refuse ambulance transport

[ngas]

If I refuse ambulance transport (after I have a complex partial seizure in public), am I legally responsible to pay for the service if they force me to go despite my refusal?

 

[darcness]

This is a good question. I know that here in Michigan they can't actually take you against your will if you're cognisent enough to make the decision. This happened the last time the EMT's were here actually. They asked my wife a bunch of questions and she answered them correctly and so they said there was nothing they could do.

I would imagine this varies from state to state though so perhaps some one from your area can give you more information.

 

[Rae1889]

I manitoba, when you call an ambulance it cost $400 dollars, and it is not covered by manitoba health unless you take the ride, and the ER deems it necessary.

For instance. If someone thinks they broke their leg, they are at a park with a friend. It is better that they call a friend or family member to pick them up, as this is not deem an emergency.

But being unconscious is considered an emergency especially if there was seizing and/or bleeding involved.

But I do find it wrong when someone calls an ambulance while you are having a seizure in public and you are now held responsible for the bill. the person who called should be responsible, especially if you are wearing a medic id bracelet that gives instructions on your seizures. IF you said no, and they did it anyway, then yes they should pay, not you.

 

[danjor]

Im not sure how it is elsewhere, but here in louisiana. They can't take you against your will. That may be considered kidnapping (especially in my case since I'm a minor) haha. I know that you have to sign a release saying that you refuse services. I have never been responisble for any bills if I didn't go. A lot of times the ambulance will come because someone will call 911 when I have a seizure. Even if it is a little one.

 

[Cint]

I've had many CP seizures in public and never had an ambulance called. Why would they force you into an ambulance just because of a CP seizure? I've also had TC seizures in public. Several times 911 was called, but I wasn't taken to a hospital. They waited until I was conscious, was able to speak and someone was able to take me home. No bill.

 

[Nakamova]

I know the EMTs were called for me on one occasion (here in Massachusetts), but when it turned out I didn't need to go the hospital, there was no charge.

 

[ngas]

I know the EMTs were called for me on one occasion (here in Massachusetts), but when it turned out I didn't need to go the hospital, there was no charge.

Who decides wheather you need to go to the hospital?

90+% of the time people who have seizures do not need hospitalization. Professional first responders should know this & give a seizure victim a 5 minutes to get out the post ictal phase.

 

[Crystal11]

If they feel that your life is in danger or you should go to the hospital to get checked out and its absolutely necessary then they will take you, whether you want to or not. You can have your doctor write a note telling them not to take you if that is your wish. You might call up your local EMS department and ask them what the procedure is.
I had EMS called on my twice and I have complex partial seizures. Both time they waited until I was able to communicate better, then asked me if I felt I needed to go. They have medications and treatments with them to help if something happened.

Please take care-
Crystal

 

[Nakamova]

In my case the EMTs waited until I was conscious and asked me questions as I became alert. Even though I was still fuzzy (I couldn't tell them what month or day it was), I could tell them that I had a seizure disorder, and I was under a doctor's care. I think that's key -- if the condition is new/undiagnosed, then there's a risk that the seizure is from an infection/head trauma/drug reaction and the EMTs will play it safe and take you to the ER.

On another occasion, the decision to take me to the ER was made before I became conscious unfortunately. I woke in the ambulance just before we got to the hospital, and even though I was fine and didn't need to be there, I did have to pay for the ambulance and ER visit (or at least the parts that my health insurance didn't cover).

 

[RobinN]

In our case, I was told that once the ambulance was called they are required by law to transport that person to the hospital.

Only when I the caregiver have been present at that time and have been willing to sign a waiver that doesn't hold the EMTs responsible for liability are they willing to then not transport. However they do call the hospital and give them all the vitals and tell them that I am present and these are my wishes.

I think it is a good idea, if you live in a particular area, to go have a discussion with your local paramedics. I think that a more personal approach is really important. They can help you decided how to handle this sort of situation. They are covering their backsides though in case of a lawsuit.

 

[morgan86]

i used to have them @ school and was a minor a nd ut was covered as far as i know. then when i started having them in public i was responsible. i think im in the collection agency. lol. i should look into that. i just wish people understood the protocal.. i dont even know what it is for sure..

 

[ngas]

i used to have them @ school and was a minor a nd ut was covered as far as i know. then when i started having them in public i was responsible. i think im in the collection agency. lol. i should look into that. i just wish people understood the protocal.. i dont even know what it is for sure..

The protocol should be : the EMTs need to ask a few simple "conscience gauging" questions (like what day is it? etc.) & then ask the same questions again 3 mins later to see if there is an improvement in the responses. If so, then they know that the victim is coming out of the post ictal phase.

