TL;DR
Patient Refusal: Competent patient right to refuse care, requiring documented informed refusal with risks explained.
Patient Refusal
Definition
Competent patient right to refuse care, requiring documented informed refusal with risks explained.
Related Procedures
Procedures related to patient refusal in the EMS setting:
- STEMI protocol: 12-lead ECG within 10 min then aspirin 324mg then NTG if SBP >90 then notify cath lab then transport code 3
- Pediatric weight-based dosing: Broselow tape for length-based weight estimation in emergencies
Professional Standards
Professional standards for patient refusal are established by the relevant certification body and regulatory agencies. Certified professionals must demonstrate competency through examination and maintain credentials through continuing education. Scope of practice is defined by state law and facility policy. Never perform tasks outside your authorized scope.
Practical Example
Field Scenario: A 65-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. 12-lead shows ST elevation in leads II, III, aVF (inferior MI).
This scenario tests your ability to apply knowledge of patient refusal under time pressure with incomplete information, exactly the type of decision-making the certification exam assesses.
Key Values & Ranges
Key values and ranges relevant to patient refusal in prehospital care:
| Parameter | Adult | Pediatric |
|---|---|---|
| respiratory rate | 12-20 breaths/min | 25-50 (infant), 15-30 (child) |
| blood pressure | 90/60-120/80 mmHg | 70+(2*age) systolic minimum |
| blood glucose | 70-140 mg/dL | 60-100 mg/dL (neonates lower) |
| ETCO2 | 35-45 mmHg | 35-45 mmHg |
Equipment & Tools
Equipment used in patient refusal assessment and treatment:
- Pulse oximeter
- Measures SpO2 via infrared absorption through capillary bed. Available sizes: Finger clip, Earlobe, Pediatric wrap
- King airway
- Supraglottic blind-insertion airway device. Available sizes: Size 3 (4-5 ft), Size 4 (5-6 ft), Size 5 (over 6 ft)
- Waveform capnograph
- Measures end-tidal CO2 continuously with waveform display. Available sizes: Mainstream (inline), Sidestream (sampling)
Patient Communication
Communication about patient refusal in the prehospital setting includes: explaining procedures to the patient in simple terms, obtaining informed consent when possible (implied consent for unresponsive patients), providing a calm and reassuring presence, and delivering a structured handoff report (SBAR: Situation, Background, Assessment, Recommendation) to the receiving facility.
Why It Matters
Refusal documentation requirements tested on EMT exam.
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