A lot of confusion has arisen among EMS personnel regarding their response to accident scenes where they’re subsequently told they’re not needed. Another confusing scenario is when multiple people are involved in an accident, and only one is injured or requesting care. What about the others? Do we need to obtain vital signs on each of them, or document refusals for everyone at an accident scene? How do we document contacts made by EMS with people who don’t become patients?”ž
The courts have addressed several EMS cases that further muddle this issue. The first, the 1990 case”žWright v. City of Los Angeles,”ž involved a black man who was found “down and out” on a city sidewalk. The paramedics did only a cursory examination before deciding he was drunk and not in need of their care. He later died of a sickle cell crisis. The court ruled that the paramedics had a duty to thoroughly examine the patient to find out whether he was in need of emergency care. Another case,”žZepeda v. City of Los Angeles,”ž decided later the same year, involved a patient who was intoxicated and had fallen more than six feet from a wall to the sidewalk. In this case, the court went the opposite way, and ruled that the paramedics had not undertaken sufficient evaluation of the patient to trigger a duty. Thus, even in the same state, it’s unclear whether we should do more — or less — when faced with a patient who appears to be simply intoxicated, or who indicates they don’t want or need our care.”ž
The accident scene, however, arises almost daily for EMS personnel. In”žHackman v. AMR,”ž EMS responded to an accident scene where a young woman told them she didn’t need to be evaluated. EMS left the scene, only to be called back a few minutes later after the woman collapsed. Here, the court ruled that the paramedics had a duty to perform an examination.”ž
So how do we unravel the confusion surrounding these issues? Nothing can be worse than being named in a lawsuit and finding out there’s no patient care report (PCR) on the person now alleging that you failed to examine and treat them. Most likely, you’ll have no memory of the call, and you’ll have nothing to rely on to refute the allegations. Protecting ourselves against this unwanted occurrence falls under “best practices.” When it comes to PCRs, the “more the merrier” is the rule. We need to categorize patients and nonpatients at accident scenes where multiple people are involved, and complete PCRs — even brief ones — for the people we contact and offer care to.”ž
To accomplish this, many EMS services have gone to a “multi-tiered” patient refusal form that covers these issues, and applies to different types of EMS contacts. The form is brief and doesn’t take a lot of time to fill out. One tier is the refusal of EMS care and transport against medical advice. It applies to individuals who’ve been assessed, and EMS has recommended that they be transported. It’s paramount to document that this patient has decisional capacity and is capable of exercising clear judgment to refuse transport.”ž”ž
A second tier involves a person who was examined and had vital signs taken, and either minor injuries or no injuries were found. In this case, the EMT should recommend that the patient seek further examination at a primary care facility if they refuse to be transported by EMS. Clearly, the person should be identified, and the examination and vital signs should be documented, even when transport is refused.”ž
A third tier concerns the person who does not become a patient at all. This tier of the form documents that EMS has met with the person and been informed that there’s no medical complaint, illness or injury. This person should sign off that they’ve refused both treatment and transport.
In all tiers involving refusal of assessment and/or transport, the person should sign off on a section that affirms that EMS care was offered and treatment options were explained. Simply having the person fill in the section of the form with their name, address and date of birth may later help you affirm in a courtroom that the patient was capable of making decisions.”ž
Proper documentation of why further assessment and treatment of an EMS contact was not undertaken can keep you out of litigation. It’s important to recognize that not all EMS contacts result in a provider/patient relationship that triggers additional legal duties.”ž”ž”ž”ž”ž”ž”ž”ž”ž”ž”ž”ž
