Up to and Including Death: A Variation on a Theme

Justin nails it.

I just wanted to add a few thoughts on the matter.

When I first started writing reports, this was a topic that was so glazed over that I hardly remember any discussion on the concept. Then again, I spent a majority of my EMT-Basic and Paramedic classes in a fatigue induced haze, and I’m surprised I remember anything at all.

I was no surprise to me that when I arrived in Memphis I had hardly done refusals, and I ended up doing a lot of them. People where I was from (and trained) only called an ambulance when they wanted to go to the hospital, and they needed to. Calls for service that basically amounted to basic first aid are common place here and in just about every major city. I got really good at doing refusals (declinations, as we are speaking in legal-ese, but it amounts to what is commonly known in the business as a refusal) and I was always sure to include that phrase “up to and including death” on all the tickets because it went the farthest in what could possibly happen.

As I matured, however, and I started blogging, I thought “how ridiculous is it to threaten someone that they may die from the blister on their heel?” So I sought about to change the way I thought. Sadly, there are ZERO models to chose from, so I basically had to invent my own. Justin goes far enough to explaining the consequences of the reason they called, and that is primarily what I do. It just amuses me that I had been taught wrong all those years by medics who sought only to reduce liability, but when you actually READ the refusal document it does that for you.

You really should read what you’re having people sign, by the way. I even had to explain it to a city attorney and you would figure that a lawyer would have read the document when presented with it.

So, when you do a refusal, not much further explanation is required unless you genuinely believe that this person may die. I’ve had chest pain patient refuse care, I had an old lady die 8 hours after refusing care from a massive MI. As my medical director said: “could we be more persuasive? Maybe. But we can’t force someone who is in their right mind from doing something they don’t want to do, even if we think it’s stupid.”

This article was written by rstine