Year: 2025
Type: article
Abstract: When emergency medical service (EMS) arrives on the scene, it is estimated that patients end up declining treatment and/or transport around 5% to 10% of the time. When a patient is suspected of having a life-threatening emergency and declines care, these cases are deemed "high-risk refusals," as the subsequent delay in treatment drastically increases the risk of morbidity and mortality, as well as the legal risk for all those involved. These cases warrant careful consideration and deliberate training, not only among EMS professionals and EMS medical directors but also among any in-hospital physicians providing online medical oversight. To mitigate the risk associated with high-risk refusals, EMS systems and emergency departments should have standardized policies and guidelines in place for managing these cases, just as with any other complex, high-risk procedure. State statutes should be referenced and ideally legal counsel should be consulted when developing these guidelines. Checklists and quick references are recommended, and calling online medical supervision should be strongly encouraged. EMS medical directors should also routinely review high-risk refusal charts and include these cases in their ongoing quality improvement and quality assessment efforts.
Authors: Bryan McNeilly, W. Ann Maggiore, Mat Goebel, Michael O’Brien, Nicholas Cozzi, Navin Ariyaprakai, Thomas Lardaro, Michael Weinstock
Institutions: University of Washington, University of New Mexico, Mercy Medical Center, University at Buffalo, State University of New York, Rush University Medical Center, Rutgers Health, Rutgers New Jersey Medical School, Yale University, The Ohio State University Wexner Medical Center, The Ohio State University
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,600
OpenAlex ID: W4408163059