What constitutes a patient?

[Guest guest]

We have been having this discussion among several of the agencies I

work with to try and get a uniform definition of a patient. The most

controversy surrounds the question " If you touch a person do they

become a patient. " The scenario presented is a driver involved in a

minor MVC, they state they are not hurt and did not call the

ambulance. They allow you to do a quick head to toe and you find

nothing wrong. At this point are they a patient?

My medical director asked me to do some research on this subject. If

anyone out there has policies that address this and are willing to

share I would appreciate it. I would really appreciate it if any of

the legal people know of any case law that addresses this issue; I

have been having a hard time finding anything concrete either way.

You can e-mail me directly if you wish at ryan.mayfield@...

Thanks,

Mayfield, NREMT-P (Plus a whole bunch of other initials)

[Guest guest]

From GETAC:

What is a patient?

The consensus position of the EMS Medical Directors of Texas

follows and is submitted to the GETAC Medical Directors' Committee for

consideration in open discussion:

" A patient is any person who, upon contact with an EMS system, presents with

a complaint, circumstance, and/or condition that might require further

assessment or treatment. "

" The standard of judgment is that of a reasonable and prudent medic. "

" The designated system Medical Director is responsible for promulgating

specific criteria for designation of a patient within the above general

guideline. "

From: texasems-l [mailto:texasems-l ] On

Behalf Of mayfieldr

Sent: Tuesday, July 01, 2008 1:45 PM

To: texasems-l

Subject: What constitutes a patient?

We have been having this discussion among several of the agencies I

work with to try and get a uniform definition of a patient. The most

controversy surrounds the question " If you touch a person do they

become a patient. " The scenario presented is a driver involved in a

minor MVC, they state they are not hurt and did not call the

ambulance. They allow you to do a quick head to toe and you find

nothing wrong. At this point are they a patient?

My medical director asked me to do some research on this subject. If

anyone out there has policies that address this and are willing to

share I would appreciate it. I would really appreciate it if any of

the legal people know of any case law that addresses this issue; I

have been having a hard time finding anything concrete either way.

You can e-mail me directly if you wish at ryan.mayfield@...

<mailto:ryan.mayfield%40gmail.com>

Thanks,

Mayfield, NREMT-P (Plus a whole bunch of other initials)

[Guest guest]

I don't know of any cases on the subject.

This is a complex issue. My thoughts are as follows: First, an adult

patient with the present mental capacity to consent or refuse becomes a patient

when he decides that he is a patient.

Second, a patient is a patient when by observation it is determinable that he

is ill or injured.

One common situation occurs when a 3rd party caller calls EMS upon seeing a

MVC, or observes a person lying down and assumes the worst.

So, when I approach a a MVC, for example, and the people are all out of the

cars walking around, I ask, " Anybody here need EMS? " If they say no, and

there are no observable injuries, in my judgment they are not patients. I

don't

know of any legal rule that says they are.

However, notice that I qualify my comments. Common sense and judgment must

always prevail. When in doubt, attempt to assess, get a refusal, and

document, document, document.

GG

>

> , let me start by disclaiming that I am not an attorney; however I have

> served as the Director for several different markets for a large ambulance

> service in the US and have been privy to Risk Management and Legal issues

> surrounding this particular issue. There is nothing miraculous about

> touching the patient, that makes a person a patient. If for whatever reason

> you are called via a 911 call to the scene, whether that be by the patient,

> a witness, a bystander, or by a passer by, then at the point of arrival then

> you and your service begins to assume some liability for the patients or

> potential patients on that scene. To address your scenario below, you

> should treat all victims of the MVC as though they are patients. This means

> that each patient should be given at least as much of an assessment as

> possible, which may come from verbal communication about pain and

> an assessment of the mechanism of injury etc... If they will allow you to

> obtain a set of vitals and do a quick head to toe then great. The key, from

> my opinion, is that you must suggest transport to the hospital, since we do

> not definitively diagnose, and give them the option to refuse this and

> obtain the proper signatures for the refusal. It is my opinion that too

> many responses are documented as " no ambulance needed " and appropriate

> patient refusals are not obtained. I am not aware of any case laws, just my

> experience and what my gut tells me is right. Hopefully some of the

> attorneys can weigh in on the topic.

>

> Rick

>

>

>

> > We have been having this discussion among several of the agencies I

> > work with to try and get a uniform definition of a patient. The most

> > controversy surrounds the question " If you touch a person do they

> > become a patient. " The scenario presented is a driver involved in a

> > minor MVC, they state they are not hurt and did not call the

> > ambulance. They allow you to do a quick head to toe and you find

> > nothing wrong. At this point are they a patient?

> >

> > My medical director asked me to do some research on this subject. If

> > anyone out there has policies that address this and are willing to

> > share I would appreciate it. I would really appreciate it if any of

> > the legal people know of any case law that addresses this issue; I

> > have been having a hard time finding anything concrete either way.

> >

> > You can e-mail me directly if you wish at ryan.mayfield@...<

> ryan.mayfield%ryan.mayfie>

> >

> > Thanks,

> > Mayfield, NREMT-P (Plus a whole bunch of other initials)

> >

> >

> >

>

>

[Guest guest]

, let me start by disclaiming that I am not an attorney; however I have

served as the Director for several different markets for a large ambulance

service in the US and have been privy to Risk Management and Legal issues

surrounding this particular issue. There is nothing miraculous about

touching the patient, that makes a person a patient. If for whatever reason

you are called via a 911 call to the scene, whether that be by the patient,

a witness, a bystander, or by a passer by, then at the point of arrival then

you and your service begins to assume some liability for the patients or

potential patients on that scene. To address your scenario below, you

should treat all victims of the MVC as though they are patients. This means

that each patient should be given at least as much of an assessment as

possible, which may come from verbal communication about pain and

an assessment of the mechanism of injury etc... If they will allow you to

obtain a set of vitals and do a quick head to toe then great. The key, from

my opinion, is that you must suggest transport to the hospital, since we do

not definitively diagnose, and give them the option to refuse this and

obtain the proper signatures for the refusal. It is my opinion that too

many responses are documented as " no ambulance needed " and appropriate

patient refusals are not obtained. I am not aware of any case laws, just my

experience and what my gut tells me is right. Hopefully some of the

attorneys can weigh in on the topic.

Rick

> We have been having this discussion among several of the agencies I

> work with to try and get a uniform definition of a patient. The most

> controversy surrounds the question " If you touch a person do they

> become a patient. " The scenario presented is a driver involved in a

> minor MVC, they state they are not hurt and did not call the

> ambulance. They allow you to do a quick head to toe and you find

> nothing wrong. At this point are they a patient?

>

> My medical director asked me to do some research on this subject. If

> anyone out there has policies that address this and are willing to

> share I would appreciate it. I would really appreciate it if any of

> the legal people know of any case law that addresses this issue; I

> have been having a hard time finding anything concrete either way.

>

> You can e-mail me directly if you wish at

ryan.mayfield@...<ryan.mayfield%40gmail.com>

>

> Thanks,

> Mayfield, NREMT-P (Plus a whole bunch of other initials)

>

>

>