Page 89 - 2023 SMOG Digital

SPECIAL POPULATIONS

PATIENT REFUSAL

INDICATIONS:
If a patient (or person[s] responsible for a minor) refuses treatment or transport, after pre-
hospital providers have arrived on the scene, the following procedures should be carried out:
PATIENT MANAGEMENT PROCEDURE:
1. A Primary Assessment (to include vital signs) should be completed, if possible. Pay particular
attention to the patient's mental status.
2. Any injuries or illnesses found to immediately threaten life, limb, or eyesight (or can be
assumed will deteriorate en–route) should be addressed and treated immediately while en–
route, to the greatest extent possible while assuring safety. With patients that prevent
treatment of these injuries, all should be done to encourage the patient seek treatment and any
doubt of capacity should prompt treatment/transport under implied consent. Patient with
decision-– capacity refusing treatment of life–threatening injury or illness require further clinical
judgement and consultation with medical director prior to informed refusal.

3. Injuries or illnesses that do not represent imminent threats to life, limb, or eyesight (or
considered unlikely to deteriorate en–route) may be addressed in accordance with the following:
a. Determine the patient's (or parent's) decision–making capacity to make sound/valid
judgments concerning the patient's condition. If there are any doubts from the
provider's aspect, consider treating in accordance with the ALTERED MENTAL STATUS
GUIDELINE or COMBATIVE PATIENT GUIDELINE. Decision–making capacity means that:
• The patient is awake, alert, and oriented to person, place, time and event.

AND
• The patient is able to understand his/her medical problem(s), and recite back
an understanding of the medical problem(s) and risks of possible resulting
problems or worsening of his/her medical condition if patient is not evaluated
and treated.
b. Ensure that you clearly and repeatedly explain to the patient or responsible parties of
the concerns and possible risks involved in refusing medical care.
c. Clearly document all findings during the patient assessment and any discussions with
the patient regarding his/her condition as well as all persons involved with the patient.
Document all statements made pertaining to the risks associated with refusing
treatment and transportation and obtain a signature from a witness (crew member) and
the patient or parties responsible for the patient as to refusal of care.
d. Clearly explain to Military Personnel why the treatment is needed. Notify them that
refusal of treatment may bring judicial or administrative adverse action upon them
under UCMJ.

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