EMS based refusal of transport

[spenac]

Not totally true. There have been several interpretations of EMTALA which have be applied to various state laws. This not only includes transport but also who has the ability to a screening exam. The ownership of the ambulance must also be taken into consideration and whether the patient is on hospital property. Thus, a blanket statment can not accurately be made for all situations.

Here is an example of one opinion that allows it under direct medical control.

http://www.ag.state.nd.us/opinions/2001/Formal/01-f-06.pdf

House Bill 1282 therefore permits an ambulance service to refuse to transport an individual

to a hospital only after it has been determined by a physician who is providing direct

medical control that the transportation of the individual to a hospital is not medically

necessary. This implies that the individual desiring transport must be examined by the

ambulance crew and a physician must be consulted before the individual is refused

transport.

Vent what you provided still does not say an EMS crew can not deny transport. Yes the one you reference requires crew to contact a doctor but still allows denying transport. I have yet to see any federal or state law that says every caller must be transported.

[VentMedic]

Vent what you provided still does not say an EMS crew can not deny transport. Yes the one you reference requires crew to contact a doctor but still allows denying transport. I have yet to see any federal or state law that says every caller must be transported.

The EMS crew can NOT deny transport. Only a physician can deny transport according to this opinion in this state. Thus, any EMS protocols will be written as such.

[spenac]

The EMS crew can NOT deny transport. Only a physician can deny transport according to this opinion in this state. Thus, any EMS protocols will be written as such.

Sorry but they still do not transport. The crew calls doc, doc agrees that stubbed toe can wait till next day for office visit and the EMS crew then informs caller they will not be transported. So EMS is not denied the right to deny. lol. But as you and I have agreed before many in EMS have no business in EMS much less deciding who really needs an ambulance transport.

[CBEMT]

Occasionally, at my 911 job we will arrange private ambulance transportation for 911 callers whose medical complaint should be evaluated at an ER, and should probably (cya, basically) be transported by ambulance, but who we feel do not require emergency transport. We stay with the patient until the private crew arrives, and provide them with a complete oral report; by the time they get there I can usually get the written done as well. They sign my report as having received the patient, and get the carbon copy to refer to and transfer with the patient.

Edited May 16, 2009 by CBEMT

[Kiwiology]

From our protocol/SOP

[Ambulance Officers] are to conduct an appropriate examination of all patients who have a medical or injury related complaint, which will include, gathering a history and a physical examination, unless refused by the patient ...

Whenever personnel are called to

a patient they must make three decisions:

1. Is treatment required?

2. Is transport to a medical facility required?

3. If transport is required, what form of transport is most appropriate?

...Obligations of personnel

Personnel must convey these decisions to the patient, as firm recommendations, along with an explanation of any benefits, risks and alternatives.When making decisions and conveying recommendations, personnel must always:

• Fully assess the patient, including their competency, taking into

account all available information.

• Act in the patient’s best interest.

• Allow competent patients to decline recommendations.

• Insist on treatment and/or transport if it is in the best interest of an incompetent patient.

• Fully document their assessment, interventions, recommendations and interactions.

• Contact [the emergency department] for advice if the situation is difficult.

...There are some situations where a treatment or significant intervention can be administered and then a recommendation made that transport not occur. They are restricted to the following:

• [The emergency department] has been directly consulted with (at the time and by personnel dealing with the patient) and has decided that transport is not required.The name and contact details of the [ED] doctor must be recorded on the PRF.

• Paracetamol for minor discomfort, uncomplicated hypoglycaemia or epilepsy, and palliative care patients. Details are in the relevant sections.

...When the patient or family insist on transport

Competent patients have the right to decline recommendations, but patients and families do not have the right to insist on transport that personnel do not think is clinically indicated.

If the insistence of the patient or family appears to be based upon genuine concern, and no other reasonable transport option is available, then the patient should be transported. If the insistence of the patient or family appears to be based on maliciousness, convenience or petty concerns, then personnel may decline to transport the patient provided they:

• Continue to treat the patient and family in a polite manner and

• Explain the reasons for not providing transport and

• Fully document their involvement with the patient and family

...Comprehensive documentation must occur and include:

• Details of patient assessment and findings.

• An assessment of the patient’s competence.

• All treatment and interventions provided.

• What was recommended and the reasons why.

• A summary of what was said to the patient and/or family.

• A summary of what the patient and/or family said.

If the patient is not transported then the front copy of the patient report form must be given to them.