Save 1-2 million patients in 2009 ??

[akroeze]

Ok, I do not agree with having a supervisor overseeing my refusals. I always try and talk pt's into going to the ED, if they need to.

On that note. The last service I worked did have a slightly different refusal policy. Any refusal we did, we had to call a supervisor or dispatch on the radio. We would them switch over to an extra tac channel we had and we would give them a refusal report over the radio.

This was not asking for permission to refuse that pt and the supervisor never talked to the pt. All this was for was to have a recorded record of the report for liability reasons. The only reason we would call a supervisor is so they could acknowledge hearing the report clearly.

I had no problem with that system, as it did CYA. If a question came up, they could pull the tape on it.

Paperwork accomplishes that.

[Just Plain Ruff]

I don't understand this distrust of medics on scene. Having a supervisor come and verify that the patient isn't under any duress by the medic on scene for every refusal is just absurd.

Here's the conversation I see happening

"sorry sir but before we leave I have to have a supervisor respond to verify this refusal"

patient "How long will that take?"

medic "He's on the other side of the city, it will be about 20 minutes before he get's here"

patient "but I want to go to bed" or anything else they will say

medic "but I can't let you refuse until he verifies that your refusal hasn't been coerced by me"

patient "WTF!!!!!!!! they don't trust you enough" or "holy crap you can't just let me sign it and let me go"

medic "No sir, I'm sorry but you will have to wait"

patient "Don't they trust you enough to have me sign off???"

medic "no sir it's not that, it's a safeguard we have in place"

patient "they just don't trust you do they? Are you new or stupid or something"

medic "No sir, stupid is as stupid does but I don't like the policy any more than you seem to but rules are rules and we always have to follow the rules, and the rules state that you have to stay until the supervisor gets here"

patient "F that, I'm out of here, Edith, get the car, this guy wants to kidnap me and he's gonna kill me, get me out of here"

Medic "you can't go sir, you have to wait till the supervisor gets here"

patient "That's a bunch of crap, I'm out of here"

medic "Ok sir, have a nice night"

See where this stupid policy and advocation will lead. Dramatized for your edification but to have a supervisor verify that you are getting refusal that isn't coerced is just the dumbest idea out there. If your medics cannot be trusted to do this then that medic doesn't need to be taking care of patients.

No-one I know of (and I know many medics) have coerced a patient into signing a refusal. I say coerced because that's what is being implied by this entire topic. If any of us do coerce a patient in to not going to the hospital just to get back in service to get the next call then they should be fired - PERIOD It is not our place to force a refusal on anyone.

[HellsBells]

If someone complains, medic holds up said refusal form and says I did everything I could to try to get them to go. How do you discipline that, unless you have a witness for the patient, but even then it becomes patient's family's word against the medic, who has a refusal form ?

IF there is already a signed refusal form, why do you think that the word of a another "supervisor" who talked to the pt over the phone would hold any more weight?

In our service our refusal forms must also be signed by a competent family member or friend, I think that that is all the safeguard one needs.

[spenac]

Are you saying that in all of 2008, your service has not had a single patient death from someone who "refused" EMS transport ? And all I can do is use logic and reasoning as EMS is not required to report these incidents like hospitals are, so there are no "real statistics to use", but if you google phrases like

EMTs blamed for death

Paramedics blamed for death

EMS sued over patient death

You will see this is not an isolated problem, but in your heart you already know that, as everyone in this room has heard a story about a similar call in their region (if not their service).

None of my patients or my 4 services I have been actively involved(over 5 years time span) with have had patients that refused or we denied transport to die after we drove away. I live and work in small communitys so if someone died I would know. So thousands of patients no deaths as a result of using common sense to say no to transporting a patient or accepting a patients refusal.

Even if you factor a 1% mistake ratio most mistakes still would not result in death. Most would only lead to delay in care or wrong medicine with no long term adverse results. Even you figures based on deaths as result of hospital mistakes is less than 1% so what the hell are trying to claim now?

I can not believe this double posting obviously trolling topic has lasted so many pages. I can not believe I wasted my time responding.

[spenac]

I don't understand this distrust of medics on scene. Having a supervisor come and verify that the patient isn't under any duress by the medic on scene for every refusal is just absurd.

