You Make the Call – Walk in

It’s been a busy day at the station and you’re finally sitting down to dinner when the doorbell rings.
At the door a woman tells you her friend is having chest pains and points to a rather large fellow sitting on the bench out front, smoking a cigarette.

After cleverly hiding a sigh, you welcome him inside after he tells you it is too cold to be examined outside.  He presents in no visible distress, and all your measurable variables are within his normal range, or so he says.

He later amends his chief complaint from chest pain to chest pressure, then again to “just kind of sore.”

A 12 lead is unremarkable, blood sugar normal, then when questioning about his medical history he produces a prescription bottle of heart burn medication filled yesterday.

“I had this chest pain on Monday too, I called 911 and they took me in.  Idiots thought I was having a heart attack.  I just want you to make sure everything is OK.”

As you advise the boss to slow the ambulance to code 2, the patient shifts in his seat and glares at you over his reading glasses.

“Son, maybe you’re not sure how this works, if I wanted an ambulance I would have called one this morning when the pain started.  Instead I waited until now to come by to make sure this isn’t something new.”

He goes on at great lengths advising you that he will not be boarding any ambulance, no matter what words he has said or risk factors, or chance of a continuing issue from 2 days ago, he refuses to even consider boarding an ambulance.

“If an ambulance even pulls into this lot I’m gone.” he says to you.

Wondering what his motivations are you consider other options and discover his hospital of choice is only 10 blocks away and the person he is with is driving for him.

He agrees to goto the ER only after you describe it as a “Do not pass go” moment and he agrees.  He then refuses to sign your form, or speak to your Medical Control via telephone, as required by protocol for a refusal of this kind (considering his buzz words).

The ambulance pulls into the lot just as he is leaving and he gives you the 1 finger salute, then turns away from the hospital in the opposite direction.

Do you have a duty to follow up, have the ambulance track him down, or can you simply sigh and cover this with a solid chart?  Every system is different.

You make the call.

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28 thoughts on “You Make the Call – Walk in”

  1. Bless their hearts (that’s southern for something nasty)!! Document PCR only, also an incident report signed by those present with all the details. At least you didn’t have to drive across town for this idiot, too bad they don’t do that more often.

  2. Bless their hearts (that’s southern for something nasty)!! Document PCR only, also an incident report signed by those present with all the details. At least you didn’t have to drive across town for this idiot, too bad they don’t do that more often.

  3. I would document document document. Still fill out a Pt. Refusal and have my on looking crew, hopefully including some collar brass witness it. He has every right to refuse transport, granted he could have been a bit nicer about it.

  4. you hunt this obvious belligerent guy down, you could get in a bundle of trouble if he gets in an accident trying to ‘get away’ or files a complaint for harassment. if the guy doesn’t care about his health, why should you loose sleep over it. you do your job, and that is your duty, not forcing legally competent (no altered loc, drugs or alcohol) people to pay thousands of dollars for an possibly unnecessary ride to the er. do good refusal documentation (including the salute), post patch and maybe give the sup a buzz. then have a nice, stress free dinner.

  5. I would document document document. Still fill out a Pt. Refusal and have my on looking crew, hopefully including some collar brass witness it. He has every right to refuse transport, granted he could have been a bit nicer about it.

  6. you hunt this obvious belligerent guy down, you could get in a bundle of trouble if he gets in an accident trying to ‘get away’ or files a complaint for harassment. if the guy doesn’t care about his health, why should you loose sleep over it. you do your job, and that is your duty, not forcing legally competent (no altered loc, drugs or alcohol) people to pay thousands of dollars for an possibly unnecessary ride to the er. do good refusal documentation (including the salute), post patch and maybe give the sup a buzz. then have a nice, stress free dinner.

  7. YOU CAN’T FIX STUPID! We all do this because we care about people, we try our best to give them good medical recomendations based on how they present and their medical history, Or as much of it as they will share with us. Once they leave and refuse everything, I just fill out a PCR with the details and let it go at that, we usually see them again sometimes sooner than later. BUT I am not chasing them down. You can’t save them all. I KNOW,,,I KNOW,, BUT THEY WILL SUE YOU>> BS,,,, In 20 years never been sued yet! Because I stick to the basics, and KISS. Keep it simple stupid!

  8. YOU CAN’T FIX STUPID! We all do this because we care about people, we try our best to give them good medical recomendations based on how they present and their medical history, Or as much of it as they will share with us. Once they leave and refuse everything, I just fill out a PCR with the details and let it go at that, we usually see them again sometimes sooner than later. BUT I am not chasing them down. You can’t save them all. I KNOW,,,I KNOW,, BUT THEY WILL SUE YOU>> BS,,,, In 20 years never been sued yet! Because I stick to the basics, and KISS. Keep it simple stupid!

