How should you handle a patient who refuses transport after a medical call?

• A. Assess capacity, provide information about risks, document the refusal, and obtain a signed release if possible; arrange follow-up instructions.
• B. Respect the patient’s decision and end care.
• C. Call law enforcement to compel transport.
• D. Record the refusal but take no further action.

Answer: (B)

When a patient refuses transport, the most appropriate approach is to ensure they are making an informed decision while safeguarding their safety. Begin by determining if the patient has decision-making capacity: can they understand the medical situation, appreciate the risks and consequences of declining transport, communicate a choice, and maintain a consistent plan of action. If capacity is present, you should clearly explain the potential risks of not being transported, possible deterioration, and what symptoms would require urgent care. Offer and discuss follow-up instructions, provide written and verbal guidance, and encourage them to seek care if symptoms worsen. Document the refusal comprehensively, including the capacity assessment, the risks discussed, and the patient’s stated decision; obtain a signed release if possible and note who witnessed it and the time. This approach respects the patient’s autonomy while ensuring there is a clear record that they understood the implications of their choice.

If capacity is absent or the patient is medically unstable, you should not accept a refusal; continue assessment and treatment and, if necessary, transport or obtain consent from a legally authorized representative. Law enforcement involvement is not the default response; it’s reserved for situations where the patient poses a danger to themselves or others or when there is a specific legal mandate.