DO PATIENTS REFUSING TRANSPORT REMEMBER DESCRIPTIONS OF RISKS AFTER INITIAL ADVANCED LIFE-SUPPORT ASSESSMENT

Objective: To determine patient recall and understanding of instructio ns given to patients who refuse transport after initial paramedic asse ssment and medical treatment. Methods: Following patient consent, a ph one interview was completed for consecutive persons living in a large urban area for whom 9-1-1 was contacted but who subsequently refused t ransport after advanced Life support (ALS) assessment. Subjects were a sked about their recall of explained risks and benefits of transport, their understanding of those risks at the time of assessment, and subs equent use of medical care, including hospitalization. Results: From O ctober 1, 1996, to February 23, 1997, 324 people refused transport aft er ALS arrival. Sixty-eight people could not be contacted, providing a response rate of 79% (256/324). Six percent were subsequently admitte d to the hospital for the same problem and an additional 59% sought ca re from a health care provider (66 ED visits, 63 personal physician, 1 6 urgent care, 5 other). There were no unexpected deaths. Ninety (35%) respondents were still experiencing symptoms at the time of phone con tact. Despite the routine practice of providing a verbal explanation o f risks and written instructions, only 141 (55%) recalled receiving wr itten instructions and 56 (22%) recalled an explanation of risks. Twen ty-six percent believed they did not fully understand their conditions or circumstances surrounding the 9-1-1 call when they refused transpo rt and 18% would now take an ambulance if the same incident were to re cur. Conclusion: A substantial proportion of patients refusing transpo rt do not recall receiving verbal or written instructions and would re consider their transport decision, raising doubts about people's abili ty to make informed decisions at a time of great vulnerability. The ma jority of patients accessed health care after refusing transport and 6 % were hospitalized.