Convincing a patient to be transported

STXmedic

STXmedic

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A recent comment made me curious. What's the longest you've had to stay on scene to try to convince your patient they needed to be transported? What made you so concerned? And were you successful?

I'll start. Mine was 3.5 hours. We had a gentleman in his mid 90s who was sharp as a tack, lived alone, completely independent, and very healthy. I think his only history was BPH that was well-managed.

He began having progressive weakness over the last week, which culminated in a fall (what we were dispatched for, no injuries). Once we sat him up, he was unable to stand or even bear his weight with assistance. He was adamant about not being transported, stating that he would rather just crawl around his house.

It took 3.5 hours of convincing, ultimately ending in an Emergency Detention (5150 hold for some of you) due to him stating he would shoot himself if he ever lost his independence, and a .45 was found under his pillow.

Luckily, we saw the patient later that shift and he ended up thanking us for bringing him in and apologized for being so stubborn. Ended up being an easily treated infection.​
 
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Around 1.5 hours I believe. Forget the details of the scene but she ended up having a brain bleed.
 
On my medic ride time, we spent like 20 minutes trying to convince a guy with a big STEMI to go. I was showing him the 12 lead like, "see these big upward deflections? They're called tombstones. Why do you suppose they're called that?"

Eventually he decided to have a family member drive him to the ED (we told him to go to a cath lab hospital). Maybe 30 minutes after we leave, we're called to the local ED for emergent transfer of a patient to PCI facility... :rolleyes:
 
Not very long. Our fire departments have a thing about calling PD and having the patient written up on a psych hold for patients who need to go to the hospital but don't want to.
 
DesertEMT66 said:
Not very long. Our fire departments have a thing about calling PD and having the patient written up on a psych hold for patients who need to go to the hospital but don't want to.
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I'm surprised that no one has gone after the PD and FD for that. Just because I don't want to go to the hospital does not mean I am crazy.
 
Gurby said:
On my medic ride time, we spent like 20 minutes trying to convince a guy with a big STEMI to go. I was showing him the 12 lead like, "see these big upward deflections? They're called tombstones. Why do you suppose they're called that?"

Eventually he decided to have a family member drive him to the ED (we told him to go to a cath lab hospital). Maybe 30 minutes after we leave, we're called to the local ED for emergent transfer of a patient to PCI facility... :rolleyes:
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Had a similar call like this but we took the refusal and literally waited outside his door for about 15 minutes until we heard the guy fall, then busted back in an worked him.
 
FireWA1 said:
I'm surprised that no one has gone after the PD and FD for that. Just because I don't want to go to the hospital does not mean I am crazy.
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Exactly. A person has a right to not go to the hospital. It very well may be the wrong decision, but it's their decision to make. I don't believe in forcing anyone to go. I'll present facts and logical opinions and talk 'straight' to them, but unless they fit the legitimate criteria for being IDed, I won't force it.
 
Just had one the other day. Only about 30 minutes of the pt and his wife refusing. He looked fine when we arrived but I didn't feel comfortable letting them refuse. Finally talked wife into talking him into going. He stroked out hardcore as I was giving report to nurse.
 
2.5-3 hours. Well-built man in 70s-80s suffering from liver failure. He was mentally disoriented/confused and refusing to leave his bed. EMS ended up finally sedating with haldol in order to transport.

No information on the outcome. Was very tough to be with his wife pleading with him to go to the hospital.
 
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Flying said:
2.5-3 hours. Well-built man in 70s-80s suffering from liver failure. He was mentally disoriented/confused and refusing to leave his bed. EMS ended up finally sedating with haldol in order to transport.

No information on the outcome. Was very tough to be with his wife pleading with him to go to the hospital.
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I'm imagining hepatic encephalopathy. Apart from some drug users, these are some of the hardest people to reason with I have ever encountered. They seem to maintain their strength and dexterity even while being absolutely incoherent and unable to care for themselves. It's hard on the family as these are often people who are otherwise fairly reasonable and they can't imagine what is happening to them.
 
His presentation and postulation by a medic on scene all seem to agree with hepatic encephalopathy.

