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Refusal of Transport

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Refusal of transport
Any individual has the right to refuse transport. To refuse transport is to indicate or show that one is not willing to accept the transportation from one place to another by means of vehicle, aircraft or ship. (White and Harber, 1992). Every adult has the right to make decisions regarding their health care; this also includes the decision to refuse transportation even when highly recommended by Paramedics. Even if the decision is regarded to be insensible or even irrational to other family members or health care providers so long as the patient has provided a valid refusal the decision must be respected.
When attending a patient who expressly refuses ambulance Treatment and/or transportation to hospital, the paramedic is required to conduct an assessment of the validity of that decision. This assessment is referred to as a VIRCA assessment. (Queensland Government, 2013)
A crew has been called by a relative to an elderly emaciated woman with a history of Type 1 diabetes. She presents as lethargic, too weak to sit up in bed, cool skin and is somewhat irritable. She is resistant to a full vital signs examination and repeatedly says she does not want to go to hospital, has a GCS of 13, though at no time does she open her eyes to respond to questions. The crew decides to leave her at home as she has refused assessment. A short time later a second ambulance crew is called. They are more assertive and find the patient to be significantly hypotensive and with a blood sugar too high to be recorded. They carry her to their stretcher and find she is restless and somewhat oppositional, but quite manageable. In ED she is found to have a pH of 6.9 and a blood sugar of 60 m/mol/L. Soon after she is transferred to intensive care, critically ill with ketoacidosis. (Steer, B. 2012).
Whilst the first crew respected the patient’s right to refuse transport they did not fully conduct the VIRCA assessment which is designed to validate a patients refusal of transport whilst ensuring complete legal coverage of the Queensland Ambulance Service and furthermore themselves. VIRCA is an acronym that contains 5 steps; Voluntary, informed, relevant, capacity, and advice. The decision to refuse transport must be voluntary and not influenced by others. The Paramedics must insure that the patient is fully informed of the risk when refusing transport. The refusal must be relevant relating to the treatment that has been recommended. The patient must have the capacity to understand the nature and risks of refusing transport. Assuming the refusal is valid it is required that the Paramedics provide advice or recommendations to ensure comfort if the patient is to stay at home.
As long as the patient has the capacity to refuse transport and the refusal has been validated by the VIRCA assessment, it is the legal obligation for any Paramedic to respect their patient’s wishes to remain where they are.

Reference list

Corvallisoregon.gov.
In-text: (Corvallisoregon.gov, 2014)
Bibliography: Corvallisoregon.gov. 2014. [online] Available at: http://www.corvallisoregon.gov/modules/showdocument.aspx?documentid=4597 [Accessed: 18 Mar 2014].

Government, Q.
In-text: (Government, 2014)
Bibliography: Government, Q. 2014. [online] Available at: https://ambulance.qld.gov.au/docs/10_cpg_other.pdfjavascript:void(0) [Accessed: 15 Mar 2014].

Steer, B.
Paramedics, consent and refusal--are we competent?
In-text: (Steer, 2012, p. 6)
Bibliography: Steer, B. 2012. Paramedics, consent and refusal--are we competent?. Australasian Journal of Paramedicine, 5 (1), p. 6.

White, L. and Harber, K.
Bibliography of Australian literature project
In-text: (White and Harber, 1992)
Bibliography: White, L. and Harber, K. 1992. Bibliography of Australian literature project. Clayton, Vic.: National Centre for Australian Studies, Monash University.

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