Patient Refusing Treatment and Transport Policy

Occasionally, an ambulance may respond to a scene and be confronted with a patient who refuses to be transported to the hospital. There may also be times when a patient’s situation does not warrant transport. These guidelines are intended to assist the staff. Responding to the call, in determining how to deal with the situation.

Patients whose condition does not warrant transports

An example of the type of patient who would not warrant transport might be an individual who was involved in a minor motor vehicle accident to which the ambulance was dispatched.

q Briefly examine the scene for clues as to the potential for injury or illness.

q Question the patient as to his or her condition.

q Examine the patient. The exam should include, at a minimum, neurological status and vital signs. In a trauma situation, look for bleeding and check for pain that might indicate an underlying fracture.

q If the exam indicates a potential threat to the well being of the patient, strongly suggest to the patient that he or she allow the ambulance crew to transport him or her to the hospital for examination by a physician.

q Discuss the potential for complications with the patient and advise the patient to seek medical attention, either at the hospital or from their personal physician, at their earliest opportunity. If possible, include a responsible family member in the conversation and suggest that the family member monitor the patient for any evidence of distress.

q Have the patient sign a Refusal to Transport form. If the patient is a minor, have the form signed by a parent or guardian, if possible. The EMT who examined the patient should witness the signing.

q Thoroughly document, on an Ambulance Run Report, a description of the scene, the results of the patient exam, all information discussed with the patient, and any advice provided to family of the patient.

Patients whose condition warrants medical treatment but who refuse transport by ambulance

q Briefly examine the scene for clues as to the potential for serious injury or illness.

q Request that the patient allows a brief physical examination at the scene the exam should include, at a minimum, neurological status and vital signs. In a trauma situation, look for bleeding and check for pain that might indicate an underlying fracture.

q Advise the patient of the results of the exam and advise him or her of the potential for complications if not treated immediately.

q Strongly suggest that the patient accompany the ambulance to the hospital for examination and treatment by a physician.

q It the patient continues to refuse transport, consider if the patients condition warrants obtaining a court order for transport.

q Advise the patient to seek medical attention₁ either at the Emergency Department or with his or her personal physician.

q Have the patient sign a Refusal to Trans port form. If the patient is a minor, have the form signed by a parent or guardian_, if possible. The EMT who examined the patient should witness the signing.

q If the patient refuses to sign the form, the EMT who examined the patient should note on the form that the patient refused to sign, sign the form, and have a Law Enforcement Officer or member of the Fire/Rescue team sign as a witness.

q Thoroughly document, on an Ambulance Run Report, a description of the scene, the results of the patient exam, the fact that the patient refused to be transported, all information discussed with the patient, and any advice provided to family of the patient.

Patients who refuse transport, but whose condition warrants immediate and, if necessary, forcible transport to the hospital,

q Briefly examine the scene for clues as to the severity of the injury or illness.

q Request that the patient allow a brief physical exam at the scene. The exam should include, at a minimum, neurological status and vital signs. If the patient was involved in a trauma situation, look for bleeding and check for pain that might indicate an underlying fracture.

q Discuss the results of the exam with the patient, stressing the potential threats to the patients well being. Advise the patient that it is in his or her best interests that he or she accompanies the ambulance to the hospital for further treatment.

q Discuss the situation with Law Enforcement personnel and if warranted obtain a court order to transport the patient. If the patient poses a threat to the staff of the ambulance, Law Enforcement personnel can be asked to accompany the ambulance to the hospital.

q Do not physically restrain a patient unless it is necessary to protect the patient from him or herself, or to protect the ambulance staff.

q Thoroughly document all information about the scene, the physical and/or emotional condition and behavior of the patient that made transport necessary and efforts made to get the patient to allow him or herself to be transported. Also document all steps taken to obtain legal permission to transport against the patients will and the reasons for the use of physical restraints, if needed.