When is someone a patient?

[Jybehofd 85]

Recently this has come up at my job. When is someone a patient? If 6 cars bounce off each other minor damage too all vehicles and no one is complaining of anything, note everyone is up of the vehicles and walking around. Are they all patients? Is a PCR writtien as no patient found with the name of all the individuals that were asked if they were patients? What is the proper way?

[vtach39680 23]

a individual is a patient when

1. the person requests medial assistance (direct request)

2. a 3rd party requests medical assistance for an individual at their request (informed request)

3. a 3rd party requests medical assistance for an individual who can not request on their own (unresponsive, altered,) (implied request)

[sympathomedic 383]

If I may add in another scenario:

Someone has an MVA and DOES NOT ask for EMS and is NOT unconsciuous. Someone does call 911 and report it and and ambulance arrives. An involved person says, to the effect, "I have an abrasion on my arm from the airbag, but I am OK", or "My knee hurts from hitting the dash board but I think I am OK." I would say this common type of event makes these folks patients.

On the other hand, same collision scenario- no one asked for EMS but an ambulance gets sent due to caller info and the then all involved deny any complaint. I don't think those folks are patients. If you are not sick or hurt I don't feel you area patient. I bet the DOH has some info on this commonly discussed issue, but I am far too lazy to research it and post a link. And it may vary state by state. And State policy may allow for agency protocol.

[Dinosaur 844]

If I may add in another scenario:

Someone has an MVA and DOES NOT ask for EMS and is NOT unconsciuous. Someone does call 911 and report it and and ambulance arrives. An involved person says, to the effect, "I have an abrasion on my arm from the airbag, but I am OK", or "My knee hurts from hitting the dash board but I think I am OK." I would say this common type of event makes these folks patients.

On the other hand, same collision scenario- no one asked for EMS but an ambulance gets sent due to caller info and the then all involved deny any complaint. I don't think those folks are patients. If you are not sick or hurt I don't feel you area patient. I bet the DOH has some info on this commonly discussed issue, but I am far too lazy to research it and post a link. And it may vary state by state. And State policy may allow for agency protocol.

I would tend to agree with you but I was told before I retired that our commercial EMS agency would write up everyone as a patient and have them RMA. I later found out that they billed for this. THAT changed my opinion on the subject

[AFS1970 504]

I know of one town in NJ where EMS is sent on all reported MVA's regardless of reported injuries. The ambulance gets there and the police will say they want everyone checked out. From what I have heard this is some sore of perceived liability issue where the police want EMS to be the ones to say there are no injuries. So in this case even when people say they are not paients they seem to be patients none the less.

[velcroMedic1987 330]

I know of one town in NJ where EMS is sent on all reported MVA's regardless of reported injuries. The ambulance gets there and the police will say they want everyone checked out. From what I have heard this is some sore of perceived liability issue where the police want EMS to be the ones to say there are no injuries. So in this case even when people say they are not paients they seem to be patients none the less.

That is just asinine. Using that logic EMS should have gotten 600 RMA's at the MNRR train accident a couple weeks ago. Did they? Or did they just seperate those claiming injury from everyone else?

That PD has issues and the EMS agency is nuts if they put up with it.

[WAS967 97]

Recently this has come up at my job. When is someone a patient? If 6 cars bounce off each other minor damage too all vehicles and no one is complaining of anything, note everyone is up of the vehicles and walking around. Are they all patients? Is a PCR writtien as no patient found with the name of all the individuals that were asked if they were patients? What is the proper way?

The policy of your primary agency stipulates that a person is a patient if any of these three items are met:

1) The person requested medical assistance. (Either directly or indirectly)

2) The person appears ill or injured (subject to good clinical judgement).

3) There is a mechanism of injury that raises enough suspicion in the providers mind that injury could result (this obviously is open to large amount of interpretation).

Out of sheer CYA, if I roll up on an MVC that involves 6 parties and all of them state they are okay, I grab names and DOBs so that if later on down the road someone turns around and claims I never offered them assistance I have it documented that I made contact with all involved and they denied injury at that time.

