Calling for an ambulance balances a person’s right to self-determination against the professional medical assessment of an emergency. When Emergency Medical Services (EMS) personnel arrive, they assess the patient’s condition and the need for immediate transport to a hospital for definitive care. While accepting transport is the default expectation, patients must weigh the immediate medical need against their personal rights and preferences. This article is for informational purposes only and is not a substitute for legal or medical advice.
The Foundation of Patient Autonomy
A competent adult possesses the right to refuse any medical care, including ambulance transport, even if that refusal may be detrimental to their own health. This principle of patient autonomy is a long-standing ethical and legal standard in healthcare. The ability to refuse treatment hinges on the patient being deemed “competent” by the EMS crew.
Competence means the individual can understand the information presented, appreciate how it applies to their situation, and communicate their decision clearly. EMS providers must assess if the patient is oriented to person, place, time, and situation, and if their judgment is impaired by factors like severe intoxication or an altered mental state. If the patient meets the criteria for competence, the EMS team must respect their wishes, even if they strongly disagree with the decision.
When Refusal is Not Permitted
A person’s right to refuse transport is legally superseded when they lack the mental capacity to make an informed decision. Individuals with a severely altered mental status due to head trauma, stroke, or high levels of intoxication may be considered incompetent. They are transported under the concept of implied consent, assuming the patient would consent to life-saving care if capable of doing so.
Minors, typically those under 18, generally cannot legally refuse transport; consent or refusal rests with a parent or legal guardian. However, EMS may proceed with treatment and transport if they suspect abuse or neglect, or if the minor’s condition is life-threatening and a guardian is unavailable. In severe mental health crises, law enforcement may initiate an involuntary hold, mandating transport for evaluation if the person is deemed a danger to themselves or others.
Documentation Requirements for Refusal
When a competent patient refuses recommended transport, the EMS team must follow a formal documentation procedure. This process ensures the refusal is informed by requiring the EMS crew to advise the patient of the specific risks and consequences of not going to the hospital. This explanation includes the potential for their condition to worsen, the development of new symptoms, or even death.
The core of this procedure involves the patient signing a legal document, often called a Refusal of Care or Against Medical Advice (AMA) form. Signing this form acknowledges that the patient was warned of the potential negative outcomes and chose to decline transport. If the patient refuses to sign, EMS providers must document that refusal and have a witness, such as a family member or law enforcement officer, attest to the patient’s decision and the warning provided.
The EMS team must also attempt to persuade the patient to accept transport, especially in high-risk situations. They must thoroughly document the patient’s history, assessment findings, reasoning for refusal, and all advice given, including instructions to call 9-1-1 again if symptoms worsen. This documentation serves as a record that the patient’s autonomy was respected after a comprehensive, informed warning was delivered.
Medical and Liability Consequences of Refusing Transport
Refusing transport carries significant medical risk because a patient’s condition can rapidly decline after the EMS team leaves the scene. Conditions like internal bleeding, a slow-evolving cardiac event, or a subtle infection may not be immediately apparent, but can quickly become life-threatening without hospital resources. The initial EMS assessment is not a substitute for the comprehensive diagnostic tools available in an emergency department.
Refusing transport does not automatically mean the service is free, as the patient is often still billed for the assessment, treatment, and time spent by the EMS crew. This bill covers the highly trained personnel, specialized equipment, and medical procedures performed, such as vital sign measurement or medication administration, up to the point of refusal. The cost of an ambulance response varies widely, but the bill for assessment and non-transport still represents a financial obligation.
The most substantial consequence is the assumption of future liability for any adverse health outcomes stemming from the refusal. By signing the AMA form, the patient releases the EMS providers and the service from liability for the consequences of their refusal. This transfer of responsibility means the patient accepts the full legal and medical burden for any subsequent injury, illness, or death occurring due to not receiving hospital-level care.