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Mental disorders and pre-hospital refusal of transport for treatment: ethical challenges for ambulance staff
Thompson, F., Jaco,b R., Clare, I.C.H., WATSON, P.C. & Holland, A.J.
Journal of Psychosomatic Research, 63, 338-339
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Backgrounds and aims: Emergency ambulance staff are often called to attend adults in the community, and may recommend that transport to hospital for treatment is required. Previous research has shown that refusal of transport can lead to poor outcomes with deterioration in health. The aims of this study were to establish the demographic and clinical characteristics of 'refusers' and the prevalence of mental disorders amongst this group. Methods: All report forms for emergency ambulance calls in a large area of England were reviewed over a two-week period. Patients who refused transport to hospital against ambulance staff advice were identified and demographic and clinical details were ascertained, and compared with those of a control group of 'accepters'. Results: Calls relating to 10530 individuals were received, of whom 4344 were judged by ambulance staff to require transport to hospital for treatment. This advice was refused by 115 (2.6%) people. Compared with a control group, who accepted transport, 'refusers' were more likely to be young, male, living alone, with a history of, or current, mental disorder, and were more likely to be intoxicated or to have self-harmed. Refusers were more likely to refuse examination by ambulance service staff and to be more aggressive towards them. Conclusions: Against advice, a proportion of individuals refuse transport to hospital for treatment. Refusal relates to similar factors to impaired capacity to make decisions about treatment in other medical settings. This study highlights the need for ambulance staff to be familiar with relevant legal frameworks when treating patients without capacity.