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Question
EMS may call the hospital to obtain online medical direction when a patient does not wish to come to the hospital. One difficult task faced by the physician at the hospital is determining the decision making capacity of the patient. There is currently no nationally recognized standard protocol for physicians providing EMS oversight in this situation.
The four components involved in the determination of capacity are: understanding, appreciation, reasoning and expression of choice. This study used a modified Delphi approach with 19 physician experts to develop standardized steps to guide best practices for physicians who are called in real time about a patient refusing EMS transport. Consensus was defined as 80% agreement.
The example worksheet with the compilation of recommendations is attached.
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References
Carrillo, E. A., Ignell, S. P., Wulfovich, S., Vernon, M. J., & Sebok-Syer, S. S. (2024). Critical Steps for Determining Capacity to Refuse Emergency Medical Services Transport: A Modified Delphi Study. Prehospital Emergency Care, 1–6. https://doi.org/10.1080/10903127.2024.2403650