AMA's and definition of a medical patient

[Sin City Medic]

I'm posting this topic after an argument with a supervisor at work over the nature of a call. Let me preface by describing the event.

We were dispatched to a MVA where by, in the initial dispatch and over the radio, the dispatcher stated that there is no patient but that they needed a "refusal". We arrived on scene to find just that. The subject was sitting on a set of stairs near a side walk with 4 FD personel standing next to him with their hands in their pockets. Upon our arrival and subsaquent conversation, the subject stated he advised the on scene FD that he was fine and didn't want an ambulance called. His vehicle had very, and I do mean very, minor vehicle damage. Vehicle speed was so slow that, while impacting the front of his vehicle, his airbag did not deploy. No starring on the windshield and the subject stated he was wearing a seatbelt and denied any LOC. He advised me that he didn't want to be assessed or vitals taken. I spoke with the on scene fire department EMT who advised me that they needed me to complete a refusal on the patient.

I don't like doing AMA's because I am of the belief that if someone calls me, they should probably be transported because they felt it was bad enough to call 911. That being said when I do an AMA I make darn sure to cover my butt! The point I made during this argument with my supervisor is over the definition of a medical patient.

This individual had ZERO complaint, didn't want us to be called, and was irritated when we actually showed up. My supervisor stated that this is how things are done. Obviously that's not logical answer! I made mention to the fact that the MOI was minor if there was any at all and that the individual specifically instructed FD not to call us. I'm new to the area and from the sounds of it, this city uses the ambulance company to refuse EVERYONE regardless of complaint for shift of liability reasons. In my opinion that is ridiclious! Am I wrong, what are you thoughts on the matter?

BTW I know what my screen name says, I'm no longer in Las Vegas. I currently live and work in the NorthEast.

Edited March 25, 2010 by Sin City Medic

[Kiwiology]

Dude WTF so why were you even called? If this guy told the Fire Department he didn't want medical help then why call you guys? If the EMT/Firefighter needs a refusal why not get one himself?

I agree with you it's pretty weird and think your supervisors logic is pretty fubar.

[HERBIE1]

Why couldn't the FFEMT obtain a refusal here? Are they not allowed? This makes no sense.

A patient is considered to be anyone you make contact with, even if they have no complaints. As for not wanting EMS, I understand how that works. Often times at accidents, police are afraid of liability and call for us even if a person claims they are not injured and do not want medical evaluation. Obviously if it's a very minor incident- dented bumper, scratched paint, etc, then the LEO's probably wouldn't insist on an EMS response, but if it's a more significant incident, the cops are simply CYA.

I've tried to explain to cops that once called, we need to evaluate, examine, and document a patient encounter. Simply eyeballing them is not acceptable.

[tcripp]

One thing about it, that makes me appreciate the service in the area in which I live. Our first responders, as credentialed by the service (this includes ESD and CFOs), can by all means cancel the ambulance and get the refusal. If we have a multi-car pile up, this works really well in a triage situation. The 911 crews can focus on serious injuries and the first responders can take care of the rest.

Very much a team approach to patient care.

[Kaisu]

Run into the same problem... on the way back to the station after a call, we came upon an accident scene. No one called 911 but we stopped to see if everyone was OK. They were, no patients on the scene.

Our supervisor said everyone in a vehicle that was hit needs to sign a refusal. It's dumb but that's the way we roll. Either first responder's or ours will do.

[Lone Star]

I'm posting this topic after an argument with a supervisor at work over the nature of a call. Let me preface by describing the event.

We were dispatched to a MVA where by, in the initial dispatch and over the radio, the dispatcher stated that there is no patient but that they needed a "refusal". We arrived on scene to find just that. The subject was sitting on a set of stairs near a side walk with 4 FD personnel standing next to him with their hands in their pockets. Upon our arrival and subsequent conversation, the subject stated he advised the on scene FD that he was fine and didn't want an ambulance called. His vehicle had very, and I do mean very, minor vehicle damage. Vehicle speed was so slow that, while impacting the front of his vehicle, his airbag did not deploy. No starring on the windshield and the subject stated he was wearing a seatbelt and denied any LOC. He advised me that he didn't want to be assessed or vitals taken. I spoke with the on scene fire department EMT who advised me that they needed me to complete a refusal on the patient.

