If a detained patient refuses transport, what is the EMS protocol?

• A. Assume consent and transport anyway
• B. Execute a standard refusal process and inform the LEO
• C. Transport only after LEO's confirmation
• D. Do not document the refusal

Answer: (B)

In this situation, the patient’s right to refuse EMS transport must be respected, provided they are competent and fully informed. The proper approach is to execute a standard refusal process and inform the law enforcement officer involved.

Start by assessing the patient’s decision-making capacity and ensure they understand what refusing transport means, including potential risks and consequences. Confirm that the choice is voluntary and not coerced, and offer any needed alternatives or further evaluation if symptoms change. Then document the refusal thoroughly, noting the capacity assessment, information given, and the patient’s stated reasons, and obtain the patient’s signature or a witness to the process. Finally, inform the custody officer or LE in charge about the refusal and the patient’s condition.

This is the best approach because it upholds patient autonomy, ensures safety and informed decision-making, and provides a clear, legal record. Transporting without consent ignores autonomy; waiting for LE confirmation isn’t the standard practice for medical decisions; and not documenting the refusal creates liability and uncertainty about what was communicated.