Comments on: Sign here please http://medicmadness.com/2010/02/sign-here-please/ Just another EMSBlogs.com site Tue, 07 Feb 2012 04:00:00 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: SeanEddy http://medicmadness.com/2010/02/sign-here-please/#comment-41 SeanEddy Fri, 05 Feb 2010 22:51:52 +0000 http://www.medicmadness.com/?p=139#comment-41 Great point you make on the stubbed toe. In the area that I work, we do not have a "declines transport" option. We only have an AMA form for them to sign. This is actually the first that I have heard of any systems having anything but AMA forms. I learn something new everyday!Our system unfortunately sets us up for liability. We do not require base contact to obtain an AMA. The paramedic or EMT (yes we actually send BLS units on some 911 calls) just has the patient sign and they call it good. It doesn't even require the signature of the responder on scene. Now when I worked up north, we did have to make base contact to obtain an AMA, so I am not surprised to hear of that type of system.I actually agree more with the way your system works as it protects the responders better and eliminates much of the gray area that we have. Thanks for the reply! I love hearing about how other systems operate. Great point you make on the stubbed toe. In the area that I work, we do not have a “declines transport” option. We only have an AMA form for them to sign. This is actually the first that I have heard of any systems having anything but AMA forms. I learn something new everyday!Our system unfortunately sets us up for liability. We do not require base contact to obtain an AMA. The paramedic or EMT (yes we actually send BLS units on some 911 calls) just has the patient sign and they call it good. It doesn't even require the signature of the responder on scene. Now when I worked up north, we did have to make base contact to obtain an AMA, so I am not surprised to hear of that type of system.I actually agree more with the way your system works as it protects the responders better and eliminates much of the gray area that we have. Thanks for the reply! I love hearing about how other systems operate.

]]> By: the Happy Medic http://medicmadness.com/2010/02/sign-here-please/#comment-40 the Happy Medic Fri, 05 Feb 2010 21:19:27 +0000 http://www.medicmadness.com/?p=139#comment-40 Glad my thoughts get other folks thinking too.Great post and you bring up some points many folks new to the business miss.We have two signature areas on our forms, "Patient Declines Transport" and "Refusal of Care Against Medical Advice." I rarely have to use the latter because of my holistic detective coersion skills (sweet talking grandma into the rig) but on the rare occasion we do have someone who refuses against our advice my protocols require MCEP contact.Unfortunately many times I'll hear the trauma center (where our MCEP is) slammed and not want to bother them with an obvious AMA, but I still have to.An AMA in my system requires 2 Paramedic signatures and the MD name noted, but starts with me having them read the language of the refusal out loud to their family. That usually does the trick.When you mention playing it safe and just taking people in instead of signing AMA, I'm wondering why a stubbed toe would have to sign AMA instead of just a refusal of transport. If I advise them to stay home and they want to go in anyway, against my advice, do they still have to sign?Do you have a "Declines transport" option that is not AMA? Glad my thoughts get other folks thinking too.Great post and you bring up some points many folks new to the business miss.We have two signature areas on our forms, “Patient Declines Transport” and “Refusal of Care Against Medical Advice.” I rarely have to use the latter because of my holistic detective coersion skills (sweet talking grandma into the rig) but on the rare occasion we do have someone who refuses against our advice my protocols require MCEP contact.Unfortunately many times I'll hear the trauma center (where our MCEP is) slammed and not want to bother them with an obvious AMA, but I still have to.An AMA in my system requires 2 Paramedic signatures and the MD name noted, but starts with me having them read the language of the refusal out loud to their family. That usually does the trick.When you mention playing it safe and just taking people in instead of signing AMA, I'm wondering why a stubbed toe would have to sign AMA instead of just a refusal of transport. If I advise them to stay home and they want to go in anyway, against my advice, do they still have to sign?Do you have a “Declines transport” option that is not AMA?