Edited February 20, 2015 by WAS967

[Jybehofd 85]

Out of sheer CYA, if I roll up on an MVC that involves 6 parties and all of them state they are okay, I grab names and DOBs so that if later on down the road someone turns around and claims I never offered them assistance I have it documented that I made contact with all involved and they denied injury at that time.

So for sheer cya why not just RMA them. Now you have a half ass PCR with a list of names and DOBs n them... No exam on them or any other detailed information about the event... And for some odd ball reason it goes to court and the ambulance chafing lawyer asks why you didn't d a full assessment on there client(s). The RMA would only help in this situation to fully cover you from the fear of something happening.

Does having a dialog now make them a patient?

Where in the other hand writing no patient found states that you went to the MVA and found no patients and that the matter was being handled by the police. Simple done. The police report shows who was there thus to link who was involved in the accident. If something hurt or they felt the need for being treated it now rests on them to call again or seek other medical treatment.

[antiquefirelt 994]

This is a good question that certainly ought to have an answer consistent with agency policy. We struggle with this every few years and just now are looking for an actual documented policy.

The issue we seem to face is the MVA where some passerby calls 911, while no one in the MVA requests EMS or needs it. Along come our EMS crews who do full "refusals" on everyone at the scene. I've contended for many years that one of the "patients" could simply refuse to be evaluated, talk to EMS and flat out not sign a thing. Of course that would get documented. Really the full signed refusal is a CYA for the service and personnel. The problem comes when you're fairly busy and being tied up for 'no reason" causes further problems with responding to other calls. This just came up two shifts ago when the crews responded to a "property damage" MVA when 20 minutes later the driver reported to the LEO that he had a headache from striking his forehead on the steering wheel. Along comes Fire & EMS and finds 5 persons involved, three are minors with no parents available. No one needed EMS, all wanted to refuse all evals and any transport. Now we have a crew tied up trying to get sign offs for minors who were involved in a PD only MVA. In the end, they could have treated this as a single victim EMS responses due to how it was reported/requested.

There are many services that require refusals on everyone involved in an MVA they respond to, we do this 95% of the time, as our City Attorney feels it's much easier to defend things that are documented, vs. responding and not documenting any contact. His question has been: What's to stop someone from claiming they were injured and EMS never evaluated them to determine if they were at the time? I can see WAS 967's point of getting Name and DOB, which at least shows that you had some contact and backs up your claim that the denied wanting/needing EMS evaluation. Basically, the more that is documented the better? As far as taking that to the next level of conducting a full refusal? On our system each patient refusal takes about 1/2 hr (soup to nuts)...

[Jybehofd 85]

Yeah that is the question but it seems like it should be answered at the supervisor level or even higher I was original trained that a flycar medic does a fast triage takes a report on one patient and let's the BLS unit do the rest or do what there department has in SOP/GOPs for the situation But coming on scene and finding no patients can simple put it as a police matter no patients The answer I got from my job is to write paper on all persons involved no matter wha as a fly car medic because the BLS departments can't be trusted to do it...

But this was a verbal change. No policy memo or email on it

[EMTBrian 4]

Interesting question in my honest opinion. As simple as it may seem or sound of a question, It can actually at the same time be a complicated and tricky one to answer as well. Patients may very well be out of their vehicles, but in my honest opinion here, encourage patient to at least undergo a quick assessment. to legallh cover your you know what in this sue happy society we live amongst today. If they absolutely refuse, just gently advise them, they may feel and think they'e fine just because they are walking, and just encourage them to get evaluated at the hospital. If they refuse quick assessment, and hospital evaluation you've done your duty and job. Just explain as well you need their signature on the Patient Care Report attesting refusal to seek medical attention. Just do as you learned in class, and through the training you've undergone with your respective agency.

[WAS967 97]

So for sheer cya why not just RMA them. Now you have a half ass PCR with a list of names and DOBs n them... No exam on them or any other detailed information about the event... And for some odd ball reason it goes to court and the ambulance chafing lawyer asks why you didn't d a full assessment on there client(s). The RMA would only help in this situation to fully cover you from the fear of something happening.

