Was it the right decision

[CBEMT]

I've had plenty of fully oriented patients who I considered too intoxicated to refuse, so I transported. It's about clinical judgment and decision-making.

[Dustdevil]

I've had plenty of fully oriented patients who I considered too intoxicated to refuse, so I transported. It's about clinical judgment and decision-making.

Another fine point!

[spenac]

Another fine point!

Wait a minute clinical judgement is kind of like common sense, we're not allowed to use it. Thats why we're all just TAXI Drivers. :twisted:

[captainstandup]

In terms of liability to a pre-hospital provider or service the only thing that trumps refusals is of course issues related to driving. With that said I have never taught students to become focused on liability as their sense of right and wrong in caring for another person. Start your day with the desire to use a combination of education, training, experience and clinical judgment to guide your actions. Our SOG's require the following to allow a person to refuse: 1)Conscious alert and oriented 2)No evidence of impairing substance 3)No injuries of a severity that could be classified as distracting ie: pain that could distract or alter a persons ability to comprehend the risks of refusal 4) Person is of legal age to refuse (18y/o) If we encounter situation where the childs life or quality of life could be at risk, we involve law enforcement and child protective services.

A signed refusal is only as good as the civil jurys sentiment toward a plaintiff with a claim against you, or even worse the family of a dead patient. A lot of folks treat the refusal as if were the holy grail that covers them in event of bad things, unfortunately this is a fools bet.

Its also important to note that this refusal occurred during a time when the EMT or Medics were due to get off shift. It would easily be perceived as though a crew didn't want to work over whether this is the case or not. Another thing that jury's look at is an EMT or Medic's "refusal rate" or how many refusals a particular provider does over time. Don't be mislead into thinking that HIPAA would protect you from them being able to look at other patient records as all they need is a court order.

The key to all this is to clearly follow your protocols / SOG's to the letter. Painstakingly document a THOROUGH patient assessment, establish the patients LOC in a manner other than "A/)X4". Instead state something like "Patient is fully conscious alert and oriented to date time person, place and is without evidence of impairing substance or distracting injury." Also note in the documentation that the risks of refusal were clearly explained to the patient and he/she states they understand and accept those risks. If possible under your SOG's call in on a recorded line or over the radio to include Medical Control in the documentation process and finally have someone other than your partner to sign the refusal form as a witness.

There are no guarantees in EMS but I can assure you if things go wrong with a refusal situation they (the agency, admin and perhaps the Md's) will throw you under the bus instantly!

[spenac]

A signed refusal is only as good as the civil jurys sentiment toward a plaintiff with a claim against you, or even worse the family of a dead patient. A lot of folks treat the refusal as if were the holy grail that covers them in event of bad things, unfortunately this is a fools bet.

How true. I actually see many that after getting the refusal will write a narrative that just says refusal form signed. I maybe give to much. I explain my multiple attempts to get them to go. I put in detail types of risks that were explained to the person. I try and put as much info to back why I determined them to be alert and oriented to make an educated refusal. Etc.

[steph1030]

for me it is always better to include a full report ...transport or refusal doeesnt matter

saves liability for you and your servic eetc

and just makes sense

wouldnt you want a thorough recored kept if it were you the report was about ?

[certguy]

I agree with the guy who talked about good documentation in addition to the refusal form . It's been a while since I've worked the field , but this is something that never changes . Good documentation can save yours and other people's backsides . I once had a product demonstrator for a large chain store who fell , did the classic arm lockup and shattered her humorus and upper shoulder . A year and a half later , I was called to our main station to give a deposition . I was met by a lawyer and a PI who aked me about the call . ( my partner on that one had left the company to join the navy ) I remembered some of the details . Then they produced copies of my paperwork and gave me a few minutes to refresh my memory before going on . As we talked , she claimed she slipped on spilled eggs in the dairy section on the OTHER side of the store . This place was huge and she was in so much pain , she could barely walk . We found her in the employees lounge on the second floor , at the base of the steps was a water fountain . There on the ems form , was the statement , " pt. states she slipped on some spilled water at the water fountain . " along with a description of where we found her . The lawyer thanked me and said they'd recontact if they needed me . They never did and I found out later from my manager she was trying to sue the company for a cool million . Apparently my documentation helped blo w her story out of the water . I always tried to document well , but especially if it was a crime scene or something like this that well coud involve a lawsuit .