A call for EMS services is generally considered “consent” for providers to treat and transport an emergent patient. If the patient is conscious and cognitive, it is still recommended to ask their permission to treat and transport them.
“Implied Consent” applies when a true emergency exists, and the patient is unable to give permission. This may be due to one of the following:
Unable to communicate because of an injury, accident, illness, or unconsciousness and suffering from what reasonably appears to be a life-threatening injury or illness
Suffering from impaired present mental capacity
A minor who is suffering from what appears to be a life-threatening injury or illness and whose parents or guardian is not present
In the case of a minor child, a parent or guardian may give consent. When a parent or guardian is not present, it is acceptable to assume that treatment and transport permission is “implied”. The care should be limited to life-threatening emergencies and no “prophylactic” measures taken not immediately required to save life or limb.
A patient should be transported to the appropriate medical facility according to the following priorities:
Patient / family choice
If the patient or family has NO PREFERENCE, the patient should be transported to the facility serving as Medical Control for the current week.
Diversion is a medicolegal term that indicates that a hospital is “at capacity” and unable to safely assume care of patients. This may be due to a full ED, no in-patient beds, limited staff, or limitation of a specialized service. When a medical facility notifies EMS that they are “on divert” and the type of divert, EMS shall transport patients to the alternate hospital.
Note: Priority 1 medical patients are to be transported to the CLOSEST medical facility for stabilization before being transported to a definitive facility. Priority 1 trauma patients are to be transported to the CLOSEST designated trauma center.
Patients transported to another facility not dictated by the above priority list should have the reason documented in the EMS medical record. Except in cases of scheduled transfers, patients are NOT to be transported to a doctor (or other care provider) office from the scene; but only to an appropriate medical facility.
Patient refusal of treatment and/or transport shall be respected. A patient may refuse treatment/transport under the following circumstances:
The patient does NOT have an altered mental status
The patient is of legal age (> 18 y/o)
The patient is not in lawful custody
In the case of suspected acute intoxication, it is advisable for law enforcement personnel to take the person into “protective custody” so they may be transported to a medical facility for assessment.
When the patient (or guardian) is refusing treatment/transport, they should be informed of any risks of refusal, including inability to assess the problem, deterioration of condition, and/or death. If the patient still refuses, this should be documented in the patient record and signed by the patient or guardian. In any situation in which EMS providers truly feel that the patient may be in danger, contact Medical Control for advice.