Original Effective Date: 01/01/2001 | Revised Date: 02/01/2010

REFUSAL / ADULT

DESIGNATION OF CONDITION
A competent adult (18 years or older) may refuse any or all treatment or transport at any time. A patient must be alert and oriented, not under the influence of drugs or alcohol, not be a danger to self or others, and have vital signs within normal limits. If patient is not capable of making rational decisions, follow Refusal/Involuntary Restraint and Transport Protocol

Protocols. All refusal patients must be evaluated. Vital signs should be obtained (if possible). The patient must be informed of the potential life threat or disability by refusing care. Studies have shown that a significant number of patients who refuse EMS treatment and transport will later seek medical assistance and require admission to the hospital.

EMPHASIS ON PATIENT CARE
Provider safety, transport decisions.

FIRST RESPONDER, BASIC, INTERMEDIATE AND PARAMEDIC PRE-HOSPITAL MANAGEMENT
1. Assess airway, breathing and circulation and manage as indicated.
2. Perform Focused H&P History, physical exam, vital signs (if patient allows):

• Inform patient of her/his medical condition, potential injury or illness and the potential ramifications if treatment and transport are refused.
• Assure the patient fully understands what you are saying. Attempt to have the patient demonstrate understanding by describing potential harm in his or her own words.
• Attempts to inform should be done in the presence of a witness, i.e. family members, bystander, or Police Officer (preferably not a member of the EMS service).
• Obtain the patient’s signature on refusal and needed information for PCR.
• If possible, have the refusal of treatment and/or transportation witnessed and signed by a third party, preferably not an EMS provider.
• Even though you have obtained a signature, take reasonable steps to protect patient by calling a friend or family member to attend to patient.
• Advise the patient to seek medical attention if symptoms develop or worsen.