Treatment Refusal
	Date: Mon, 05 Aug 1996 00:39:48 From: Erik [G1MAN1@aol.com] Patient is an adult male involved in an MVA. Car flips and pt is supposedly ejected. Witnesses call 911 and E.M.S. and police respond. On scene pt is stable with normal B.P. and H.R. Bilateral beath sounds. GCS 15 PERRL. A&Ox3(name, place, date) Patient does not want medical treatment and refuses to come to E.R. E.M.S. calls into Base station at E.R. and the decision is made to release pt on scene. Is it O.K. to release pt on scene or is it safer to transport patient to E.R. for more detailed evaluation to rule out asymptomatic trauma?
	Date: Sun, 4 Aug 1996 22:10:07 From: John Trickett [thornbur@travel-net.com] Safer to transport for whom? It might be safer for the crew not to try .......I beleive the patient is technically refusing Rx and he has a right to do so. It would surprise me if you had any alternative but to follow the patient's wishes except in extenuating circumstances.
	Date: Sun, 04 Aug 1996 23:37:49 From: Brian Olson [brian@vonl.com] The general rule of thumb should be listed first: "You should follow your agency's guidelines" In my experience, it is up to the in-charge of the ambulance to decide. If a person does not want to go you have different options. Don't tell the patient that he/she MUST go to the hospital. I start out first by getting permission to at least assess the patient to give them a little time to ease their anxiety. You have to remember...right now the car is totalled, there are 2000 flashing lights. They have just stopped traffic and every cop for 10 miles has to stop by. They're thinking of their insurance and how it's going up and wondering if they're going to get a ticket. I stop to take a few moments, put myself in their shoes (which I've been) and get them to agree to one thing at a time. Telling them "you might die" doesn't always work. Of course, alcohol is another factor all together. My experience has been to have Law Enforcement offer to arrest the patient and then they'll go with us or them but are going no matter what. It's a judgement call. My hardest call wasn't from an MVA but rather a 15 year-old girl who fell from standing on a chair, hit her head on the ground and was knock unconscious until we arrived. The mother would not allow us to transport. I had the Sheriff's department come out and called out medical director to speak with the woman, but she ultimately refused. What can you do? *shrug*
	Date: Mon, 5 Aug 1996 16:54:41 +0300 From: Aviel Roy-Shapira [avir@bgumail.bgu.ac.il] I do not believe one can legally force a patient who refuses treatment to come to the ER. Have him sign and date a release form, and make a note in the record attesting that the patient refused Rx and that you had explained to him the gravity of the situation etc etc. and that he apeared to be oriented and sound of mind.
	Date: Wed, 7 Aug 1996 06:50:46 From: Ira HArtman [ihartman@inter.net.il] We have a patient form for entering penitent info name findings, pb sao2, puls etc. Part of the form has a place for the patient to sign that he/she refused medical assistance
	Date: Tue, 13 Aug 1996 21:00:38 From: Eran Tal-Or MD [airdoc@actcom.co.il] In north of Israel (and as far as I know it go all over Israel) when a patient refuses to medical help we not force it. We strongly advise every one that was involved in MVA to go to the E.R. for check up. If s/he refuse s/he have to sign o the EMT reports on the refusal. Then they are release on scene.