Homepage / Uncategorized / To Haul or Not to Haul - Should the Complexity of a Refusal Influence Transport?
Happy 2018, Y’all! CHP Officer Andrew Camilleri’s Family on the first day back at school Patient – Defined. Wrong, but defined. Merry Christmas from #TCS! Three Discipline Sponsors – Kosher or Corruption? Has Video Killed the Radio Star?! Dispatch centers tracking the wrong things? Does your confidence exceed your abilities around the homestead? This post is about fentanyl so you shouldn’t read it, you’ll OD Off-duty: Intervene or Be a Witness? Mass Shootings in a Small Town: What are Your Resources? #TapTapTime: The Latest Trending Topic Police Responsible for Ambulance Bills on College Campus? The Spooktacular Episode “I’m out of ideas” Advanced Airway Seminar HM on Medic 2 Medic Podcast Respond to the Rollover – Tales from the Interwebs Hazards we can most certainly remove Witty Banter with the Unaware – Volume 3324 the Crossover Ep 125 – Who Gives Two Sh*ts Why Giving Two Shits About a Patient is Not a Bad Thing the Crossover Episode 122 – Annual Kilted Show! Things keep getting worse for Cop who likes arresting Nurses My Beautiful Blue Eyes The Seizure Patient 500 – An EMS Race Crossover Podcast – Ep 116 – That’s Not Why we Have Cameras, Gary …for the head injury, PD on scene Crossover Podcast ep 113 – Middletown Ohio or Deathville USA? the Crossover Ep 112 – Are you a good hair boss or a bad hair boss? Stop Responding for Overdoses? Sign Me Up! Yup. Still Barfing I Heard You, She Heard You, the Baby Heard You Is there a Doctor on board? the Crossover Podcast – Ep 111 – Paramedic Perv Reporter Unclear of Aircraft EMS Operations The new rigs are here! the Crossover Show – Ep 110 – Do You Poop Where You Eat? What to do for an allergic reaction…or not The Last Shift of the Lost Cause The Crossover Show – ep 109 – Is that Cocaine or Anthrax? How to respond when your spouse tells you to be safe at work Always, In Service – EMS Week 2017 Lost Cause gets cocky FDIC 2017 – Structural Response to Aviation Incidents: Engine Company Operations I Got Lost Going to a Call – So I made sure everyone knew about it Crossover Podcast Ep 102 Mrs Happy Medic and Mike the Cop Arby’s Roast Beef Ad angers EMTs, not sure why Strippers and Cocaine watch – 2017 Seizures! Seizures Everywhere! Nothing is certain except death and taxes. I can help you with both What to do when the powers that be – just can’t. Episode 99 the Crossover Ep 98 – Off Duty and Fancy Free NO is Never Easy to Hear Ohio Cop vs Ambulance Crew Member on Video – Crossover Show Investigates! An MCI With Wings: Aviation Incidents EMS Today 2017 First in Ambulance MCI at EMS Today 2017 Crossover Show Learns How to Take a Joke To Haul or Not to Haul – Should the Complexity of a Refusal Influence Transport? Crossover Show – Ep 91 – ACLU cameras Tip of the Helmet – Bj’s Brewhouse the Crossover Show – Episode Eighty Eight Eminence Based Medicine If You Don’t Give Him Insulin He’s Going to Die Lost Cause Strikes Again the Crossover Podcast – Ep 85 – Florida Cry Baby “I Can’t Breathe!” you keep using those words… the Crossover Show – 84 – TN Bus Crash Happy 150th Anniversary San Francisco Fire Department! Thank You For Your Service? A Complete Secondary Assessment the Crossover Episode 81 – Let’s Talk Politics! Aircraft skids off runway, rescue task force ill equipped Crossover Show – Ep 79 – Do we need so much active shooter training? How to Ignore Everyone in the Room: Be an Intern Your Meme is Bad and You’re Not One of Us Anymore Goodbye tarps, I never loved you The Crossover Episode 76 – Flashback to the Beginning You found me how? Less CSI, More Columbo EMS Festival Standby – You can’t just park a car there the Crossover Show Ep 72 – Florida EMT photo game A&O vs able to make decisions Kilted to Kick Cancer Cops vs Firemen Writer calls for Medics to risk more in shootings, misses the target What’s with the French? the Crossover – Ep 69 – Twelve Ninety Désolé the Crossover Show – Ep 67 – Traffic Stops and Profiling Actually, Officer, No. It Really isn’t that hard to try When Patients Don’t Play by the Old Rules Letters in the File – Oklaloosa Selfies the Crossover Podcast – Ep 64 – Turning Passion into Retirement Why Pokemon GO is so much like EMS Us Against Us Apathy is worse than absence So Now I’m Back! Changes are a-comin’ The Sounds of Silence I know that feel, Bro


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.

Related posts:


  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.

Post a Comment

Your email address will not be published. Required fields are marked *