GUEST EDITORIAL By Thom Dunn, NRP, PHD
20 JUNE 2015 | EMSWORLD.com
EMS IS CALLED to a local drinking establishment
for a report of a bar fight with injuries. After arriving
on scene and checking in with the police, the crew
is directed to a 22-year-old male standing outside,
holding a bloody bar towel to the upper left quadrant
of his abdomen. "I've been stabbed in the gut!" he
shouts. The attending paramedic finds a strong radial
pulse of 124 and directs the man to start walking
toward the ambulance. "I'm not going to the hospital,
and you can't kidnap me!" he shouts even louder. The
paramedic calls medical direction, which asks, "Is he
sober and competent?"
EMS providers are regularly challenged with ethical
issues during the course of their work. Ethical dilem-
mas are situations that present with no clear right
answer and where more than one course of action
can be defended.
In the case above, there is a patient with penetrat-
ing trauma to the abdomen. In any EMS system, this
is a priority patient. But wait: He is objecting to treat-
ment and transport. The ethical dilemma is created
due to our value of patient autonomy and shared
decision-making between provider and patient.
However, many would argue this patient is at high risk
for a bad outcome if he doesn't seek medical care.
I started thinking about these issues long after I
started working in EMS in the 1980s. I'm an active
paramedic field instructor for an urban EMS system,
Evaluating Patients' Decision-
Making Capacity
Some may wish to decline needed care—should you allow it?
© Jones and Bar tlet t Publishers. Cour tesy of MIEMSS.