Patient Refusal of Transport Administrative Guideline

Question 1

Individual meets the definition of a patient
and patient or parent/legal guardian
wishes to refuse EMS treatment or transport

Answer 1

Determine the patient’s ability to make an informed decision
Judgment must not be impaired by illness, injury, or significant drug/alcohol
intoxication per 6 item cognitive screen.
GCS score must be 15 or at the patient’s baseline mental status

Question 2

What must you document?

Answer 2

1. Understand and communicate the relevant information and risks of
   refusal of medical treatment or transport
2. Articulate a decision consistent with their understanding of the risks
   and justify that decision with logic that fits int the patient’s own value
   system.

Question 3

Perform appropriate assessment and provide appropriate medical care with
the consent of the individual then?

Answer 3

• Obtain a complete set of vital signs
• Complete an initial assessment with particular attention to neurological
  and mental status.

Question 4

Attempted suicide, verbalized suicidal
intent, exhibit any other indicator of 
significant risk of danger to self
or others 
YES?

Answer 4

Patient must be evaluated by qualified mental
health professional or transported to an
appropriate facility to recieve evaluation

Question 5

Attempted suicide, verbalized suicidal
intent, exhibit any other indicator of 
significant risk of danger to self
or others
NO?

Answer 5

Advise patient of the potenial risks from
refusal of medical care.
Consider contacting medical direction for
assistance when provider is concerned for:
- potentially life-threatening condition
- possible physical/psychological abuse
- other concerns related to risk of refusal

Question 6

What is the definition of decision making capacity?

Answer 6

An individual who is alert, oriented, and has the ability to understand the circumstances surrounding his/her illness or impairment, as well as the possible risks associated with refusing treatment and/or transport, typically is considered to have decision-making capacity.

Question 7

Decision-making capacity should be demonstrated and documented as defined by the presence of the following criteria. The patient must be able to:

Answer 7

• Receive and comprehend information needed to make a decision,
• Process and deliberate a decision and its potential consequences,
• Make and articulate a decision that is consistent over time,
• Justify that decision with logic that fits the individual’s own value system.
• The individual’s judgment must not be impaired by illness, injury, or clinically apparent drug/alcohol
  intoxication. GCS score must be >15

Question 8

Individuals must be advised of the risks and consequences resulting from refusal of medical care, which includes:

Answer 8

• Assess the patient’s understanding of the medical emergency: the possible medical problems, the
  proposed medical care, the benefits of medical care and risks of refusal.
• Contact online medical direction based on local protocol.
• Document the patient encounter.

Question 9

What about pediatric refusals?

Answer 9

• It is preferable for a minor to have a parent or legal guardian who can provide consent for treatment on
  behalf of the minor. However, EMS providers may provide emergency treatment when a parent is not
  available to provide consent.
• Minors cannot refuse care on their own behalf unless they have documentation of emancipation.
• A parent or legal guardian must be contacted to refuse care for minor patients.
• The provider should take additional means necessary to facilitate transport if abuse or neglect is
  suspected. Notify law enforcement as necessary to facilitate transport to the hospital.
• A DCS report should be made as required for suspected abuse or neglect.

Question 10

What about psychiatric patients?

Answer 10

• Patients may generally refuse EMS medical care even with petition for mandatory psychiatric evaluation.
• The only exception to this is patients with a revoked court order.