Here's the conversation I see happening

"sorry sir but before we leave I have to have a supervisor respond to verify this refusal"

patient "How long will that take?"

medic "He's on the other side of the city, it will be about 20 minutes before he get's here"

patient "but I want to go to bed" or anything else they will say

medic "but I can't let you refuse until he verifies that your refusal hasn't been coerced by me"

patient "WTF!!!!!!!! they don't trust you enough" or "holy crap you can't just let me sign it and let me go"

medic "No sir, I'm sorry but you will have to wait"

patient "Don't they trust you enough to have me sign off???"

medic "no sir it's not that, it's a safeguard we have in place"

patient "they just don't trust you do they? Are you new or stupid or something"

medic "No sir, stupid is as stupid does but I don't like the policy any more than you seem to but rules are rules and we always have to follow the rules, and the rules state that you have to stay until the supervisor gets here"

patient "F that, I'm out of here, Edith, get the car, this guy wants to kidnap me and he's gonna kill me, get me out of here"

Medic "you can't go sir, you have to wait till the supervisor gets here"

patient "That's a bunch of crap, I'm out of here"

medic "Ok sir, have a nice night"

See where this stupid policy and advocation will lead. Dramatized for your edification but to have a supervisor verify that you are getting refusal that isn't coerced is just the dumbest idea out there. If your medics cannot be trusted to do this then that medic doesn't need to be taking care of patients.

No-one I know of (and I know many medics) have coerced a patient into signing a refusal. I say coerced because that's what is being implied by this entire topic. If any of us do coerce a patient in to not going to the hospital just to get back in service to get the next call then they should be fired - PERIOD It is not our place to force a refusal on anyone.

Good illustration of the stupidity of proposed idiotic suggestion. In fact I would have to vote this entire topic as the stupidist idea of 2008.

I agree you should never force a refusal. If they do not need the ambulance deny them transport and write it up as a denial not a refusal. To force a refusal is fraud, be honest if they refuse they refuse, if you do not want to transport because they do not need transport write up a denial.

[fiznat]

I am talking about the patients that should go, but are told they will be ok to go by car, or go to their PCP the next day, and then they die.

What service outwardly allows this to even happen? Where I work there is no such thing as not advocating for transport to the hospital.

My general talk (even for the abusers) is to tell them "look, I am only trained to a certain degree and there are a lot of things that the hospital can check out that I cannot. I think it is in your best interest to go to the hospital with us because we can't tell right here and now how sick you really are. You need to be aware that refusing to go with us or going by other means is potentially very dangerous... etc etc" I have NEVER told a patient that they don't need to go the hospital (even I believe they dont) and I NEVER will. Its bad practice and it will get you into trouble. There are times where I may make the point in some other way, but what I say (and what I will document every time) is "I suggest that you come to the hospital with us, and not doing so is potentially dangerous."

Now, if a patient still wants to sign AMA after my little talk and they meet the other requirements (not a danger to themselves, mentally competent, of age, etc), that's fine by me and I would resent any requirement that I would have to obtain a supervisory permission first.

[brentoli]

I think everyone here has been with a patient who would not be convinced to take a ride in the ambulance, when they really needed it.

Are we now supposed to sit with these patients and blab their ears off until they go unconscious and then use implied consent?

Sorry if someone brought this up already, I just read the first page, and the unsupported facts and statistics annoyed me too much to read on.

[spenac]

I think everyone here has been with a patient who would not be convinced to take a ride in the ambulance, when they really needed it.

Are we now supposed to sit with these patients and blab their ears off until they go unconscious and then use implied consent?

Sorry if someone brought this up already, I just read the first page, and the unsupported facts and statistics annoyed me too much to read on.

Welcome back. Your right some patients that really need to go say no. Nothing we can legally do. Some people that do not need to go should be told no. We are not taxis and should not allow ourselves to be used as such.

[Just Plain Ruff]

And one more thing, the service I work for runs two als trucks. We do not have a supervisor on duty at night EVER.

Day shift does have a supervisor but it is the ED supervisor and they cannot leave.

To require that a supervisor get out to make sure that we little boys and girls who are entrusted to a 100K piece of ambulance truck, a 15k lifepack and a 7K cot cannot judge accordingly who needs to go to the ER and who doesn't and get that supervisors signature then I must be living in the dark ages.

To get someone out to my scene which may be 30 miles away is just a ludicrous thought. Factor in the snowstorm that we had overnight and the wrecks they worked and got refusals on, just puts everyone involved in danger and makes scene times much longer.

How can you justify keeping a unit out of service until the supervisor get's there? You have a unit that is available technically (only waiting for a supervisor) and that unit is closest to a MI or a trauma and they have to send another ambulance to run the call will never never never stand up in court.

don't make me get my script pad out again to demonstrate the absurdity of that thought process.

[brentoli]

I tried to read through this thread again. I couldn't do it.

How can you bring up all of these numbers.... 99% this.... 5% this... 1,000,000 that. $5 here, $50,000 there....

WITH OUT CITING ANY SOURCES?