If a patient refuses ALS assessment and transport, contact base to verify capacity and follow proper protocol.

What should be done when a patient requiring transport refuses ALS assessment, treatment, and transport?

• A. Transport without consent
• B. Contact base
• C. Document the refusal
• D. Provide additional treatment

Answer: (B)

In situations where a patient refuses advanced life support (ALS) assessment, treatment, and transport, the appropriate course of action is to contact base. This is crucial because when a patient refuses care, it is important to verify their capacity to make that decision and to ensure that all protocols and legal requirements are followed. Contacting base allows medical control to assist in evaluating the situation and provides additional guidance on how to proceed with the patient's care. This step is vital to protect both the patient’s well-being and the healthcare provider’s legal and ethical responsibilities. Opting to transport without consent could expose the provider to legal implications, as consent is necessary for treatment and transport. Documenting the refusal is important but should be done in conjunction with contacting base; documentation alone does not address the immediate need for guidance in the face of a refusal. Providing additional treatment without the patient's consent goes against the principles of informed consent and can lead to serious consequences for the provider and the patient's legal rights. Thus, contacting base is the proper action to ensure a responsible and medically sound approach to the patient's refusal of care.

When a patient who needs transport refuses ALS assessment, treatment, and transport, what should you do? If you’re riding with Los Angeles County emergency teams, the right move isn’t to push care or to shrug it off. It’s to get medical control involved. Specifically, the correct action is to contact the base. Here’s why that step matters, and how to handle the moment with clarity and care.

Let’s start with the core idea: medical control knows the rules of the road when a patient says no

In the heat of the moment, it’s tempting to rely on a gut feeling or past experiences. But health care is governed by protocols that protect both patient rights and provider responsibilities. When a patient refuses ALS assessment, treatment, and transport, you don’t want to guess. You want a trained physician or medical director on the line who can guide the situation, confirm capacity, and help you document the decision properly. That’s what “contact base” accomplishes.

What “contact base” actually involves

Think of base as the central hub that offers medical direction and policy interpretation. When you call, you’re not just making a courtesy call—you’re ensuring that the patient’s rights are respected and that your actions align with legal expectations. Medical control can confirm whether the patient’s decision stands up to capacity checks, remind you of the required documentation, and tell you whether you should proceed with transport or reassess later.

Capacity matters more than you might think

Here’s the tricky part: a patient can be capable of making a decision about care, but only if a few boxes are checked. Capacity means the patient understands:

• the nature of their condition and the proposed care

• the risks and benefits of accepting or refusing

• the alternatives, including the option of accepting transport later

• the consequences of declining care

And they must be able to communicate a clear choice and show consistency in that choice.

If the patient is confused, intoxicated, agitated, or otherwise impaired, the decision isn’t straightforward. In those cases, calling base for guidance is essential because capacity can be questioned, and the legal and ethical lines get blurry quickly. Medical control can walk you through whether a reevaluation is needed or whether other steps should be taken.

A practical path when you meet a patient who refuses

• Do a quick safety check: Is the patient in immediate danger? Is the environment safe for everyone involved? If there’s risk, you may need to reassess and consider transport for safety, but don’t jump to conclusions about consent.

• Talk plainly and respectfully: Explain what you’re offering, what the patient is declining, and what could happen if they refuse. Use simple language. Avoid jargon that might confuse someone who’s not feeling their best.

• Assess capacity on the spot: Ask questions that reveal understanding and consistency. “What’s the plan if you don’t get treated?” “What would you like me to do next?” If their answers show clear, rational thinking and they empathize with the consequences, you’re more likely to be dealing with an informed decision.

• Attempt to obtain consent: If the patient appears capable, ask for a voluntary agreement to treatment and transport. If they say no, make a note of their stated decision and the information you provided.

• Call base: If there’s any doubt, or if the patient’s capacity is unclear, contact medical control. They’ll help determine the right course of action—whether to proceed, to document a formal refusal, or to continue to reassess.

