REFUSAL / INVOLUNTARY RESTRAINT AND TRANSPORT

Created 02/01/2010

DESIGNATION OF CONDITION
Emergency treatment applies to any age patient. Emergency treatment without consent implies that a life threat exists and patient is mentally incapable of making decisions on their own behalf. Reasonable force can be used, but only that force necessary to treat and transport the patient.

EMPHASIS ON PATIENT CARE
Provider safety, transport decisions.

FIRST RESPONDER, BASIC, INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT
1. Several attempts to gain consent for treatment and transport must be made prior to any attempts to subdue the patient.
2. If the patient meets the following criteria, the EMT may use reasonable force to treat and transport.

• The patient’s words or actions indicate that he/she is mentally incapable of making decisions on his/her own behalf. Such as:
  • Displays inappropriate and erratic behavior.
  • Has inappropriate responses to questions.
  • Shows evidence of significant drug or alcohol impairment.
  • Is disoriented to time, person, place, or event.
  • Attempts suicide or is talking about attempting suicide.
• A life-threat is suspected of existing or does exist.

3. Use the following protocols to secure and treat the patient.

• Call for law enforcement assistance, if needed.
• Have enough personnel to safely secure patient and assure that all personnel are informed of plans and are involved.
• Adequately restrain the patient to stretcher or other device, as needed.
• Keep at least two EMTs present at all times, if the patient is, or suspected of being combative.
• Keep bystanders and onlookers away from the patient as they may agitate the patient.
• Provide all resuscitative measures to sustain life.
• Maintain voice contact with medical control.
• Transport to an appropriate health care facility.

4. Document all actions, statements, and responses to your questions that support your decision to treat the patient without consent.

REFUSAL (PEDIATRIC)

DESIGNATION OF CONDITION
Children are unable to refuse treatment and transport on their own behalf. A parent, or guardian, may refuse any part of or all treatment and/or transport on behalf of the patient. Remember this protocol is used only if no life threats exist. If a life threat is present, follow Involuntary Restraint and Transport Protocol.

EMPHASIS ON PATIENT CARE
Provider safety, transport decisions.

FIRST RESPONDER, BASIC, INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT

Obtain focused H&P - History, physical exam, vital signs (if patient allows):

• Inform parent or legal guardian of patient’s medical condition, potential injury or illness, and potential ramifications if treatment and transport are refused.
• Make certain the parent or legal guardian fully understands what you are saying.
• Make sure your attempts to inform are 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 parent’s or legal guardian’s signature on refusal and information for report.
• If possible, have the refusal of treatment and/or transportation witnessed and signed by a third party, preferably not an EMS provider
• Document all attempts to gain consent for treatment, advisement of potential injury or illnesses, and potential ramifications if treatment is not rendered.