EMS World

JUN 2015

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | JUNE 2015 21 but I'm also a clinical psychologist in an academic medical center. As a psycholo- gist, I am regularly called upon to assess the decision-making capacity of patients who refuse lifesaving care. After several years of this, I was invited to sit on the hospital's ethics committee, where many issues are similar to the case above: Someone refuses care or cannot voice their wishes, and others make deci- sions for them. What struck me most was how many EMS providers face the same ethical dilemmas as physicians, but without the support often found in hospitals (such as on-call specialists like psychologists, an ethics committee, risk managers, legal department, etc.). This article is intended to help guide EMS providers through an ethical dilemma they encounter often: the patient who needs treatment but declines help. The Shared Decision-Making Model EMS providers and physicians share many parallels. Both meet their patients and ascertain a chief complaint, then form a clinical impression after taking a history and performing a physical exam and using other diagnostics. Options are discussed, and a treatment plan is decided upon. This model, "shared decision-making" (SDM), came about in the early 1990s and honors the patient's right to autonomy over their own body. 1 This is the bedrock of informed consent. The patient is given options, risks and benefits are explained, and the patient makes an informed choice. Conflict arises when the provider and patient are unable to reach a decision together about the best course of action, typically when the patient decides differently than what the clinician believes to be best. EMS providers regularly meet patients who decline ambulance transport. For example, there are individuals who are injured in motor vehicle collisions, but not sufficiently that they believe they need pre- hospital care and transport. Similarly, dia- betics who have become hypoglycemic and recovered after the administration of glu- cose often decline transport. In most EMS systems, the patient and provider complete paperwork documenting the patient's deci- sion not to be transported by ambulance. Often this paperwork documents the risks to declining care and that the patient has been informed of such risks in deciding against transport. Less common but far more risky are the patients who would likely benefit from transport and treatment who decide against it. In some instances these patient may be making decisions that will lead to death or disability. It's a fine line for the paramedic or EMT to walk: Respect the patient's right to autonomy to refuse care, while knowing such a decision may lead to that patient's death. In these instances, Developed in partnership with key professional training organizations, American Military University ofers public safety leaders: • Support through scholarship programs • Cohort class registration options • Financial incentives available for select partnerships TAKE THE NEXT STEP TOWARD YOUR LEADERSHIP GOALS. LEARN MORE TODAY AT PUBLICSAFETYATAMU.COM/EMS EMERGENCY MANAGEMENT & LEADERSHIP UNDERGRADUATE AND GRADUATE CERTIFICATES American Military University is part of the accredited American Public University System, and is certifed to operate by SCHEV. For More Information Circle 20 on Reader Service Card

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