• Document thoroughly: When a patient refuses, documentation is not just a formality. It’s the record that demonstrates you respected patient autonomy while following proper procedure. Include the capacity assessment, information given, patient responses, and the final decision reached with medical control’s guidance.

• Stay with the patient as needed: If you’re continuing to monitor the patient, keep an eye on any changes in condition. If capacity wanes, revisit consent and base input.

Why not transport without consent or push treatment without permission?

• Transport without consent can create serious legal and ethical jeopardy. If the patient has capacity but declines, forcing transport can be a violation of patient rights and can expose the provider to liability.

• Providing treatment without consent crosses lines that protect patient autonomy. Even in emergencies, consent rules apply, and medical control guidance helps keep you aligned with those rules.

• Documentation alone, while important, isn’t a substitute for real-time medical control input. The line between a well-documented refusal and a legally defensible action is the guidance you receive from base.

A quick note about minors and impaired adults

If the patient is a minor or lacks capacity, you’ll follow different protocols. In those cases, medical control will guide you on whether a guardian or surrogate decision-maker should be involved, and what steps you should take to ensure the patient’s safety while respecting legal rights. The principle remains the same: contact base to get clear, authoritative direction.

The documentation side of things—how to do it right

• Time and identifiers: Record the date, time, patient’s name (if available), age, and location.

• The core decision: Note that the patient refused ALS assessment, treatment, and transport, and record the patient’s stated reason if possible.

• Capacity check: Document your capacity assessment—what you observed, how the patient answered questions, whether they appeared oriented, and any signs of impairment.

• Information given: List what you told the patient about risks, benefits, and alternatives, including the option for medical control to advise and re-evaluate.

• Medical control contact: Record the name or ID of the medical control physician or base operator you spoke with, plus the guidance you received.

• Sign-off and witnesses: If required by policy, have the patient sign a refusal form and include witness signatures. Note that you followed base instructions.

• Aftercare plan: Describe any plan to reassess, or any changes in the patient’s condition that would prompt a new call to base.

A small digression that still ties back to the main point

Sometimes it helps to think about this in everyday terms. Imagine you’re advising a friend who’s decided not to seek medical help after a fall. If their situation could deteriorate quickly, you’d probably call a clinician or someone who can weigh the risks and provide guidance. In EMS, that “someone” on the line is medical control. It’s not about being a meddling dispatcher; it’s about ensuring safety, legality, and the patient’s right to decide what happens to their body.

A few myths to debunk along the way

• Myth: If a patient says no, there’s nothing more to do. Reality: You still must assess capacity, inform them of consequences, attempt consent, and contact base for guidance. Documentation alone isn’t enough if capacity is uncertain.

• Myth: Refusals are final and unchangeable. Reality: If the patient’s condition changes or if capacity changes, you should reassess and may need to call base again.

• Myth: Medical control always says yes to transporting. Reality: The direction depends on the patient’s capacity, the risk of deterioration, and the clinical judgment you and base share.

Real-world resources and why they matter

In Los Angeles County, EMS guidelines place a strong emphasis on medical control for refusals. Base staff can help you interpret capacity, ensure you’ve given the patient complete information, and provide a legally defensible path forward. It’s not a boring formality; it’s a safeguard that keeps both patients and providers protected, and it helps ensure that life-saving care is given when it’s truly needed.

A closing thought to keep you grounded

When you’re the clinician on the scene, the room can feel chaotic. People’s emotions run high, and the clock seems to tick louder. In those moments, calling base isn’t a sign of hesitance—it’s a sign of professional diligence. It’s your chance to verify you’re following the rules, to give the patient a real voice in their care, and to document the moment with precision. That combination—autonomy, safety, and accountability—has a quiet but powerful impact on patient trust and on the integrity of your work.

If you’re moving through LA County scenarios, remember this simple rule: contact base whenever there’s a question about capacity or a patient who declines ALS assessment, treatment, and transport. It’s the path that keeps everyone on the right side of care, ethics, and the law. And when you’re aligning with that path, you’re not just following a protocol—you’re helping to protect lives with clarity, compassion, and competence.