either 1. ) need or 2.)want to be transported to the ED. Event cover is a whole different kettle of fish as people attend for stuff they simply would not call an ambulance for outside and of course depending on the event there's a far higher rate of certain presentations ...

e.g. trips and falls on uneven ground , burns and scalds where peopel are camping and /or having informal barbeques on a site , plus the high levle of alcohol and illicit drug use at music festivals / concerts ... there is also a particular pattern of presentation at stadium sporting events in the UK.

[Cookie]

We just had such an incident, and driver said she was ok, paramedic checked her out and she refused, stated she was fine and wanted to continue on to her destination. Refusal explained, twice, signed by driver, witness: paramedic and deputy Sheriff who also explained refusal to her. Whenever we have a refusal of treatment or whatever, and its an accident, we have the deputy or highway patrol do the witnessing.

[Capman]

We just had such an incident, and driver said she was ok, paramedic checked her out and she refused, stated she was fine and wanted to continue on to her destination. Refusal explained, twice, signed by driver, witness: paramedic and deputy Sheriff who also explained refusal to her. Whenever we have a refusal of treatment or whatever, and its an accident, we have the deputy or highway patrol do the witnessing.

Very smart Cookie, any other way would be leaving yourself wide open for a shark bite! :wink:

[CBEMT]

the issue arises as thereis apresumption in a 999/911 orientated system that people ring because they either 1. ) need or 2.)want to be transported to the ED.

I find that in the case of auto accidents, quite often it's someone not involved at all that does the calling. Half the time the people who ARE involved are just exchanging information, MAYBE one of them called 911 and asked for the POLICE so as to make a report. It's the cellphone busybody that called in, reported an accident, and some dispatcher rolls Fire and/or EMS.

So no. Just because you are dispatched to an incident doesn't mean that anyone there wants you.

[sevenball]

For those of you who believe that we should be getting refusals from all pt. contacts:

Should the same apply when you onsite an accident and the occupants tell you there are no injuries?

Remeber this as well, in order to get into trouble, their lawyer needs to prove that you were negligent. Now I won't bring you back to basic school, but we all know how hard that is. Not only that, but the majority of us roll with fire and police, who also will be able to recall that the accident was minor, and that all occupants waived all services but the police. That may also be a good backup plan.

That being said, nothing will EVER stop the foolishness that is the legal system. No matter what they sign, no matter what you've done, it is never enough. Some smarty pants will always accuse you of not explaining the risks and benefits good enough, and even if you documented well, some lawyer will always find a way to shoot a hole in your report.