Because an RMA is for patients. If they don't meet any of the aforementioned criteria of being a "patient" then there is no RMA to be done, plain and simple. If your agency has a policy that you do an RMA on everyone regardless, then so be it....RMA everyone. And the resulting report with names and DOBs is hardly half-assed. If it goes to court and they ask why I didn't assess their client I have documentation saying I made contact with them and they denied injury. Fact of the matter is, you can get sued for anything now-a-days. But I'm not going to start forcing people with no injuries to go through a long drawn out process (often in the cold because no ambulance can get there in a reasonable time) of an RMA when none is needed.

Does having a dialog now make them a patient?

If you pull up to a fender bender and everyone says they are okay and just need a police report, are they now patients?

Where in the other hand writing no patient found states that you went to the MVA and found no patients and that the matter was being handled by the police. Simple done. The police report shows who was there thus to link who was involved in the accident. If something hurt or they felt the need for being treated it now rests on them to call again or seek other medical treatment.

My report would show the same and just shows that an effort was made to ensure that everyone was okay and that medical care was offered and they declined. Unlike some providers I have seen who don't even bother to get out of the truck.

[NWFDMedic 58]

This topic is one that we've been arguing about for years in the EMS world. Agency policies come as a result of our litigious society and lack of common sense on the part of providers.

Regardless of your agency policy, when you arrive on scene of a call, it's your job to document what you found. If you arrive on the scene of a car that has literally just driven off the road due to snow and ice (a common theme this winter), then it's perfectly acceptable to document that there is no patient. However, writing "canceled, no injuries" does not suffice. Instead, you should document what you found and why you felt it acceptable to state that there were no injuries. This should include the names of the occupants and that you offered them a medical assessment.

If another agency cancels you, be sure to document the agency and, if at all possible, the name/shield number and rank of the person canceling you. Remember that the State (in New York, at least) puts the duty to act on the highest medical provider responding. If you pull up to a scene with significant damage and the PD is taking the driver into custody and they are denying him a medical assessment, you should explain to them that the patient should be assessed and sign off in the best interest of all involved. If they continue to refuse you access to a potential patient, obtain the name and shield number of the officer taking the patient into custody and, if possible, their signature refusing care of the patient. Sometimes, asking them for a signature will actually change their minds and at least let you do an assessment.

If a person has a complaint, no matter how vague, they become a patient. "I'm a little shaken up but I'm fine" is a complaint and warrants documentation of an RMA. If the patient has no complaint but there is damage or reports of mechanism indicative of potential trauma, that also warrants documentation of an RMA. If you have any question about either of these two, it warrants documentation of an RMA.

If your agency policy states that you do something, then you do it. However, if you don't have an agency policy, use some common sense and document, document, document, even if your survey of the scene and occupants leads you to the impression that there are no patients.

[antiquefirelt 994]

If you arrive on the scene of a car that has literally just driven off the road due to snow and ice (a common theme this winter), then it's perfectly acceptable to document that there is no patient.

Must be a regional terminology difference, I'd never heard of using "no patient" before coming to this forum. Every time I see that I imagine a report stating "we arrived found a vehicle off the road in the snow, no patient." Which would say to me, no one is around. Whereas your description alludes to a more detailed description of who may have been involved, but for the reasons you documented, they were not considered "patients". In our area reports of this nature typically use the term "upon arrival" or "upon investigation, EMS not needed".

Edited March 7, 2015 by antiquefirelt

[Dinosaur 844]

This topic is one that we've been arguing about for years in the EMS world. Agency policies come as a result of our litigious society and lack of common sense on the part of providers.

Regardless of your agency policy, when you arrive on scene of a call, it's your job to document what you found. If you arrive on the scene of a car that has literally just driven off the road due to snow and ice (a common theme this winter), then it's perfectly acceptable to document that there is no patient. However, writing "canceled, no injuries" does not suffice. Instead, you should document what you found and why you felt it acceptable to state that there were no injuries. This should include the names of the occupants and that you offered them a medical assessment.

If another agency cancels you, be sure to document the agency and, if at all possible, the name/shield number and rank of the person canceling you. Remember that the State (in New York, at least) puts the duty to act on the highest medical provider responding. If you pull up to a scene with significant damage and the PD is taking the driver into custody and they are denying him a medical assessment, you should explain to them that the patient should be assessed and sign off in the best interest of all involved. If they continue to refuse you access to a potential patient, obtain the name and shield number of the officer taking the patient into custody and, if possible, their signature refusing care of the patient. Sometimes, asking them for a signature will actually change their minds and at least let you do an assessment.