I don't like doing AMA's because I am of the belief that if someone calls me, they should probably be transported because they felt it was bad enough to call 911. That being said when I do an AMA I make darn sure to cover my butt! The point I made during this argument with my supervisor is over the definition of a medical patient.

This individual had ZERO complaint, didn't want us to be called, and was irritated when we actually showed up. My supervisor stated that this is how things are done. Obviously that's not logical answer! I made mention to the fact that the MOI was minor if there was any at all and that the individual specifically instructed FD not to call us. I'm new to the area and from the sounds of it, this city uses the ambulance company to refuse EVERYONE regardless of complaint for shift of liability reasons. In my opinion that is ridiculous! Am I wrong, what are you thoughts on the matter?

BTW I know what my screen name says, I'm no longer in Las Vegas. I currently live and work in the NorthEast.

First off, AMA stands for 'Against Medical Advice', whereas what would apply here is 'RMA'; or Refused Medical Attention'.

Second, is the Fire Department a 'first responder department', meaning that they respond to medical emergencies without requiring EMS to be called?

If not, then having EMS obtain a signed RMA form isn't necessarily 'shifting liability' as protecting everyone’s backside in the event that the patient decides later that there may be a few thousand dollars in filing a lawsuit claiming that they didn't receive medical treatment when it might have been needed. If they ARE a ‘first responder department’, then there is no reason that they can’t obtain the required RMA on their own.

Most calls can be broken down into either ‘trauma’ or ‘medical’, with some of those calls covering both criteria.

Trauma is obviously defined as:

1. A serious injury or shock to the body, as from violence or an accident.

2. An emotional wound or shock that creates substantial, lasting damage to the psychological development of a person, often leading to neurosis.

3. An event or situation that causes great distress and disruption.

Medical calls would fall outside of this broad definition.

Some calls will fall into both areas, (i.e.: an MVA caused by a diabetic emergency, cardiac event or seizure).

I don't like doing AMA's because I am of the belief that if someone calls me, they should probably be transported because they felt it was bad enough to call 911.

Remember, it wasn’t the patient in this case that called EMS. Even in the event that it WAS the patient that called for an ambulance, they ultimately have the right to refuse medical treatment for whatever reason they feel. As long as they meet the criteria to be able to legally refuse treatment, there is really nothing you can do. Of course, if you feel that in your medical opinion that they really need to see a doctor, then you have the obligation to try to get them to go to the hospital.

The patient has to meet certain criteria to be able to refuse treatment, and you have certain requirements to validate the RMA process.

[zzyzx]

You didn't do anything wrong. However, if the fire department is stupidly insisting on an AMA, why not just do one and make everyone happy? And if the patient refuses to sign one or be evaluated, just write one up anyway and document what happened.

[Richard B the EMT]

So it takes a few minutes to fill out the call report. I have written up some indicating the patient was not the one made the call for an ambulance, and declined to give us their name or address, and wanted nothing to do with EMS. I put it into the call report comments, that the patient declared not wanting to have anything to do with us. Usually, this is accompanied by action and then our record, "...,then, the patient left the scene on their own, to unknown destination(s)".

[Dustdevil]

I spoke with the on scene fire department EMT who advised me that they needed me to complete a refusal on the patient.

Who gives a flying F what they need? If they need it, they need to get it. If they aren't competent to do so, then why are they responding to these incidents in the first place?

Letting nonsense like this go without protest just feeds their already overblown egos. Time to draw the line. Not that I expect your employer to do so. Few have the guts to speak up.

[Richard B the EMT]

I think I need a clarification here. Was the initial agency a non transporting agency, as opposed to the OP's agency, which does transport? If I am the first EMS BLS, and transfer the care to an ALS, also on scene, my paperwork indicates any and all care, or attempt at such, was transferred to the ALS crew.

Or did I miss something else in the translation, here?