How is not touching the patient until the've consented to care a "lawsuit waiting to happen"? And how can the patient make a reasonable and informed decision whether to "AMA and transport in their own POV" when they have no idea what the transport is going to cost, and what the potential benefits of EMS transport are?
It isn't as if people only call 911 for life threatening situations. In case you've never noticed, very few EMS responses are true emergencies. So it's not like every call is some time-critical super dramatic life-or-limb emergency where there's simply no time to discuss risks / benefits / costs of EMS transport vs. other options. People can and should be educated and given options to whatever extent possible, just like everywhere else in medicine. That should be considered part of obtaining informed consent.
I would not expect an EMS crew to ever spend any time at all "haggling" over the cost of the transport or the care that the crew deems appropriate, or to provide an itemized estimate of the cost of the transport beforehand. However, if asked, it seems pretty reasonable that the crew should be able to say "Ma'm, the base cost of a BLS transport is $1000 plus $X per mile, plus supplies. If we have to start an IV or provide other advanced interventions in order to manage your condition or treat pain, then it becomes an ALS transport, and the cost increases. That should give you some idea, but there is no way I can tell you exactly what your transport will cost you." Then the crew can go down one of two roads and either say "We are very concerned about your chest pain and low blood pressure and we really think it is in your best interest to come with us and worry about the cost later", or "we'll gladly transport you in the ambulance, but it doesn't appear as though your sprained wrist will benefit from EMS transport. So if you are concerned about the cost of transport, you can go by POV to the ED or an urgent care, or even your regular doctor's office". Is that really that hard?
If it were that easy, then the issue wouldn't come up often as it does. Most people with insurance are confined to the use of one or perhaps two health systems for their care if they want to use their insurance meaning shopping around isn't an option at all. Also, many people have found that hospitals can't or won't give you an answer when you call to inquire what your lap cholecystectomy (for instance) is going to cost, or even what your share of the cost will be after your insurance pays its part. Part of that is of course because the cost of surgical procedures is heavily dependent on the amount of time that the procedure takes, but many times you can't even get a rough idea or an average.