If a person has a complaint, no matter how vague, they become a patient. "I'm a little shaken up but I'm fine" is a complaint and warrants documentation of an RMA. If the patient has no complaint but there is damage or reports of mechanism indicative of potential trauma, that also warrants documentation of an RMA. If you have any question about either of these two, it warrants documentation of an RMA.

If your agency policy states that you do something, then you do it. However, if you don't have an agency policy, use some common sense and document, document, document, even if your survey of the scene and occupants leads you to the impression that there are no patients.

If "I'm a little shaken up" is a complaint, then we should also be at every movie theater showing a horror flick and Great Flags at the end of their crazy roller coasters. People claim to be "shaken up" by lots of things but that doesn't make them a "patient".

There is (or was) an EMS policy on calls involving no patient, cancellation, etc. Maybe people should refer to that.

[velcroMedic1987 330]

All these responses are just opinion and agency guidelines. Are there any state policies on the subject?

I looked through NYS EMS for policy statements and found nothing on the subject. Is it possible that there is no policy for this scenario?

[vtach39680 23]

It would be very hard to write that policy. To many variables.

Just some thoughts

If you walk into a hospital are you automatically a patient?

If the FD responds to an alarm is there automatically a fire?

If the police respond to an accident is there automatically a summons?

All documentation should clear and accurate but as with my first reply to this thread. Not every call we respond on yields a "Patient" rather just an individual or individuals

[antiquefirelt 994]

If you walk into a hospital are you automatically a patient?

If the FD responds to an alarm is there automatically a fire?

If the police respond to an accident is there automatically a summons?

All documentation should clear and accurate but as with my first reply to this thread. Not every call we respond on yields a "Patient" rather just an individual or individuals

I agree with the sentiment, but one could also ask:

If the FD leaves the premise is there no fire? I'm sure a realistic expectation is that there is no problem when they leave.

If the police leave an accident, were all the crimes addressed? I'm sure the realistic expectation is that all citations have been issued, criminals summonsed and a proper report will be filed.

So the question might be: If EMS leaves the scene, is it a realistic expectation that everyone has been evaluated or refused?

[Dinosaur 844]

I agree with the sentiment, but one could also ask:

So the question might be: If EMS leaves the scene, is it a realistic expectation that everyone has been evaluated or refused?

"Everyone"? So if the call is for a sick person at Wal-Mart do you have to solicit a refusal from everyone in the store?

[antiquefirelt 994]

"Everyone"? So if the call is for a sick person at Wal-Mart do you have to solicit a refusal from everyone in the store?

Really? How about "everyone involved" or do we not even bother to figure that out?

[Dinosaur 844]

Really? How about "everyone involved" or do we not even bother to figure that out?

It's not so far-fetched. Others in this thread have made included everyone in their decision making. There's no common sense in the equation for some people (not referring to you).

[antiquefirelt 994]

It's not so far-fetched. Others in this thread have made included everyone in their decision making. There's no common sense in the equation for some people (not referring to you).

Without a doubt, there are many policies that attempt to cover everything to ensure common sense (a diminishing quality) is not a factor. We have attorney's telling us how we must protect the agency from liability, and some employees that push everything right to the line. Like almost everything, if your department or agency applies policy and riles fairly, but consistantly, everyone will know how to procede under the expected "rules" of conduct. We have plenty of rules that are minimalistic, but most o our folks understand they are "minimum standards" and we expect more than just the minimum on a daily basis.

[AFS1970 504]

Without a doubt, there are many policies that attempt to cover everything to ensure common sense (a diminishing quality) is not a factor. We have attorney's telling us how we must protect the agency from liability, and some employees that push everything right to the line. Like almost everything, if your department or agency applies policy and rules fairly, but consistantly, everyone will know how to procede under the expected "rules" of conduct. We have plenty of rules that are minimalistic, but most o our folks understand they are "minimum standards" and we expect more than just the minimum on a daily basis.

If the lawyers and insurance agents who try daily to handcuff public safety actually had to ride a few shifts in any related field, I think their heads would explode.