How to take "no" for an answer

Approximately 20% of all patients who are assessed by Council Bluffs Fire EMS providers refuse transport due to absence of any injury, minor injuries or illness that did not require medical attention. Using instruction sheets for this population has resulted in increased satisfaction with our EMS services. There are two important things to remember when educating personnel on the use of instruction sheets. First, the sheet does not replace the need for EMS providers to discuss their assessment findings with the patient. It is used to enhance the discussion and give the patient a written resource to refer to later. The patient hears the information from the provider, sees it on the information sheet and can review it and/or show it to a family member. Second, there should not be an increase in the number of refusals EMS personnel obtain. Providers should continue to encourage the patient to be transported to the hospital for further medical care and evaluation. Patient information sheets should never take the place of credible, well-written documentation on the signed refusal of care report. We have found that medics use the information sheets as resources during their documentation and communication with the patients. The medic documents in the refusal form that the information sheet was reviewed with the patient and the patient signs the refusal, acknowledging receipt of the form. Using standardized instruction sheets can improve both customer service and the image of prehospital care, as well as encourage providers to document and educate their patients who refuse transport.