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The Outcome of Patients Refusing Prehospital Transportation

Published online by Cambridge University Press:  28 June 2012

Andrew Sucov ,
Vincent P. Verdile ,
Doug Garettson  and
Paul M. Paris
Andrew Sucov*
Affiliation:
Clinical Instructor in Medicine, Division of Emergency Medicine, Brown University School of Medicine, Providence, R.I.
Vincent P. Verdile
Affiliation:
Assistant Professor of Medicine, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Doug Garettson
Affiliation:
Assistant Chief, Department of EMS, Division of Public Safety, City of Pittsburgh, Pa.
Paul M. Paris
Affiliation:
Associate Professor of Medicine and Chief, Division of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
*
Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
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Abstract

Objective:

To study the natural outcome of patients refusing prehospital transportation (PT).

Methods:

A total of 188 consecutive patients who refused PT in an urban, advanced life support (ALS), emergency medical services (EMS) system were studied. Of these, 77 (41 %) were male, and the average age was 51 years. Patients were entered into the study group only once.

Results:

Only 94 (50%) patients could be reached by telephone follow-up. Seven (7%) of these 94 patients had abnormal vital signs, 33 (35%) had cardiopulmonary complaints, 16 (17%) had an altered level of consciousness, nine (10%) were involved in accidents, and eight (8%) had abdominal pain. Six (6%) patients were admitted to the hospital, two (2 %) received ALS-level treatment by the paramedics and then refused conveyance, and 31 (33 %) either saw or contacted a physician. Consultation with an EMS physician was initiated for nine (5%) refusals. Of all the patients contacted, six (6%) needed PT for hospitalization.

Conclusion:

As only 50% of the patients refusing prehospital transportation could be reached using follow-up telephone calls, the 6% figure probably underestimates the true number of patients requiring PT. Telephone follow-up is an inadequate means of determining the natural outcome for this patient population. The ALS nature of many of the complaints combined with the lack of consistent physician consultation, exposes the EMS system to an undefined medico-legal liability risk.

Keywords

emergency medical servicesfollow-upliabilitymedical controlmental statusparamedicspatient competenceprotocolsrefusal of transportationrefusal of treatment
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 4 , December 1992 , pp. 365 - 371
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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Footnotes

Presented at the Sixth Annual National Association of EMS Physicians Conference and Scientific Assembly, May 1990, Houston, Texas; also presented at the First Society for Academic Emergency Medicine—Emergency Medicine Research Society (UK) Joint Meeting, October 1990, Edinburgh, Scotland. Abstract published in Prehospital and Disaster Medicine, 1990;6:310; also Ann Emerg Med 1990;19:1222–1223. Abstract.

References

1. Holroyd, B: Prehospital patients refusing care. Ann Emerg Med 1988;17:957–963.CrossRefGoogle ScholarPubMed
2. Selden, BS, Schnitzer, PG, Nolan, FX: Medicolegal documentation of prehospital triage. Ann Emerg Med 1990;19:547–551.CrossRefGoogle ScholarPubMed
3. Thompson, RH, Wolford, RW: Development and evaluation of criteria allowing paramedics to treat and release patients presenting with hypoglycemia: A retrospective study. Prehospital and Disaster Medicine 1991;6:309–314.CrossRefGoogle Scholar
4. Mottley, LL: Refusal of Medical Assistance in the Field. In Kuehl, AE (ed), EMS Medical Directors Handbook. St. Louis: CV Mosby, 1989, pp 261–265.Google Scholar
5. Schloendoff vs. Society of New York Hospital (1914), 211 NY 125.Google Scholar
6. Drane, JF: Competency to give informed consent: A model for making clinical assessments. JAMA 1984;252:925–927.CrossRefGoogle Scholar
7. President's Commision for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research: Making Health Care Decisions. Washington, D.C.: U.S. Government Printing Office, 1983, p 60.Google Scholar
8. Anonymous: Autonomy and Informed Consent. In Iserson, KV, Sandrews, AB, Mathieu, DR, et al. : (eds) Ethics in Emergency Medicine. Baltimore: Williams and Wilkins, 1986, pp 45–47.Google Scholar
9. Brock, DW: Informed Participation in Decision. In Iserson, KV, Sandrews, AB, Mathieu, DR, et al. : (eds) Ethics in Emergency Medicine. Baltimore: Williams and Wilkins, 1986, pp 47–52.Google Scholar
10. Buchanan, AE: The Question of Competance. In Iserson, KV, Sandrews, AB, Mathieu, DR, et al. : (eds) Ethics in Emergency Medicine. Baltimore: Williams and Wilkins, 1986, pp 52–56.Google Scholar
11. Deutsch, E: The right not to be treated or to refuse treatment. Medicine and Law 1989;7:433–438.Google Scholar
12. Capron, AM: Legal Setting of Emergency Medicine. In Iserson, KV, Sandrews, AB, Mathieu, DR, et al. : (eds) Ethics in Emergency Medicine. Baltimore: Williams and Wilkins, 1986, pp 13–27.Google Scholar
13. Lazar, RA: EMS Law: A Guide for Professionals. Rockville, Md.: Aspen Publishers, 1989, p 82.Google Scholar
14. Epilepsy Foundation of America: Seizure Recognition and First Aid. Landover, Md.: Epilepsy Foundation of America, 1988.Google Scholar
15. Ayres, RJ: Medicolegal Aspects of EMS: An Update. Lecture given at ACEP Annual Meeting, San Francisco, Calif., 17 September 1990.Google Scholar
16. Stark, G: Patients who initially refuse prehospital evaluation and/or therapy. Am J Emerg Med 1990;8:509–511.CrossRefGoogle ScholarPubMed
17. Shanaberger, CJ: Legal Issues in Medical Control. In Kuehl, AE (ed) EMS Medical Directors Handbook. St. Louis: CV Mosby, 1989, pp 394–404.Google Scholar