  9. Document, I would even contact an EMS supervisor and get my company officer involved (hopefully he was there as a witness) and maybe follow up with an interdepartmental memo to describe the situation in more detail. If he comes back, treat him just as nice, but instead of an ambulance, call for the LEO’s.

  10. Document, I would even contact an EMS supervisor and get my company officer involved (hopefully he was there as a witness) and maybe follow up with an interdepartmental memo to describe the situation in more detail. If he comes back, treat him just as nice, but instead of an ambulance, call for the LEO’s.

  11. I may have a unique take on this so please bear with me, This patient showed up to have you check him out. you checked him out and didnt find anything that would flag you for an Immediate threat other than his complaint of Pain. Due to the fact that he was alert and oriented he has the right of autonomy which states Basicly that you can choose what type of treatments you get and can choose to die if you so Choose. you did your job by doing an assesment on him. you informed him of the risks of refusal, he showed understanding, you called the medical director and he still refused, and he refused to sign the patient refusal. You had plenty of witnesses that you did everything right. when you get a patient refusal and they will not sign the PR form we have always been told to write on the signature line that “Patient refused to sign” although this may not hold up in all areas Besides you have the medical director on the phone you can explain that the patient refused to sign the Patient refusal and he can take it from there. Our Medical director has been known to have people arrested (for thier own good) but that is completely situational……

    Definition of AUTONOMY
    1: the quality or state of being self-governing; especially : the right of self-government
    (according to Merriam- webster dictionary)

  12. I may have a unique take on this so please bear with me, This patient showed up to have you check him out. you checked him out and didnt find anything that would flag you for an Immediate threat other than his complaint of Pain. Due to the fact that he was alert and oriented he has the right of autonomy which states Basicly that you can choose what type of treatments you get and can choose to die if you so Choose. you did your job by doing an assesment on him. you informed him of the risks of refusal, he showed understanding, you called the medical director and he still refused, and he refused to sign the patient refusal. You had plenty of witnesses that you did everything right. when you get a patient refusal and they will not sign the PR form we have always been told to write on the signature line that “Patient refused to sign” although this may not hold up in all areas Besides you have the medical director on the phone you can explain that the patient refused to sign the Patient refusal and he can take it from there. Our Medical director has been known to have people arrested (for thier own good) but that is completely situational……

    Definition of AUTONOMY
    1: the quality or state of being self-governing; especially : the right of self-government
    (according to Merriam- webster dictionary)

  13. In my system we actually have an outcome status for this.. it is called “RMA by action” The fact is just as i have now to right forces unwanted treatment on an alert pt, I also cant force them to talk to my doc or sign my paper. So i document it and move onto the next job

  14. In my system we actually have an outcome status for this.. it is called “RMA by action” The fact is just as i have now to right forces unwanted treatment on an alert pt, I also cant force them to talk to my doc or sign my paper. So i document it and move onto the next job

  15. From a co-worker earlier today: “I read your blog about the walk in. I remember the one finger salute! I think I was there that day, but that’s not at all what the person who came to the door looked like dude. Are you allowed to lie like that?”
    Required, actually.

  16. From a co-worker earlier today: “I read your blog about the walk in. I remember the one finger salute! I think I was there that day, but that’s not at all what the person who came to the door looked like dude. Are you allowed to lie like that?”
    Required, actually.

  17. I’m sorry but when he said that he didn’t want to go to the hospital…..the assessment stopped there PERIOD! There is no further action, no talking to MEDCOM via phone, no contacting a supervisor. Give him the form and let him sign, send him on his way….the door is over there! If he doesn’t sign, then document that he didn’t. I don’t have the time to waste to make some idiot go to the hospital. Thats his choice. Doubtful I would have requested an ambulance before he said he wanted to go the hospital anyway. Why waste a resource for nothing.

  18. I’m sorry but when he said that he didn’t want to go to the hospital…..the assessment stopped there PERIOD! There is no further action, no talking to MEDCOM via phone, no contacting a supervisor. Give him the form and let him sign, send him on his way….the door is over there! If he doesn’t sign, then document that he didn’t. I don’t have the time to waste to make some idiot go to the hospital. Thats his choice. Doubtful I would have requested an ambulance before he said he wanted to go the hospital anyway. Why waste a resource for nothing.

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