It was testing to try to convince the man. He had instilled in him the idea that he was fine, when he clearly was not, and our conversation remained on parallel lines, never meeting at any point.
 
redundantbassist said:
Honestly, at that age I can't really blame the guy.
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I agree completely. But infection was my gut feeling, which is typically easily treated. His family stated he was very active and capable. Before we found out about the gun, he was making it seem like he would just crawl around until he died, which would not likely have been soon. It seemed like a poorly thought out decision when the alternative was just a week or two of antibiotics.
 
Recently I had a head trauma patient with four deep lacerations each about four inches long. He was alert, oriented, bleeding, and refusing transport.

We got ALS on scene and they spent half an hour trying to convince him.

The paramedic turns to me and says "he has to go! The mechanism is bad."

They eventually got the trauma doc on the phone and he gave up after about 30 more minutes of chatter.
 
My instructor told of an event he worked where the sound mixer / DJ had a STEMI but refused transport until the singer act was done.

They were doing ACLS for six hours. And the city depleted its supply of oxygen bottles.

Then he was taken to the hospital at long last.
 
An hour or so the other day. Dude with either hyponatremia or some sort of new onset neurological problem. Sucked cause he was a vet, obnoxiously healthy and in fantastic shape. Funny thing was I transported him 2 weeks prior for the same thing but the VA kicked him loose and blamed a pre-workout drink he was using for a seizure, which I do believe he had both times. He really didn't want to go and was about twice the size of my partner and I and like I said, in really good shape. He'd have fought us and won if we tried to force him. We'd probably still be there now (4 days later) if we hadn't gotten his fiancé to come home and talk him into it.

Thought hyponatremia because of his acute ALOC, goofiness, evidence of a seizure (oral trauma and incontinence and hypoglycemia without Hx of DM) and the fact that he drank gallons of only water every day with multiple 2+ hour intense workouts every day including a run in a suit like boxers use to lose weight.

Never did find out what happened to him, I'll have to track down his records at the big hospital since I managed to get the VA Doc to divert us to a...more capable and thorough...facility.
 
Handsome Robb said:
An hour or so the other day. Dude with either hyponatremia or some sort of new onset neurological problem. Sucked cause he was a vet, obnoxiously healthy and in fantastic shape. Funny thing was I transported him 2 weeks prior for the same thing but the VA kicked him loose and blamed a pre-workout drink he was using for a seizure, which I do believe he had both times. He really didn't want to go and was about twice the size of my partner and I and like I said, in really good shape. He'd have fought us and won if we tried to force him. We'd probably still be there now (4 days later) if we hadn't gotten his fiancé to come home and talk him into it.

Thought hyponatremia because of his acute ALOC, goofiness, evidence of a seizure (oral trauma and incontinence and hypoglycemia without Hx of DM) and the fact that he drank gallons of only water every day with multiple 2+ hour intense workouts every day including a run in a suit like boxers use to lose weight.

Never did find out what happened to him, I'll have to track down his records at the big hospital since I managed to get the VA Doc to divert us to a...more capable and thorough...facility.
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Do VA hospitals receive ambulance patients / do they have emergency rooms? My understanding was that VA patients are seen in a standard ER than transfered to VA hospital if needed.
 
RedAirplane said:
Do VA hospitals receive ambulance patients / do they have emergency rooms? My understanding was that VA patients are seen in a standard ER than transfered to VA hospital if needed.
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Depends which VA hospital. Some have ERs and some don't having clinics and hospital rooms only. Depending on the patient condition and which VA hospital they are going to it could be that they go to there or get rerouted to another hospital with the proper emergency capabilities.
 
The Indy VA has an ED. It's not a trauma center though, so someone fitting trauma criteria will go to one of the trauma centers. But our VA here does have an ED for the "difficulty breathing", "abdominal pain", etc calls.
 
I let them "kick their own ***", so to speak If a patient is actually in distress or appears to be ill, I don't ride the idiot train and preach doom I simply ask them to demonstrate that they can take care of themselves. When they fail, I let them talk themselves into going.
 
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