You are transporting a patient, and are down the road from the hospital. A couple minutes before arrival to ED, your patient decides they do not want to go. What is the correct thing to do in this scenario? Isn’t keep them in the ambulance knowing the don’t wanna go kidnapping? But at the same time, you can’t just dump them on the side of the road right? How would you handle this?
Thoughts
- Thread starter ickyvicky
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Depends on their mental state and chief complaint.
They’re alert and oriented, perfectly coherent. They were in a rollover accident and seem to just have a laceration on their arm. Bleeding has stopped
CCCSD
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MOI suggests the possibility of brain injury.
MEDicJohn
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I had a captain that use to say to us. You have to use verbal judo and convince them that this is the correct course of action even if its just delaying them until you have adequate resources to restrain. But yes I agree with CCCSD significant MOI likelihood of an unseen injury is high.
We get that a lot at my part time job;
They are drunk and unresponsive, until after 1-2 L of fluid and time they are sobering up and don't want to go to the hospital anymore.
We tell them we have to take them all the way, but they don't have to stay until they are checked in.
We don't get paid for the transport (by insurance) unless they go all the way, but it doesn't matter if they stay.
That is one of the bad things about 135 mile transports
They are drunk and unresponsive, until after 1-2 L of fluid and time they are sobering up and don't want to go to the hospital anymore.
We tell them we have to take them all the way, but they don't have to stay until they are checked in.
We don't get paid for the transport (by insurance) unless they go all the way, but it doesn't matter if they stay.
That is one of the bad things about 135 mile transports
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You've already began transport to the hospital, I would:
My guess is that most physicians would be unlikely to release the patient to the side of the road.
As much as I wouldn't want to do it, this patient likely has the legal right to be released in a safe location.
- Contact a supervisor
- Attempt to convince them to continue the transport to the hospital, suggesting that they can deny further treatment upon arrival at the hospital
My guess is that most physicians would be unlikely to release the patient to the side of the road.
As much as I wouldn't want to do it, this patient likely has the legal right to be released in a safe location.
DesertMedic66
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While I agree with the first part of your statement I will put a hard stop at the “adequate resources to restrain”. Please say you are not advocating for physically restraining a competent adult patient who no longer wants to be under your care? If so, can I become a patient in your response area because I would love a nice lawsuit for assault/battery and kidnapping.
Aha, yes! I didn’t even think about that being a factor.
This is the first time I’ve ever encountered a situation like this. I did end up keeping the patient, and I’m glad I did. But I realized after the fact that I wasn’t really sure if that was the correct thing to do. I was frustrated just by that one time, I can’t imagine that happening all the time.
Makes sense. I did keep the patient but I was questioning the legality of it. I wasn’t 100% sure if I could still keep them based on that if they’re don’t seem altered at the time.
akflightmedic
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"We are almost at the hospital and yes, you are free to go at any time. However, for the safety of us and you, please let us drive onto the hospital property to offload you. At that point in time, you are free to do whatever you want, and it will be safer for you to call for a ride from there".
Not that difficult.
Not that difficult.
MEDicJohn
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if required I wasn't giving a specific scenario in this instance.
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The MOI has nothing to do with it. A patient could be critically injured or ill yet have the mental capability to refuse care. “Could have a brain injury is baloney,” I would hazard that the majority of rollover MVCs result in no or extremely minor injuries provided seatbelts are worn. If a patient wants out, we will do so safely. That may be at the hospital, but we will do a refusal.
CCCSD
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It’s a possibility. Can’t Dx it in the field now, can you? By all means, pull over and dump the pt with all the treatments you’ve started pulled out and off. Leave them by the side of the road.
The Attorneys love this… That piece of paper they “signed”…yeah.
DesertMedic66
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Anything is a possibility but possibilities don’t decide if a patient is able to refuse care or not. Patients have the right to refuse care as long as they are competent, adults, and are able to understand what is currently happening to them.
CCCSD
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Fully aware of that. Seems the gist is that some are so godlike in their Dx skills that they KNOW what’s going on with every pt…
Jump all you want: I’ve NEVER been sued by a pt, nor had my care questioned.
DesertMedic66
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That really doesn’t mean anything. I know some medics who have killed patients and not been sued. I would also say the vast majority of clinicians have never had their care questioned.
What did you tell the pt? How did he/she react?
Ensihoitaja
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I've had a few variations on this happen. All patients were clinically sober and had decision-making capacity. One was a few minutes from the hospital and I convinced him to talk to someone at the hospital and see if he wanted to be seen. They talked to the charge nurse, then left without checking in.
Another changed their mind a few blocks from home, so we turned around and made sure he made it back inside.
The third one had requested transport to a hospital further away and we were over halfway there when he changed his mind. I informed him that we couldn't take him all the way back to where we picked him up, so we found a safe place to let him out and left him to find his own ride.
In each case, I had the patient talk to a base physician by phone and sign a refusal form before letting them out.
Another changed their mind a few blocks from home, so we turned around and made sure he made it back inside.
The third one had requested transport to a hospital further away and we were over halfway there when he changed his mind. I informed him that we couldn't take him all the way back to where we picked him up, so we found a safe place to let him out and left him to find his own ride.
In each case, I had the patient talk to a base physician by phone and sign a refusal form before letting them out.