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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GUEST EDITORIAL 22 JUNE 2015 | EMSWORLD.com most EMS systems require the EMT or para- medic to assess the patient's capacity to decline transport and make contact with medical control. The case at the beginning is an extreme one, but exploring it can help frame how to approach such situations. Evaluating Capacity While the word competent is often used when discussing decision-making ability, such a term is typically reserved for use only by judges making legal decisions. 2 Our dis- cussion concerns medical decision-making ability (as opposed to the capacity to make other decisions, such as financial ones). The physician's question, "Is he sober and com- petent?" speaks directly to this. It means, "Are there features about this patient that impair his ability to make decisions?" including intoxication. It's important that EMS providers are able to evaluate medi- cal decision-making capacity. There are several different approaches to assessing decision-making capacity. I am partial to this one and use a modified ver- sion of it when working as a paramedic and or assessing patients as a psychologist. 3 1. Is the patient an adult without a guard- ian? In the prehospital arena, children may not refuse transport. Some adults also have guardians who make their decisions. In these instances the EMS providers deal with the patient's parent or guardian. 2. Can the patient communicate a choice about his or her care? For obvious reasons, if the patient cannot communicate their wishes, decisions have to be made by some- one else. I also believe patients who refuse to cooperate with an evaluation regarding their decision-making capacity fall into this category. By refusing to communicate with me, these patients are deemed as lacking decision-making capacity. Steps 3 and 4 are incumbent on the patient being able to process informa- tion. Inherent in these steps is whether the patient is free from an altered mental status and not under the influence of an intoxicat- ing substance. I also worry about patients with possible head injuries or other disease processes known to impair cognition (such as hypoglycemia, seizure/postictal phase, dementia, CVA, etc.). Be very careful about leaving patients behind who have central nervous system impairment and who you believe would otherwise benefit from ambu- lance transport. EMS providers need to be able to perform a thorough mental status I ALSO WORRY ABOUT PATIENTS WITH POSSIBLE HEAD INJURIES OR OTHER DISEASE PROCESSES KNOWN TO IMPAIR COGNITION. 888-240-4911 www.24-7ems.com You need to train your team. You need to keep them in the feld. You need an easy, fexible training solution. Offer your students unlimited-use seats and single course credits for easy access to individual e-learning and classroom delivery options, including streaming and DVD, that help you save time, money, and most importantly, lives. 1530-0009 GET TRAINING AS SERIOUS AS YOUR JOB For More Information Circle 21 on Reader Service Card

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