So have you ever heard the phrase, “You call, we haul?” That comes with a certain mindset and one that I think has seen its time pass in EMS. All too often, however, I think that our providers and services focus on us as a transportation service and not a health care service. The worst part is they will often be the ones who complain the loudest about the patients who use us as a taxi service, all the while working hardest to be a taxi service.
No More “You Call, We Haul”
This comes back to the challenge of responsible patient refusal policies and making sure we are doing a complete patient assessment and providing them the information to make an informed medical decision. Art Hsieh wrote an article recently at EMS1.com about getting stuck in the “You Call, We Haul” mindset. He was referring to an article about a Spokane, Washington incident involving a man who died in police custody after refusing treatment by paramedics.
The paramedics involved are being questioned about whether they should have transported this patient to the hospital even though he exhibited no immediate signs or symptoms of a problem. The man claimed to have ingested methamphetamines and later died in police custody at the jail. I don’t like to second guess providers in situations like this one.
Protect Yourself with Good Documentation
What I prefer to do is look at ways we can all protect ourselves in a similar situation. Art’s article points to the patient’s family asking why didn’t we do our jobs and take this guy to the hospital? I want to point out that you can provide a protective barrier to your own exposure to problems like this is not to just take them all to the hospital and let the ER sort them out.
The solution to this issue is education on patient refusal policy and responsibility coupled with really good documentation. I, for one, write a longer narrative for a refusal than I do for a patient I transport. I want to make sure I document my assessment findings and everything I told the patient so I can back up my claim with the refusal that the patient made an informed decision.
So protect yourself from the “you call, we haul” mindset while still enabling yourself to take a responsible patient refusal. There is a happy medium.
Find the link for this and all the news items plus additional resource links in the show notes for this week’s episode of the MedicCast — Changing EMS Jobs and Episode 325.