When does a Person become a Patient? I have had this argument dozens of times and am curious what others have to say. The scenario is you are called to an MVC. Upon arrival you find that no one is injured and there are no complaints. The accident is property damage only. Are Refusals necessary? Why? Does our presence at the incident make them patients, or do complaints and injuries make them patients?

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Who called an ambulance? If it was a bystander then the occupants of the car did not call you and have no obligation to sign anything. If it was the people in the car who initially said they were hurt, or weren't sure, then they are patients and need to officially state that they dont want your care after all. (they are informed of who you are, the risks and they give no consent to treat) Thats my understanding anyway....
Well, your duty is to stil check their B/P and vitals. Check head, neck,etc.
If they refuse treatment or a ride get an AMA never know when a call will bite ya back in the butt. Remember CYA!
Actually, it's more like Nathan describes. For you young folks, this wasn't nearly the problem before the advent of the cellphone and what we lawyers call "officious intermeddlers" - people who call in incidents, often without knowing anything at all about what's going on.

A person becomes a patient when (a) he or she calls EMS and and requests help, or (b) when he or she has apparent injuries and someone else called for help. Just because they are a person at the scene of an MVC to which we were called does not make them a patient (at least in our county and according to our protocols). If they answer "no" to "Did you call for medical help?" and "Are you hurt?" then in our world they are not patient. No "refusal," no ePCR, etc.
well unlike the fire dept we still have to check everyone even the green tags. CYA
"If they were involved in the incident that provoked the call for service in any way, legally they are then OUR patients."

not true.
If they never requested help they are not and never were our patients. Im not saying dont give everyone the once over, but if they didnt request help they are not necessarily required to sign anything.
Chance Gearheart said:
If they were involved in the incident that provoked the call for service in any way, legally they are then OUR patients. In this litigious society, yes, anyone who you make physical contact with gets a refusal signed if they don't want to go. If you do not do this, you've just committed abandonment of your patient.
In the extreme case, does that mean that if a car with 4 belted occupants crashes into a motorcycle and throws the rider, you have to stick around on scene with the biker dying in the back of your ambulance while a second unit shows up to handle refusals lest you "abandon" the uninjured patients? Or is that ambulance allowed to go as long as there's a second one en route to handle the refusals?

Your lawyers have probably told you the truth for your region (let's face it, there are always weird local conditions legally). If so, that sucks--most of the rest of the country doesn't have to get refusals on people who don't want our help and weren't the ones who called.

Of course, there's also a cynical side of me that thinks your bosses have found a way to pad the patient count each year. ;)
Where I work in Indianapolis we are lucky and have a 3rd option, other than SOR/ROT, and nothing. About 3 years ago we developed a one page form we call a CRASH CARD, that has basic demographic information of our "patients." These forms are of course only for the patients that have no complaints (and generally no significant MOI, if my reaction to seeing the car is "that looks liked it hurt" I'd be inclined to at least do an SOR) It also has a place for a signature and a half page tear-out to hand to the patient, explaining to them to call 911 if their lawyer needs a new boat, and that they actually don't have anything to complain about.
The only thing about having them sign a true AMA is that if they're not hurt, is EMS or the command physician they answer to actually going to "medically advise" them to go to the hospital? If command says it's OK to release them, or you say they can be released without command notification, they are not actually AMA, because you can't refuse advise you weren't offered. I know it sounds like I"m splitting hairs, but the point I'm getting at is if these people did not call and obviously not hurt, what are they really refusing? and why?

MK said:
Well, your duty is to stil check their B/P and vitals. Check head, neck,etc.
If they refuse treatment or a ride get an AMA never know when a call will bite ya back in the butt. Remember CYA!
As far as someone here mentioned a second unit to respond to get refusals, that reminds me of something a year or so back. I heard on our dispatch channel an off duty EMT requesting an ambulance to respond to an accident they came across where nobody was hurt...they wished a unit to come to scene to get refusal forms signed. Is it me, or does this seem a little absurd? I mean, if I roll up on an accident off duty, and everyone says they're fine, I don't think I need to call an ambulance to come to scene for the purpose of getting them to refuse services that they know up front they didn't want.
JED

blair4630 said:
As far as someone here mentioned a second unit to respond to get refusals, that reminds me of something a year or so back. I heard on our dispatch channel an off duty EMT requesting an ambulance to respond to an accident they came across where nobody was hurt...they wished a unit to come to scene to get refusal forms signed. Is it me, or does this seem a little absurd? I mean, if I roll up on an accident off duty, and everyone says they're fine, I don't think I need to call an ambulance to come to scene for the purpose of getting them to refuse services that they know up front they didn't want.
It is a little absurd. It's ridiculous.

And Chance, I guess I'd have to ask you for the legal authority that supports your proposition that everyone at a crash scene is our patient. I've been around and researching this for a long time, and never have heard any such proposition. Remember your basic tort law - duty, breach of duty, damages, and causation. Your duty doesn't begin until the patient requests you to provide service. So, no duty, no tort (negligence, abandonment, etc.). In other words, I think that your statement is incorrect. If a person says "I'm not hurt and didn't request an ambulance" then end of discussion. If they've got an obvious injury, then further encouragement might be in order.

Why some feel that we have to force ourselves on everyone at a scene is beyond me......

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