 

[Loopy Lou]

Luckily i've only been in the back of an ambulance once, when i had the tc in the nightclub in dec last year.

They said that they really thought they should take me to hospital as at that time i was undiagnosed, but i refused outright. By the time i'd been sitting in the ambulance 5-10 minutes or so, i was coming round properly. They insisted that i should at least get a taxi home, but luckily the place is only a short walk from my house, so my brother walked me home. I had to sign a form and stuff, and they told me in no uncertain terms that if i was refusing to go to hospital, then they couldn't be held responsible.

 

[BuckeyeFan]

An EMTs View

Sorry if this is long - but I hope it answers some questions for everyone.

For the newer members here, I was a volunteer EMT for 20 years.

Any laws mentioned here are for Ohio, but most of them extend elsewhere.

Emergency - When a squad is called, it is by law considered an emergency situation until determined otherwise. That is one of the reasons we were required to always respond with lights and siren unless there were mitigating circumstances. This did not matter who called, because that is not always determined before the response. Many times with seizures, the call would go out as unresponsive which is always considered serious.

Required Transport - Any adult who is cognitive may refuse transport to the hospital. The key here is being cognitive and postictal states can make that hard to determine. In our heads, we may be thinking we are responding correctly, but the EMT will be seeing something different. Other times, a family member can help determine this level of awareness.

Our requirement was to have the patient sign off on our run sheet if cognitive. We would document the situation, review it with them including our recommendations, and then have them sign (witnessed). Even if we agreed they did not need transport, we still followed this procedure. Much of that was due to liability, but it also gave us that last chance to review their cognitive state.

Once in awhile, people would even refuse to sign off and we would just document the heck out of our response and leave them be.

Implied Consent - Our law considered anyone unconscious to have implied consent for treatment. That would include a seizure. Now the extent of the treatment was based on the situation. Whatever was medically appropriate was protocol. That could include simply waiting for the patient to clear the postictal state. Each situation was different. Good histories were important. Someone undergoing a medicine change or missing doses may be pushed a little harder to get checked out due to the risk of a repeated seizure. Implied consent can be reversed be the patient responding. Being a small town and familiar with repeat patients gave us a better view of these situations.

Minors - Anyone under the age of 18 was not allowed to sign off for themselves. If a parent or other person we deemed responsible was present, they could sign off the same as an adult.

In fact, once we were called to an emergency, we became legally responsible for that minor until turned over to further medical care or the guardian. Letting them go created an abandonment situation on our part. This is quite the opposite of the kidnapping Danjor described. We could be in big time trouble for not taking care of them.

Billing - Our local squad did not bill for non-transports. We did not have that many and many insurances did not cover them. Since we were a non-profit volunteer unit, we did not have an issue with this.

In the cities with Paid Medics, budgets simply require them to bill. They need the funds to operate. They also have situations where fire dept. paramedics respond, but transport is by private ambulance services. Don't know how that is handled. Many cities have had to cut back on services due to lack of funds.

EMT View - Over 20 years, I saw a wide variety of situations with E. Common sense was always a rule with our crew. For a volunteer squad, we had some very experienced well trained individuals who understood this fully. Unfortunately, that is not always available in every area. There are always going to be rookies. Every EMT has to start somewhere.

The legal side would quite ofeen drive much of the situation as well. Yes, we were covering our backsides, however with all the lawsuits today, who could really blame us. We did this for free. We didn't need to lose our houses over a mistake.

 

[seizingbeauty]

In Montreal, our first responders are the Fire Department, then the EMTs. It usually gives me enough time to get it together, so I have refused repeatedly and there was no cost.
I did have a seizure at a company I was working for. They insisted that I go and under the law they were resonpsible for the bill.
If I am not coherent enough to refuse I have to foot the bill and my company insurance only covers 2 trips a year.

 

[skillefer]

Here in cali, you can refuse transport, or someone may refuse on your behalf. This is why I have the school call my hubby first if I have a seizure. That way, if Im still loopy, he can refuse transport for me. I really don't need an $800 cab ride to the er, just to hear the doc say I need to go see my doc.

This does not always work. ONe time, I got hijacked. I was coming out of a seizure and in post ictal state. The EMT asked if I wanted to go to the hospital while nodding his own head yes. I was trying to lock onto him, so I nodded along with him. I'm still PO'ed about that bill. $800 to go 3 blocks. That's just wrong.