]]> By: Sean Eddy http://medicmadness.com/2010/02/sign-here-please/#comment-256 Sean Eddy Fri, 05 Feb 2010 17:51:00 +0000 http://www.medicmadness.com/?p=139#comment-256 Great point you make on the stubbed toe. In the area that I work, we do not have a "declines transport" option. We only have an AMA form for them to sign. This is actually the first that I have heard of any systems having anything but AMA forms. I learn something new everyday! Our system unfortunately sets us up for liability. We do not require base contact to obtain an AMA. The paramedic or EMT (yes we actually send BLS units on some 911 calls) just has the patient sign and they call it good. It doesn't even require the signature of the responder on scene. Now when I worked up north, we did have to make base contact to obtain an AMA, so I am not surprised to hear of that type of system. I actually agree more with the way your system works as it protects the responders better and eliminates much of the gray area that we have. Thanks for the reply! I love hearing about how other systems operate. Great point you make on the stubbed toe. In the area that I work, we do not have a “declines transport” option. We only have an AMA form for them to sign. This is actually the first that I have heard of any systems having anything but AMA forms. I learn something new everyday!

Our system unfortunately sets us up for liability. We do not require base contact to obtain an AMA. The paramedic or EMT (yes we actually send BLS units on some 911 calls) just has the patient sign and they call it good. It doesn’t even require the signature of the responder on scene. Now when I worked up north, we did have to make base contact to obtain an AMA, so I am not surprised to hear of that type of system.

I actually agree more with the way your system works as it protects the responders better and eliminates much of the gray area that we have. Thanks for the reply! I love hearing about how other systems operate.

]]> By: the Happy Medic http://medicmadness.com/2010/02/sign-here-please/#comment-255 the Happy Medic Fri, 05 Feb 2010 16:19:00 +0000 http://www.medicmadness.com/?p=139#comment-255 Glad my thoughts get other folks thinking too. Great post and you bring up some points many folks new to the business miss. We have two signature areas on our forms, "Patient Declines Transport" and "Refusal of Care Against Medical Advice." I rarely have to use the latter because of my holistic detective coersion skills (sweet talking grandma into the rig) but on the rare occasion we do have someone who refuses against our advice my protocols require MCEP contact. Unfortunately many times I'll hear the trauma center (where our MCEP is) slammed and not want to bother them with an obvious AMA, but I still have to. An AMA in my system requires 2 Paramedic signatures and the MD name noted, but starts with me having them read the language of the refusal out loud to their family. That usually does the trick. When you mention playing it safe and just taking people in instead of signing AMA, I'm wondering why a stubbed toe would have to sign AMA instead of just a refusal of transport. If I advise them to stay home and they want to go in anyway, against my advice, do they still have to sign? Do you have a "Declines transport" option that is not AMA? Glad my thoughts get other folks thinking too.
Great post and you bring up some points many folks new to the business miss.
We have two signature areas on our forms, “Patient Declines Transport” and “Refusal of Care Against Medical Advice.” I rarely have to use the latter because of my holistic detective coersion skills (sweet talking grandma into the rig) but on the rare occasion we do have someone who refuses against our advice my protocols require MCEP contact.
Unfortunately many times I’ll hear the trauma center (where our MCEP is) slammed and not want to bother them with an obvious AMA, but I still have to.
An AMA in my system requires 2 Paramedic signatures and the MD name noted, but starts with me having them read the language of the refusal out loud to their family. That usually does the trick.
When you mention playing it safe and just taking people in instead of signing AMA, I’m wondering why a stubbed toe would have to sign AMA instead of just a refusal of transport. If I advise them to stay home and they want to go in anyway, against my advice, do they still have to sign?
Do you have a “Declines transport” option that is not AMA?

]]> By: SeanEddy http://medicmadness.com/2010/02/sign-here-please/#comment-39 SeanEddy Thu, 04 Feb 2010 06:33:19 +0000 http://www.medicmadness.com/?p=139#comment-39 Wow, that's really interesting. I never heard of such a thing in the states. For us it's either transport or refuse. We do have one option of classifying the call as a "public assist" for calls like helping someone to their bed, or things that come with no complaint of pain or medical abnormality. However these do not require signatures. Wow, that's really interesting. I never heard of such a thing in the states. For us it's either transport or refuse. We do have one option of classifying the call as a “public assist” for calls like helping someone to their bed, or things that come with no complaint of pain or medical abnormality. However these do not require signatures.

