5-12 DETERMINATION OF CAPACITY

Notes:

• This protocol addresses determining whether an individual has the capacity to refuse care and/or transport in the prehospital setting.
• Determining if a patient has capacity to refuse care should be done systematically and carefully to ensure patient safety and protection of the crew.
• For patients < 18 years old, contact medical control for management recommendations.

 

EMR/EMT/AEMT/Intermediate/Paramedic

A patient can refuse care/transport if these 3 criteria are met:

1. Patient demonstrates understanding of information relevant to the decision in question.
   1. Understands that there they may have a medical issue and why there is concern for decompensation.
2. Patient has the ability to weigh risks and benefits, and to assess alternative options.
   1. Transport with EMS for ongoing assessment/care and to ED for further evaluation.
   2. Private transport without ability to have ongoing assessment/care—risk of deterioration or death.
   3. No transport for evaluation—risk of deterioration or death.
3. Patient can communicate clearly with medical providers about the decision in question, and verbalize the ultimate decision.
   1. (Patient makes statement, “I have decided X because of Y, knowing that Z could happen.”)

Notes:

1. The patient must be consistent when the provider is assessing these areas.
2. Providers must also clearly document this conversation occurred, and an impression as to whether patient demonstrates capacity in medical decision making.
3. Prehospital providers are capable to make this assessment.  However, if there are any concerns or questions establishing capacity, medical control should be contacted.
4. If uncertainty exists about a patient’s ability to demonstrate capacity and the provider has concern about the necessity of a medical evaluation and the patient refuses, consider involving law enforcement.
5. Occasionally, a patient may not be able to fully demonstrate capacity.  If no significant or immediate concerns exist, the provider may consider leaving the patient with an associate/family member/friend who is determined to have capacity and agrees to the care plan of the individual in question and will pursue further evaluation if the status of the patient changes.
6. If there is concern for a suicide attempt or suicidal ideation, law enforcement MUST be involved if the patient is determined to have decision making capacity - but is refusing transport.