To have and to hold, until competence do us part!

Area of Science:

• Emergency Medicine
• Medical Law
• Patient Autonomy

Background:

• Patient refusal of treatment and transport presents significant challenges for Emergency Medical Service (EMS) providers.
• EMS providers may be the final medical professionals to interact with patients before they refuse care.

Purpose of the Study:

• To provide EMS providers with tools to mitigate risks associated with patient refusal of treatment and transport.
• To emphasize the importance of understanding local laws and establishing clear policies for managing patient refusals.

Main Methods:

• Review of EMS protocols and legal considerations for patient refusal.
• Discussion of methods for determining patient competence, including the Mini-Mental State Examination (MMSE).
• Emphasis on the role of Online Medical Control (OLMC) consultation and informed consent.

Main Results:

• Implementing specific EMS "tools" can significantly reduce, though not entirely eliminate, exposure to mismanagement of patients refusing care.
• Determining patient competence is key, allowing competent patients to refuse treatment and transport after risks are explained.
• Informed refusal documentation, witnessed by a third party, is essential when patients decline transport.

Conclusions:

• EMS providers must research and adhere to state-specific laws regarding patient refusal.
• A robust refusal policy should include criteria for medical oversight, competence assessment, and documentation with post-review.
• Clear communication of risks and benefits, alongside proper documentation, supports safe management of patient refusals.