]]> By: Medic999 http://medicmadness.com/2010/02/sign-here-please/#comment-38 Medic999 Thu, 04 Feb 2010 05:06:34 +0000 http://www.medicmadness.com/?p=139#comment-38 I have the same concerns over in the UK. I have sat on many clinical practice panels for cases where medics have had a patient sign a refusal of treatment form after advising them that they don't need to go.Now, I know it's different for me as I actually can advise patiets that they don't need to go, or that they do but they can go in their car, bus, taxi etc. I then get then to sign my 'respond not convey' form which has various sections to tick ranging from a true refusal all the way down to 'assistance only, no medical care required'However, the most important thing I do, and it's something I haven't heard any one else do, is my little speech I give to the patient which consists of" blah blah blah, sign here. Now then this is not you refusing treatment the decision we have come to is based on my assessment and findings and then my advice. It all sits on my shoulders and not yours. However, by signing this you are stating that you are happy with my advice but you are also agreeing that you will call back if you feel your symptoms worsen or a new urgent or emergency problem crops up, ok?"To take on 'respond not convey' you HAVE to be willing to take on the responsibility too. I have the same concerns over in the UK. I have sat on many clinical practice panels for cases where medics have had a patient sign a refusal of treatment form after advising them that they don't need to go.Now, I know it's different for me as I actually can advise patiets that they don't need to go, or that they do but they can go in their car, bus, taxi etc. I then get then to sign my 'respond not convey' form which has various sections to tick ranging from a true refusal all the way down to 'assistance only, no medical care required'However, the most important thing I do, and it's something I haven't heard any one else do, is my little speech I give to the patient which consists of” blah blah blah, sign here. Now then this is not you refusing treatment the decision we have come to is based on my assessment and findings and then my advice. It all sits on my shoulders and not yours. However, by signing this you are stating that you are happy with my advice but you are also agreeing that you will call back if you feel your symptoms worsen or a new urgent or emergency problem crops up, ok?”To take on 'respond not convey' you HAVE to be willing to take on the responsibility too.

]]> By: Sean Eddy http://medicmadness.com/2010/02/sign-here-please/#comment-254 Sean Eddy Thu, 04 Feb 2010 01:33:00 +0000 http://www.medicmadness.com/?p=139#comment-254 Wow, that's really interesting. I never heard of such a thing in the states. For us it's either transport or refuse. We do have one option of classifying the call as a "public assist" for calls like helping someone to their bed, or things that come with no complaint of pain or medical abnormality. However these do not require signatures. Wow, that’s really interesting. I never heard of such a thing in the states. For us it’s either transport or refuse. We do have one option of classifying the call as a “public assist” for calls like helping someone to their bed, or things that come with no complaint of pain or medical abnormality. However these do not require signatures.

]]> By: Medic999 http://medicmadness.com/2010/02/sign-here-please/#comment-253 Medic999 Thu, 04 Feb 2010 00:06:00 +0000 http://www.medicmadness.com/?p=139#comment-253 I have the same concerns over in the UK. I have sat on many clinical practice panels for cases where medics have had a patient sign a refusal of treatment form after advising them that they don't need to go. Now, I know it's different for me as I actually can advise patiets that they don't need to go, or that they do but they can go in their car, bus, taxi etc. I then get then to sign my 'respond not convey' form which has various sections to tick ranging from a true refusal all the way down to 'assistance only, no medical care required' However, the most important thing I do, and it's something I haven't heard any one else do, is my little speech I give to the patient which consists of " blah blah blah, sign here. Now then this is not you refusing treatment the decision we have come to is based on my assessment and findings and then my advice. It all sits on my shoulders and not yours. However, by signing this you are stating that you are happy with my advice but you are also agreeing that you will call back if you feel your symptoms worsen or a new urgent or emergency problem crops up, ok?" To take on 'respond not convey' you HAVE to be willing to take on the responsibility too. I have the same concerns over in the UK. I have sat on many clinical practice panels for cases where medics have had a patient sign a refusal of treatment form after advising them that they don’t need to go.
Now, I know it’s different for me as I actually can advise patiets that they don’t need to go, or that they do but they can go in their car, bus, taxi etc. I then get then to sign my ‘respond not convey’ form which has various sections to tick ranging from a true refusal all the way down to ‘assistance only, no medical care required’
However, the most important thing I do, and it’s something I haven’t heard any one else do, is my little speech I give to the patient which consists of
” blah blah blah, sign here. Now then this is not you refusing treatment the decision we have come to is based on my assessment and findings and then my advice. It all sits on my shoulders and not yours. However, by signing this you are stating that you are happy with my advice but you are also agreeing that you will call back if you feel your symptoms worsen or a new urgent or emergency problem crops up, ok?”
To take on ‘respond not convey’ you HAVE to be willing to take on the responsibility too.

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