Patients who initially refuse prehospital evaluation and/or therapy

Area of Science:

• Emergency Medicine
• Prehospital Care
• Public Health Policy

Background:

• Patient initial refusal of care (PIRC) presents challenges in prehospital emergency medical services (EMS).
• Understanding factors influencing PIRC dispositions is crucial for patient safety and resource allocation.
• Existing legal frameworks may not adequately address situations where patients with potentially impaired decision-making capacity refuse care.

Purpose of the Study:

• To characterize patients involved in prehospital initial refusal of care (PIRC) cases.
• To identify factors associated with different patient dispositions in PIRC scenarios.
• To inform potential policy changes regarding patient holds in prehospital care.

Main Methods:

• Retrospective descriptive and analytical cohort study.
• Analysis of 169 prehospital patient initial refusal of care (PIRC) cases over a 6-month period in an urban EMS system.
• Logistic regression analysis to identify factors associated with leaving the scene against medical advice.

Main Results:

• Nearly 10% of base station calls involved physician consultation for PIRC.
• Over half (53%) of patients left the scene against medical advice.
• Factors associated with leaving against medical advice included treated hypoglycemia, alcohol use, disorientation, and normal speech, alongside the absence of family or a police hold.

Conclusions:

• Patient initial refusal of care (PIRC) is a significant issue in prehospital settings.
• Specific clinical and social factors correlate with patients leaving against medical advice.
• Statutes enabling police holds under physician guidance may be necessary to ensure care for patients with impaired capacity.