By Michael Morse
Let’s face it: There are times when an engine company response to an EMS call is needless. Conventional wisdom tells us to treat and transport all persons who call 911 regardless of the severity of their condition. Successful lawsuits involving refusal of transport are incredibly rare, but possible. As providers of medical care in homes and in the street, we are considered the gateway into the healthcare system. That system, especially at the emergency level (including EMS) is increasingly overburdened. The people providing care are overworked, underappreciated, and overwhelmed. Confronting a caller who believes that using 911 for routine a minor injury or illness care is prudent often does not end well. Doing so creates public animosity, headaches for the crew and, as we are likely to be reminded by our employer, a loss of revenue for the service.
很难，但要记住，作为提供商，我们并不是一个可能陷入崩溃的系统中无能为力的玩家。相处并等待救护车到达可能会更容易，这样我们就可以洗手一个想要去急诊室的人。但是，在大型方案中，这种操作方法基本上放弃了我们的责任，并增加了系统的负担。我们有责任保护公众。该任务的一部分包括能够及时应对紧急情况。在执行心肺复苏术或评估和治疗创伤时，等待具有运输能力清除的单位已经在许多系统中像往常一样成为业务。不应该那样。在适当的情况下拒绝患者可能无法解决整个问题，但这可能只是一系列事件的开始，这些事件最终将在迫切需要时最终以单位结束。
There are two very different potential refusal situations:
1.患者需要治疗和运输，但拒绝。
这是我们需要所有训练和说服力的跑步。我们是训练有素的专业人员，可以识别威胁生命的伤害和疾病。我们拥有支持我们意见的设备和评估技能。我们有经验，同情和智慧。我们有一辆救护车。如果对患者进行评估和认为胜任，则必须进行适当和彻底的文档。
2. A patient demands treatment and transport but does not need it.
必须进行彻底的评估，包括生命体征和任何其他测试（血糖，心电图等），在提出不包括到急诊科的治疗方案之前，必须进行。清单可能会有所帮助。评估后，向患者解释其生命体征在正常范围内，没有畸形，没有出血，没有明显的死亡，残疾或毁容的可见威胁，可能需要紧急运输，也可能不会劝阻他们使用这种威胁。您提供的服务。有时，患者只需要放心或有能力的人来缓解他们的恐惧。他们可能需要医疗护理，但是运输到急诊室可能是他们获得护理的最不合适的方法。为他们的问题提供替代解决方案有帮助。步入式诊所可能会更短的等待。也许对他们的初级保健医生的呼吁会更明智，甚至可能正是患者想要和需求的。记录您的发现和在患者护理报告中包括您的建议并不保证如果患者提出投诉，则不会免于受到影响的免疫力，但是如果审查了电话，肯定会帮助您的情况。
There are patients who will never accept anything short of transport to an emergency department in an ambulance. For those patients, we have no options. Often, for the sake of your own sanity, it is wise to acquiesce. Engaging in an argument with somebody who called 911 inappropriately is both useless and unprofessional. We are, in effect, street soldiers. Policies are made by people above us; our best intentions may well be ignored when a complaint from a citizen is filed. Self-preservation is just as important as patient care. We need good soldiers to remain on the streets.
迈克尔·莫尔斯（Michael Morse）is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.
