Here's a hypothetical scenario for you. You respond for a call from SWAT, they have a pregnant 15 year old in custody complaining of abdominal pain after some minor trauma during the arrest process. She is currently in police custody and wishes transport for evaluation. While on scene PD decides they are not going to charge her with anything and are releasing her. She suddenly changes her mind and does not want transport or any further care from you. She wants to walk back to her aunts house where she stays.
First instincts is that its sounding like a "get out of jail free card". We see it all the time here, people on the verge of arrest vain medical complaints. Non specific history. We provide transport and they go ama as soon as they arrive at hospital.
In the case of the patient here, we apply the frasier competence (gillecks competence) that states that a child can refuse treatment provided the clinician is happy that the child has capacity so understands what is going on.
I'd probably speak to the aunt and if close by to scene offer a lift home. If that's refused then it kind of reinforces my earlier get out of jail point.
Finally I'd document everything and consider a safeguarding children risk assessment to social services if there is a child protection issue.
I would attempt to get her Aunt or parents to come and decide whether or not she is transported. The girl does not have a choice. Even though she is pregnant, at 15 she does not have the right to give or refuse consent. If the Aunt or her parent's can't be contacted, she has to go to the hospital. If she still refuses, I would involve the police or the coroner. The best solution would be to involve her family. As Neil said, document everything.
It's my understanding that a pregnant minor is considered emancipated and does have the right to make medical decisions including the right to refuse EMS transport. Aside from emancipation, we still need to look out for the best interest of the patient. She is 15 and was just involved in an altercation with the police. She may be scared and not thinking of making the best choice. So I would still try to involve family if I felt transport was warranted. But ultimately she is considered emancipated and is legally able to make the decision.
My original post was based on what I have been taught. I understood that being pregnant did not automatically emancipate a minor. They could make decisions for the fetus and issues related to the pregnancy but that was all. Upon further research, I have found that in Louisiana a minor may give consent for medical care. http://biotech.law.lsu.edu/la/consent/la_consent.htm#minor_consent
I would still do everything I could to either get the girl to consent to transport or leave her with a family member. This assumes that she has the present mental capacity to understand what she is doing. If not, then we still have to find a way to get her to go with us.
Since she's pregnant, and involved in some sort of traumatic injury inducing action, I'd try to coax her to go.. Maybe have her speak to the OMC, if anything, for the sake of the child - in the child. ha ha
The Commonwealth of Pennsylvania's Patient Refusal Protocol, Criteria Footnotes, state:
2. If the patient is 18 years of age or older, has graduated from high school, has married, has been
pregnant, or is an emancipated minor, the patient may make the decision to consent to or refuse
treatment or transport. A minor is emancipated for the purpose of consenting to medical care if
the minor’s parents expressly, or implicitly by virtue of their conduct, surrender their right to
exercise parental duties as to the care of the minor. If a minor has been married or has borne a
child, the minor may make the decision to consent to or refuse treatment or transport of his or her
child. If the minor professes to satisfy any of the aforementioned criteria, but does not satisfy the
criterion, the EMS practitioner may nevertheless comply with the decision if the EMS practitioner,
in good faith, believes the minor.
3. If a patient who has the capacity to make medical decisions refuses to accept recommended
treatment or transport, the EMS practitioner should consider talking with a family member or
friend of the patient. With the patient’s permission, the EMS practitioner should attempt to
incorporate this person’s input into the patient’s reconsideration of his or her decision. These
persons may be able to convince the patient to accept the recommended care.
4. For minor patients who appear to lack the capacity or legal authority to make medical decisions:
a. If the minor’s parent, guardian, or other person who appears to be authorized to make
medical decisions for the patient is contacted by phone, the EMS practitioner should have a
witness confirm the decision. If the decision is to refuse the recommended treatment or
transport, the EMS practitioner should request the witness to sign the refusal checklist of
b. If a person who appears to have the authority to make medical decisions for the minor
cannot be located, and the EMS practitioner believes that an attempt to secure consent
would result in delay of treatment which would increase the risk to the minor’s life or health,
the EMS practitioner shall contact a medical command physician for direction. The
physician may direct medical treatment and transport of a minor if an attempt to secure the
consent of an authorized person would result in delay of treatment which the physician
reasonably believes would increase the risk to the minor’s life or health.
c. If a person who appears to have authority to make medical decisions for the minor cannot be
located, the EMS practitioner believes an attempt to secure consent would result in delay of
treatment which would increase the risk to the minor’s life or health, and the EMS
practitioner is unable to contact a medical command physician for direction, the EMS
practitioner may provide medical treatment to the and transport a minor patient without
securing consent. An EMS practitioner may provide medical treatment to and transport any
person who is unable to give consent for any reason, including minority, where there is no
other person reasonably available who is legally authorized to refuse or give consent to the
medical treatment or transport, providing the EMS practitioner has acted in good faith and
without knowledge of facts negating consent.
5. The medical command physician may wish to speak directly to the patient if possible. Speaking
with the medical command physician may cause the patient to change his or her mind and
consent to treatment or transport.