Lazy RMA's

[NYCEMS9115]

RMAs (Refusal of Medical Assistance) are among the most time-consuming, labor-intensive calls in EMS. It is tempting for caregivers in busy systems to take shortcuts when encountering patients who do not wish to be transported.

     Bad idea, unless you are intrigued by your state's legal system.

     The three most important steps in processing an RMA are document, document and document. Documentation is important in all areas of EMS, but never more so than when you are advocating a prehospital course of action that contradicts the patient's preference.

     Two RMA scenarios to be avoided are allowing a patient to refuse transport without assuring and documenting his awareness of risks and alternatives; and enforcing transport against the patient's will, in spite of his acknowledgment of risks and alternatives. The former can lead to charges of abandonment, while the latter could be construed as false imprisonment.4

     According to a 1998 study, it is wise to involve a physician in the RMA process, not only because of his/her superior assessment skills, but also because it is more likely that a doctor will succeed in convincing a patient to seek definitive care.7 Many EMS systems make RMAs cooperative ventures between field personnel and physicians. Prehospital providers contact medical control if they are unable to convince sick or injured patients to allow transport by ambulance.

     There are medical consequences of sloppy RMAs, too. A 2002 study revealed that 32% of patients age 65 and older who refused transport were subsequently admitted to a hospital for the same or a related complaint.8 It makes sense to consider high-risk factors, such as age and medical history, in addition to the patient's presentation when con-fronted with an RMA.

http://www.emsworld.com/print/EMS-World/What-NOT-To-Do-in-EMS/1$6381