Careers: EMT/Emergency Medical Technicians/preventing implied consent
QUESTION: I have epilepsy, and I occasionally get seizures as a result. I'm good at detecting them and always get myself to a safe place when I feel them coming. I've never been hurt by the effects. Naturally, if I'm around strangers at the time, this freaks them out and some well-meaning soul will call 911 for an ambulance. However, I no longer have health insurance, and am afraid that this might happen one day and I would be deemed not to have that capacity to refuse treatment under the doctrine of implied consent. I can't afford to pay for the treatment, and I know from past experience that it is not needed. It was one thing in my smaller town when I knew all the crews and they would just make sure there was nothing obviously wrong and leave me be; I'm living in a big city now and am assured that I would get a crew who knows nothing about me. That being the case, is there some way I can prevent the forced treatment? Is it for example, feasible to carry around a living will or other document stating "I do not consent to emergency medical treatment under any circumstances"? Would a medic alert bracelet with a similar message work? Or is my only option to leave the scene before the medics arrive? Please do not comment on the advisability of refusing or avoiding treatment; I understand and accept the risks of doing so.
ANSWER: Hello Xavier,
Unless you are alert and able to refuse the ambulance has a duty to transport you. To have them not transport you you would have to (by a written note alone), that it would be inconceivable for you to be unconscious for any reason other than having a "normal" seizure. Thinking of that statement I hope you can see why the crew wouldn't honor that kind of request. They would put jobs, certifications, and the ambulance company on the line in hopes that it was "only" a seizure and when (if) you woke up you would walks away happy and not have you or your family sue the medics, the company, the place you had a seizure at, and the person who called 911 because you had an obstructed airway and now have a brain injury from being without oxygen for several minutes, or having had a stroke (yes... anyone at any age can have one). The ambulance crew, acting on written protocols set by the medical director of that region has probably written an "altered mental status" protocol that may cover seizures that says-- attempt to restore consciousness if at all possible. If the blood sugar is low give glucose, if it's high give saline, if there is evidence of a narcotic overdose give Narcan, if it looks like a cardiac problem give.... (and so on)--
Since none of these treatments will result in you waking up instantly, they are obligated in taking you to the hospital.
My one thought is that you have someone with you who can vouch for you, and take full responsibility for you in-case... A legal authorization written by a lawyer and signed by a lawyer and physician may help? (but is probably an expensive piece of paper?).
I hope this answered your question even if it wasn't the answer you had hoped for. Stay safe...
---------- FOLLOW-UP ----------
Thank you for your prompt and courteous reply. I confess, I was a somewhat confused by the second sentence of your reply, though. For the record, I "wake up" from my seizures rather quickly, and every time an ambulance has been called, I was already awake by he time the crew arrived.
Just to clarify, let's say I am awake, but am nonetheless deemed to have altered mental status by the ambulance crew. If I have a person with me who is duly designated as a healthcare power of attorney with a properly executed original document, this person can refuse evaluation/transport on my behalf, particularly if there is a living will so desiring such refusal. I'm assuming, of course, this person is also of legal age, awake, alert and oriented, etc. Is that correct?
Aside from that, if I feel I might be deemed to have altered mental status, the only way to avoid transport would be for me to leave the scene before any official first responder arrives, since you say that any document I would have would carry no weight. ( I was going to just say ambulance crew, but I have learned that in this area fire/police often arrive first.) Is that also the case? (I'm further assuming I haven't been in an MVA that it would make it illegal to leave the scene, of course)
Please do not think I don't appreciate the work done by Police/Fire/EMS. My father and several relatives were police officers, and a guy I used to play soccer with was a volunteer fireman who was killed in a MVA while responding to a call. Thank you!
Hello again Xavier,
Ok.. to clarify more,
For the ambulance to release you you would need to be alert and oriented to "time, place, and who you are" (questions that may be asked are- whats your name, date of birth, who is this person with you, what day is it, about what time of day is it, who's the president...").
You will have to prove you understand any dangers of refusing medical care ("do you understand you may have another seizure, you could fall- hit your head- and have brain damage, you could stop breathing and die"). (I know a little dramatic but crews always like to through in the death card as a way of making it more serious)
You should show you have a good plan for getting home and staying safe (show that you know you have to have someone with you to supervise... you're not going to drive a car or walk 6 miles through the city to get home, and you will call 911 if you need help).
A knowledgeable friend or family member who can take charge and has a paper showing they are your POA should work as well. A living will is usually used in end of life decisions for shutting off life support in the hospital or deciding not to continue with extraordinary lifesaving measures in the hospital or nursing home.. not so much in the field with EMS.
Police generally don't have a lot of EMS training and would rather not get involved with the medical aspect. they don't want the liability of making a decision that you are ok to refuse transport and you won't come back and sue them. They will probably want the ambulance to make that determination.
The fire department, though they have trained EMS people will probably want to wait for the ambulance and have them make the determination that you can safely refuse transport.
Yes.. leaving the scene before anyone gets there would work, as long as they cant find you (simply walking into the public bathroom won't work. I have often assessed people who have fainted while shopping, got up an walked to the bathroom and was shown where the patient had gone by store security and managers). be a block away with a friend if you can.
I hope this was a little more understandable, stay healthy.