Case summary:

An ALS crew was dispatched to a 50s man for a welfare check.  The crew found the patient walking around his apartment and looked diaphoretic.  The patient initially refused any assessment, but the crew explained they were concerned about his due to the diaphoresis.  The patient eventually allowed the crew to obtain vitals and a 12-lead EKG. 

Vitals: BP 147/97,  HR 74,  RR 18,  Sat 97%, glucose 155

The crew noted ST elevations in I, aVL and V2 with depressions in III and aVF.  The crew was concerned that patient was having a ST segment elevation myocardial infarction (STEMI) and discussed this concern with the patient.  Despite this, the patient still was refusing care but also would not give a reason why he did not want to go to the hospital.  The crew called medical control to see if the physician could convince him to go to the hospital as well as confirm capacity if he continued to refuse.  The physician was not able to make any headway and agreed with the crew that the patient had capacity to refuse.  The crew spent another 20 minutes on scene trying to convince the patient to be transported and eventually were able to convince him to be transported.  The patient was transported to a STEMI center for ongoing care.

 Highlights of the case:

EMS providers should advocate for patients if they are concerned about them.

This case shows why it is so important for EMS providers to advocate for their patients.  This patient called EMS but was refusing transport to the hospital even though that was what he really needed.  The EMS crew identified that the patient had medical decision-making capacity and that the patient was allowed to refuse care if he wanted.  It would have been very easy for the crew to leave the patient at his home, but they instead expressed their concern to the patient.  It is good to involve medical control since sometimes the simple act of speaking to a physician is all it takes to convince someone that going to the hospital is in his/her best interest (although that did not end up working here).  Another option is to involve family members or friends if they are on scene since often times friends/family are able to communicate in a way that we are unable to do.  By taking the extra time to have an informed discussion with the patient, they were able to help him make the decision that was in his best interest, which was to seek further medical care at the hospital.