Question: The new BLS that will be introduced in December 11, 2017 mentions that treatment and transport refusal would require the completion of the refusal of service. The question is whether it is required to be completed for any refusal of treatment or just treatment with possible negative outcome to patient example refusing collar vs. Dimenhydrinate or any analgesic?

Great question, this is usually covered well by service policy, and that should always take precedence locally. The key to the change is documentation of the negative consequences of not accepting a recommended provincial treatment or transport, and also the capacity of the person to decide. Patients may want treatment and hospital assessment but absolutely refuse an IV, as they are deathly afraid of needles, and be willing to accept the consequences of not having the IV on the way to the hospital. It is key for the medic to document these applications of the medical directives, and an explanation as to the reasoning and potential consequences and refusals of treatment with documentation of patient capacity. Please follow local service policy, and the MOH Ambulance Call Report Completion Manual as to how and where these refusals of treatment/transport are documented. In very difficult dynamic care circumstances dont be afraid to complete an incident report, discuss with a supervisor, and even a Base Hospital Self report as to what happened and why medical directives were not used. Documentation is key for these difficult cases.

The Ambulance Call Report Completion Manual can be found here: http://www.lhsc.on.ca/About_Us/Base_Hospital_Program/Medical_Directives/AmbulanceCallReportCompletionManualv3.0_Final.pdf

Documentation,Miscellaneous,Policy/Procedures,Refusal of Service

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