Handling Patient Refusals: A3E3P3!

Patient refusals must be handled properly to minimize the potential liability that can arise. Over the years, we have developed and modified a set of refusal guidelines we call ” A3E3P3” to help EMS providers remember the important things to consider in dealing with refusal situations.

1. Assess
ASSESS the patient’s legal and mental capacity to refuse care. Is the patient 18 years of age, or does the patient meet your state’s exceptions for emancipated minors? Is the patient suffering from any mental condition that might prevent them from making an informed decision?

2. Advise
ADVISE the patient of their condition and your proposed treatment. We don’t diagnose in EMS, but we should tell a patient what’s going on with their condition and how we would propose to help them so their refusal decision is informed!

3. Avoid
AVOID the use of confusing terminology when talking to your patient. Make sure you communicate with your patient in terms they can understand!

4. Ensure
ENSURE that the patient’s decision to refuse care is the product of their own informed decisionmaking, and not the result of improper influence or coercion by others.

5. Explain
EXPLAIN the alternatives to your patient if they refuse your care and transportation. Make sure they know their options, such as calling 911 again; calling their physician; going to the E.R., etc.

6. Exploit
EXPLOIT uncertainty! Many patients are unsure about whether or not to go to the hospital, and that uncertainty should be used to your advantage in advising the patient to obtain the care they need.

7. Persist
PERSIST in trying to persuade your patient to obtain care they need. Sometimes you have to make several attempts to convince a patient that they need to go to the hospital.

8. Protocols
PROTOCOLS — follow them! If your service or your EMS system has protocols in place regarding patient refusals, be sure to adhere to them.

9. Protect
PROTECT yourself with adequate documentation of the refusal. Write a thorough narrative, obtain the patient’s signature whenever possible, and try to get the names and addresses of impartial witnesses.

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Courtesy of Page, Wolfberg & Wirth, LLC, www.pwwemslaw.com.

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