Homepage / Uncategorized / To Haul or Not to Haul - Should the Complexity of a Refusal Influence Transport?
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To Haul or Not to Haul – Should the Complexity of a Refusal Influence Transport?

Recently overheard was a conversation between 2 Paramedics, both proactive about their Profession, discussing a complicated patient.

It wasn’t the assessment that was complicated.

It wasn’t the indicated treatment, or lack thereof, that was complicated.

It was how they were going to document their findings and whether simply transporting would eliminate liability.

You know me, I had to get involved.

The patient had a syncopal episode onboard a flight of about 4 1/2 hours.  Meaning that for 3 1/2 hours the patient has been asymptomatic and “feels fine, I just fell asleep.”

Patient has in their possession prescription medications for a knee injury, an odor of alcohol (yes, they served her after her “episode”) but speaks in clear sentences and meets criteria to be able to make her own medical decisions.

Pretty straight forward refusal in 57 of 58 Counties in California, even for an EMT-B in many places.  Not us, we need a MD consult for the witnessed syncopal.  I know, 1969 called, they want their policy back.

Medic 1 isn’t comfortable documenting a witnessed syncopal with meds and ETOH on board on a refusal and recommends in the future talking the patient into hospital to “eliminate liability.”

When pressed to explain exactly how that happens Medic 1 was unable to do so, as many are.

When we complete our assessments and figure out which 35 year old box our patient fits into it is our duty as health care providers to also assess what is in the patient’s best interests moving forward.  We are no longer in a “Go, No Go” EMS world.  Uber and Lyft have replaced spotty taxi resources in most communities, meaning we can get someone to a clinic, MD or ER in a recorded fashion.  When appropriate.  Hence the assessment.

 

We are spoiled at my station because we have a MD staffed clinic most hours of most days and I can get a wheel chair to take someone there in under 10 minutes.  But expand that concept out and you have that ability as well.

It goes back to the patient having to prove to me they’re well enough to stay where they are, but where they are can now be moved.  Do you follow?

 

Imagine being able to document in your PCR your assessment findings, indications and treatments, establishing the patient’s ability to refuse, then the name, car description and destination of the person refusing transport.  I’ve done it often and goes to show we literally did everything we could.

“That’s just adding liability, Justin, transport is the only true way to avoid being sued.”

For what, exactly?

Imagine getting a phone call that the patient you talked into transport is challenging your clinical judgment that transport was necessary.  The Anchors never warned us of this did they?

Talking someone into the ED in an ambulance simply to make for what you think is easier documentation is misguided, dangerous and wrong.  All you’ve done is gone outside your mandate and introduced a new element into the liability matrix: coercion.

“He told me I needed to go and the Doctor said I didn’t!” is a complaint your billing department gets far more often than they’ll admit.

Stop making transport decisions based on how hard your head will hurt documenting the alternate.

Do the right thing, write down what you did, nothing can go wrong.

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4 Comments

  1. BH January 25, 2017 9:49 am

    Medic 1 is a perfect example of an EMT or Paramedic whose 1-hour legal lecture was read to him off the PowerPoint slides by another EMT or Paramedic with the same extensive legal education.

    I realize we can’t all be Kurt Varone, but we’ve failed our providers and have been for generations.

  2. Kodiak January 27, 2017 11:49 am

    As a new medic, upgrading in SF, this has been the most frustrating part. I’ve been on a huge rant about this to coworkers recently, so I’m glad you posted this! Nowhere else is it this difficult to release a pt who doesn’t need transport, leading to overcrowding of our EDs and medic to follow conditions almost every day. It’s simpler to convince patients to be transported then it is to call for a second medic and make base contact. So frustrating. And it’s perpetuated by the management of a certain gigantic private ambulance company.

  3. Deandra March 8, 2017 7:17 pm

    El autor de este post que practique más con el ejemplo y nos ponga un poco más de litaertura propia, sexual me refiero. Al respecto señalar que me gustaría poner en práctica la literatura sexual contigo, Rubén.

  4. Madge March 8, 2017 8:22 pm

    It’s good to get a fresh way of loinkog at it.

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