I’m not sure that there’s a single person working in EMS that doesn’t wish we had the ability to tell people that they “don’t need to go to the hospital”. The 2am calls for stubbed toes and restless leg syndrome have frustrated us all. Even worse, sitting in the back of the ambulance with a patient complaining of constipation as you here an ambulance from the next town over being dispatched to a cardiac arrest right by your location. It’s irritating, it’s frustrating, it’s annoying, and it’s a misuse of healthcare. I’ll be the first to admit that something needs to be done to fix it. However….
We aren’t ready to start refusing care.
Go ahead, sharpen the pitchforks, light up the torches and wake up the mob, but please hear me out before you come storming my village. I’m going to give you 3 reasons why we aren’t ready to refuse care to our patients, and then I’ll follow it up next week with another article giving 3 solutions to the problem.
We Aren’t Trained for It
Having the natural ability to say “this dude doesn’t need to go to the hospital” doesn’t count as a skill. Let’s face it, we have never been formally trained to decide who needs treatment and who doesn’t. Our educational requirements are severely lacking and to think that we are ready to be the end of the road in our patient’s course of treatment is unrealistic at this point. Do I think we need to get to a point where we can do this? Absolutely! We just aren’t ready right now.
Here’s the thing, as it currently stands, aside from the select few bold EMS systems out there, only ER doctors are telling patients that their complaint isn’t an emergency. Nurses aren’t doing it, PA’s aren’t doing it and we really shouldn’t be doing it either without some serious increases in educational requirements. Emergency departments (in most states) have the ability to refuse care to non-emergent patients, they just don’t. Even in those instances where they do, they still require a medical screening exam by a physician to determine if the patient is having a medical emergency. What’s the point in all this? No matter what, they’re going to see a doctor and that doctor will ultimately make the decision.
No Legal Protection
Following a protocol isn’t going to be enough to protect us and our medical director. We need some serious documented training to back us up. I also firmly believe that we need some serious tort reform to ease some of the legal burden from us.
Medical malpractice is a funny thing. If you honestly try to do the right thing, you’re generally OK…at least as far as EMS providers go. When we are refusing to treat and transport a patient, that starts a whole new ball game for us. We can point to our protocol all we want, but we ultimately have to make that judgement call and we have to be ready to back that decision up should we find ourselves in the hot seat. No matter how you try to spin it, that’s going to be tough to do if the patient suffered because they didn’t receive treatment.
We Aren’t Designed to be the End-Point in Treatment
This goes hand-in-hand with my training argument. All of our treatment protocols have one thing in common: They all end with us handing our patient off to a physician at an emergency department. This is a big reason why we are allowed to do all the things we do, because a physician is ultimately going to take responsibility for the care of our patient. By refusing treatment, we are essentially discharging our patient and establishing ourselves as the end-point in their treatment plan. That’s a big deal.
Like I said, I firmly believe that we need to get to this point. However, it needs to be done by raising the bar in our industry and holding ourselves to a much higher standard. Actually I’ll go as far as saying that EMS will have to start doing this at some point unless we want our systems to be completely overrun with cases that should be handled by a personal physician.
If we want to establish ourselves as a true community healthcare provider, we have to start stepping our game up now. Let’s push for higher educational standards and a culture of real professionalism.
Don’t agree with me? Comment below and let’s get this conversation going!
I currently live and work as a paramedic in North Texas. I've been involved in EMS since the age of 18, and have essentially spent my entire adult life doing what I love. My passion is helping my fellow first-responders achieve successful and rewarding through healthy minds, bodies and wallets. I love talking to and meeting new people, so please don't hesitate to reach out and say hi!