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Monday, May 3, 2010


I've been thinking a lot lately about signing people out Against Medical Advice (AMA). I've been looking at it from a literal point of view. I'm supposed to use this form when my patient, against my better judgement, decides that they don't want my services or a trip to the hospital. This does not happen very often.

I can remember one time when the parents of a 3 year old girl that had a seizure refused to go to the 2 closest hospitals. We had them sign an AMA form saying that they refused to go to the hospital that was recommended by us. On the way to the hospital of the parents choice the little girl seized 3 more times, reaching a serious condition known as status epilepticus.

I have had cardiac patients, one that was a cardiac arrest patient that was brought back to life with defibrillation, that refused to go to the ER. They signed out against my advice and best judgment.

I think that these are cases where the AMA form is perfect.

More often then not I find myself having a patient sign an AMA form because we were called out for a stubbed toe. The AMA form just doesn't seem to apply. They are doing nothing against medical advice. In fact, they are doing what I would suggest. Stop wasting our time, and don't waste the ER's time or yours. Go home. You'll live. Patient's call us for all kinds of minor things. They want a medical opinion. So we, when appropriate suggest they not go to the hospital and if they are still concerned, to make an appointment with their primary care physician. We then have them sign out AMA.
Does this make sense? Didn't I just tell them not to go?

I think it's time for the EMS profession to develop a new form for a release of liability. A WMA form. You can sign out With Medical Advice. That way, after performing a proper assessment and determining that the patient does not need an ambulance ride to the ER, the patient can release us of liability without saying that they are going against our advice.

If your area is anything like mine, most of the people that we "AMA" are actually following either our explicit advice or are following what we would do in their situation.
I found this form online that has a protocol (RAS or Release At Scene) for releasing patients that don't need to go the the ER. I love it. I want to adopt it.


Sea Foam Bald said...

It sucks, but in some cases, people don't want to pay high medicals bills for ER visits out of network. As for your MI pat, maybe he liked what he saw in the light.

Brendan said...

Makes sense to me. Why not have a form that says we all agree. The AMA is certainly more of a CYA form than the RAS, although the pt has to sign the RAS too.

The Happy Medic said...

Indeed I think I should be getting an AMA signed when they demand a transport they do not need, against my Professional opinion. But, until then I have a form called a Patient Declines Transport, which is what it sounds like you need.

Firefighter/Paramedic said...

HM- That sounds like exactly what we need.

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