Up to and including death

This is a phrase I see a lot in my line of work.  There are a number of variations including another favorite “seizure, coma, death” that are designed to cover the hind quarters of the author in some half cracked attempt at documentation.

For you folks out there who will swear up one side and down the other that you were told by an EMS Anchor that if that phrase isn’t included you’ll goto court and get sued for malpractice, just take a deep breath and relax, Sparky.

Your local policy likely includes guidelines for patients to be eligible to refuse transport, care or a combination of both in certain circumstances.  For example, the patient must be alert, oriented and not under the influence of alcohol, understand the risks involved with refusing an assessment or transport and sign acknowledging that they understand…you know, the basic stuff.  When I see so many less than EMT-Basic calls being completed and the risks of refusing transport for a hand abrasion include “patient advised of all risks including seizure, coma, death” I have to shake my head and laugh.

Funny part is that this blanket statement calls into question the rest of your document most times.  Do you really believe the hand abrasion will lead to death?  In what fashion?  If it is such a risk, why isn’t the patient being transported?

A more accurate statement could be “patient advised of risks of infection and advised how to avoid repeat injury.”  BAM!  That simple statement covers you far more than the giant heavy blanket of death.

So dial back the drama and have an honest discussion with your patients, otherwise get ready to explain to me or someone like me why you were worried this was a possibly mortal wound.

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5 thoughts on “Up to and including death”

  1. I think the majority of medic’s have used similar statements in their careers @ some point in time. Not to CYA, as the majority of your article assumes, but to convince the patient or their family members that it is in their best interest that they seek further medical attention. I’ve actually used this successfully in the past. The one caveat I’d include here is that generally I wouldn’t use it for a minor abrasion as you suggest. More for that sick looking patient, who’s story doesn’t quite add up, with ‘normal’ vitals and wants to wait it out so to speak. Then they go to the ED a few days later and are septic and get admitted to the ICU. Just another perspective so to speak.

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