I had an EMT shift with four consecutive canceled calls. Here is how it went down:
It was another day of working on the weekends. After three months on the job, everything was more manageable, and workflow became a familiar process. I would show up dressed in my uniform, clock in on time, and check out the rig I was assigned. After checking and restocking the rig, we were ready to receive calls from dispatch.
On our first call, we arrived on scene at a nursing home. My partner and I arrived at the patient’s room and got a report from the nurse. The nurse expressed how the patient suddenly became agitated and denied any visitors from entering her room. With that in mind, I asked to enter the patient’s room to get their vitals. Before every transport, we would always check the patient’s vitals to ensure that they were within normal limits for transport. Upon entering, I received a strong message from the patient to leave the room. Of course, I complied and walked out of the room.
In the event that a patient denies care or transport, it is an EMT’s duty to ensure that the patient is able to make that decision for themselves.
If they are of sound mind to make that decision:
-
- acknowledge their rights to deny care
- explain the potential consequences of their refusal of care or transport.
- after the patient fully understands the consequences but still denies care, refusal of care documentation must be signed by the patient.
And so that was what we did. At the door, I expressed the reasons why we needed to get their vitals, why we were transporting them, and the potential health consequences if the patient did not comply. But still, the patient refused. After consulting with the nurse and dispatch, we had the patient sign an acknowledgment that they were refusing transport, and we made our way through the nursing home halls with an empty gurney.
It was our first canceled call, so we took our time to properly document the report. Once done, we headed to the hospital to transport a patient to receive dialysis. Once we arrived in front of the patient’s room, the patient was nowhere in sight. Perplexed, we asked the staff and found out the patient had been discharged the day before. It was common for patients or hospitals to schedule routine visits, like dialysis. And so, without a patient to transfer, my partner and I walked back to the rig with the empty gurney left untouched from the previous call.
It was now about three hours in, with two canceled calls.
After finishing up the report, we received a call to transport a patient from one hospital to another. Once we arrived, I got the patient’s history from the nurse while my partner checked in with the patient and their family. It came to our attention that the patient required an IV drip to run while in transport. Managing an IV drip was outside of our scope of practice. We were just a BLS (basic life support) unit. The patient would require a medic unit (a nurse or paramedic onboard) to keep the IV running. And so, the nurse scheduled another transport with the medic unit and canceled the call. We updated the patient and their family, then walked back to the rig.
It was three for three. My partner and I were highly optimistic that we would be able to transport on our next call. It was unlikely to receive a canceled call, to begin with, let alone four canceled calls in a row. And so we thought…
We got a call to transfer a patient from the hospital back to their nursing home. As we collected our documents, attained the patient’s history and vitals, and ensured we had all of the patient’s belongings, we thought everything was going smoothly. While the nurse gave the patient report to the accepting nursing facility, some difficulties arose. Even though the patient had plans to return to their nursing home, they did not accept her. The patient developed scabies, an itchy skin rash caused by a tiny burrowing mite. The facility did not accept the patient because the disease can be contagious and spread quickly. After clearing up the situation, the nurse canceled our call. We walked our clean and unused gurney back to the ambulance.
After four canceled calls, I felt we had wasted our time. Not being able to transport a single patient after 8 hours into the shift made it feel like we were driving around aimlessly. But after some thought, it was not a waste of time. It is part of our job to respond to calls and transport patients, but it is also our job to ensure that the patient desires to be transported and that the transport is approved and possible within our scope of practice.
And so we drove to the medical center to respond to a call to transport a patient from the ER to the children’s hospital. When we arrived at the ER room, the patient was there (that was a good sign). After checking in with the nurse and the family, the patient’s guardian consented to transport, the transport did not need to be upgraded, and the patient did not have anything contagious to require isolation (all great signs too). Finally, after four canceled calls, we were able to transport a patient at the end of the day.