 

[Loudmouth]

I have only been to hospital twice with my seizures, once for my first once and once about 2 yrs ago when I fractured my jaw and tore my shoulder muscle. I knew I had badly hurt myself and needed to go. All the other times I have refused to go. I had one in my bank a while ago and they called the ambulance even though I said not to. The paramedic crew made me sign a waiver to say that I had refused to be taken to hospital. I think it's to cover them in the event of something else happening. I try to make plain to the people arounf me not to call an ambulance when I've had a seizure, I've had a bad experiece at my local hospital the last time I went after a seizure so Unless I hurt myself badly, I wont go again and the ambulances wont take me to another hospital the next nearest in both directions are about 30-40 miles away and not in my primary care trust area.

 

[Aubrey]

I have got some strong, and granted unreasonable feelings about this. Here (here being South Carolina) EMTs refuse to work with people with E in a post-ictal state. Here the response to "just give me a minute" is you give us permission or we will escort you on to the stretcher with or without your permission. No joke. Now that I am more edjumacated, I believe I was falsely imprisoned in the back of an ambulance. That was years ago and I am still POed and I still want my $400 back, not to mention the hours I spent staring at a curtain where I dutifully waited to be discharged. Now maybe they could try educating the people they put in the front of the ambulance...

 

[John-Forrest]

This irks me, too...

This has been going for several years in the town where I live. Everytime I have a grand mal in public - they drag me away to the ER whether I like it or not. Usually by the time they arrive I'm coming to while they cross-examine me what day it is, who is the President of the United States (who cares?), my name, DOB, stuff like that. I make a frantic attempt to explain to them I just need some time to get it together while they're strapping me down as if I were headed for the loony bin. This past weekend, I just tore the intensive care wires off my body and walked out! Luckily, I get state insurance, Mass Health, in MA, but still, it's wasting tax payer's money and the ER room's time.

The only reason to take me in is if I'm bleeding or something, even that tends to be relatively minor. I think we epileptics should have some rights here!

 

[Brent]

I worked in the ER for about 5 years and was an EMT for another 5. I can tell you that this can be a dicy one. Keep in mind the laws vary from state to state and county to county (and even between fire districts), but here's the problem. Let's say I am the EMT that shows up after you have had a SZ. I don't know you from anyone else. I see people every day that really need medical help, but refuse. Some of these people seem cognizant, yet are really not. Others seem less cognizant, yet are completely aware of the implications of their decision.

The measure is generally based on a concept called "informed consent". A person can refuse medical treatment (including transport to a medical facility) if they are informed about the risks involved in the decision. This is where it gets dicy. Generally speaking, a minor cannot be "informed" since the law considers that a minor cannot be fully aware of the consequences of their actions, and therefore are not and cannot be responsible for such as decision.

Let's take low blood sugar for example though. Frequently I would show up to a call and a person's blood sugar would be, say, in the 50s. This is quite low. It would almost kill me. Yet, some people routinely get that low and are fully aware of their condition and the risks. The ability to answer questions clearly and rationally is not a good measure. I have had a very calm and rational discussion with a person who only agreed to a blood sugar test after about a half hour of persuasion. Had I taken his word for it that he was OK, I would have missed the fact that his blood sugar was 34. Most people are unconscious at 34, and some people are dead/dying. Had we left, he would have died with almost certainty.

This sort of decision happens all the time - like every day.

OK, so let's talk about seizures. From the perspective of the EMT, not knowing your medical history, the decision is very similar to the blood sugar emergency. You may be talking normally and answering questions correctly, but that doesn't mean you are OK. It is just very difficult to tell. All I know is that you had a seizure, and I don't know why. Now, if this was the 10th time I had been to your house, I would know something about your history and be more comfortable leaving once I saw that your vitals were good.

OK, now here's the problem from your perspective. If you are taken by force against your will, also something that happens on a regular basis, you might have reasonable grounds for refusing to pay. Keep in mind, people are taken in by force on a regular basis. All sorts of medical conditions result in combative behavior. EMTs see it EVERY day. However, if you reluctantly agreed to go with them, that is considered consent in most states. Frequently, EMTs will be very persistent and persuasive. They really don't like to leave a person who has had a medically significant event. If that person goes downhill or even dies, that's not only tough emotionally, but can ruin an EMT legally.

My advice to all people with frequent seizures is to go down to your local fire dept (or whoever is likely to be first on scene at your house or place of work) and introduce yourself. Find out what the guidelines are for refusal of transport in your area. They should be able to tell you what the policy is and give you tips for what to do when the EMTs show up and you want to refuse transport under informed refusal of care.

I'm lucky. In my area I know everyone, as I used to work with most of them. So, for me it's not a problem. When I move, I will go down to the fire department though and say, "Hi."

-B