Patient Refusal and ALS to BLS Protocols

Patient Refusal of Treatment and Transport

• EMS providers must document patient refusal of treatment and transport by obtaining the patient's signature and documenting details on the ePCR.
• Before a patient refuses treatment and transport, EMS providers must thoroughly assess the patient, including vital signs, and inform the patient of potential risks associated with refusing treatment and/or transport.
• The EMS provider must also advise the patient to call 911 immediately if their medical condition changes.

ALS Downgrade to BLS Transport

• If an ALS provider determines a patient is appropriate for BLS transport only, they must complete an ePCR with certain details.
• The ePCR must include a narrative explaining the patient assessment and reason for the downgrade.
• This narrative must include more than a single sentence without elaboration.
• The ALS provider should refer to the General Patient Care Protocol within the Maryland Medical Protocols for information on transitioning care from ALS to BLS.

Montgomery County Fire and Rescue Service (MCFRS) RMS Contingency Plan

• If the RMS (other than the EMS ePCR system) fails, MCFRS personnel should call the IT Help Desk.
• If all stations are affected, the MCFRS IT Section will send an email and the ECC will make an announcement.

MCFRS Document Policy

• The Document Control Officer will distribute a clean copy of a document with proposed changes and a marked-up version showing changes.
• Final copies of signed FCGO's, Directives, and Information Bulletins will be published on the MCFRS website and sent to all MCFRS County email addresses.
• MCFRS Policies and Procedures are sent to the Fire and Emergency Services Commission (FESC) for approval.
• Once approved, MCFRS Policies and Procedures are published on the MCFRS website and sent to all MCFRS personnel with County email addresses.
• Cancellation or rescission of documents is done in writing by the Fire Chief.
• MCFRS policies are reviewed every three years by the Fire Chief and amended as needed.

Apparel Policy

• All MCFRS personnel, both career and volunteer, must comply with the Apparel Policy.
• Battalion Chiefs and above may only wear a specific navy blue military-style V-neck sweater with specific features.

Station Management Policy

• MCFRS is committed to maintaining operational readiness of personnel, facilities, apparatus, and records while ensuring a safe work environment.
• All personnel must comply with the Station Management Policy.
• The Station Officer is responsible for reporting any damage or failure at LFRD owned or managed stations to the LFRD.
• The Station Officer is responsible for ensuring that apparatus and portable equipment are checked daily.
• The Station Officer is responsible for ensuring subordinates' timecards are up-to-date and overtime is properly requested and approved.
• The Station Officer is responsible for ensuring that electronic incident/unit/and EMS reports are completed according to MCFRS procedures.

Critical Illness and Injury

• MCFRS must provide support for families or significant others of personnel who sustain critical illness or injury, including those with non-work-related injuries/illnesses
• MCFRS will make resources available to families of personnel who sustain a work-related critical illness/injury
• When MCFRS personnel sustain a critical work-related illness/injury, the Fire Chief, Division Chiefs, Duty Operations Chief, or Section Chief, Health & Wellness Chief, affected Battalion Chief, Safety Officer, LFRD Chief and/or President, and affiliated bargaining unit representative must be immediately notified.
• MCFRS will appoint a Family Liaison Officer to the family or significant other of personnel sustaining a critical illness/injury
• A Department designee will notify the family or significant other of the individual sustaining a work-related critical illness/injury.
• MCFRS personnel must maintain current emergency notification information in the designated staff database.
• When MCFRS personnel sustain a critical non-work-related illness/injury, the Fire Chief, Division Chiefs, Duty Operations Chief or Section Chief, Health & Wellness Chief, affected Battalion Chief, Safety Officer, LFRD Chief and/or President, and affiliated bargaining unit representative must be immediately notified.
• All MCFRS personnel must immediately notify their supervisor when they, or someone they supervise, sustains a critical work-related illness/injury.
• All MCFRS personnel must maintain up-to-date next of kin information in the designated staff database.
• The provider must retain the original Short Form with signatures, and send that original Short Form to the Records Custodian at PSHQ via sealed interoffice mail.
• When using the Short Form to document a patient refusal on the scene, the provider must enter that information into the ePCR system as soon as possible, and note in the narrative of the ePCR that there are no patient signatures due to the use of the Short Form.
• The provider must send that original Short Form to the Records Custodian at PSHQ via sealed interoffice mail.
• The Short Form may also be used as a guide for pre-hospital consults, and copies are being provided to Montgomery County hospitals for this purpose.
• The reverse side of the Short Form includes a checklist for Patient Refusals from the Maryland Medical Protocols. Providers should use this checklist as a guide to obtain properly-informed patient refusals.

MCFRS Document Policy

• All MCFRS personnel are responsible for familiarizing themselves and adhering to all Policies and Procedures, FCGO’s, Directives, and Bulletins.
• Supervisory personnel ensure that subordinate personnel know and comply with all applicable Policies and Procedures, Orders, Directives, and other controlling documents.
• Station officers review new Policies and Procedures, FCGO’s, Directives, and other controlling documents with on-duty personnel.
• Division Chiefs and leaders in all MCFRS organizational elements are responsible for annually reviewing Policies and Procedures, Orders, Directives, and Bulletins that directly affect their Division, Section, or organizational element.
• Division Chiefs and leaders in all MCFRS organizational elements are responsible for initiating the development, revision, or rescission of documents.
• Division Chiefs and leaders in all MCFRS organizational elements are responsible for ensuring the continued progress of new and revised documents from start to finish.
• Division Chiefs and leaders in all MCFRS organizational elements are responsible for considering the comments and feedback received.
• Division Chiefs and leaders in all MCFRS organizational elements are responsible for reviewing and commenting on all other draft policies and procedures and directives in a timely fashion.
• The Document Control Officer or designee is responsible for maintaining master files of issued documents in editable and protected formats.
• The Document Control Officer or designee is responsible for assigning document numbers.
• The Document Control Officer or designee is responsible for coordinating the distribution and receipt of documents going to and from Notice and Opportunity.
• The Document Control Officer or designee is responsible for annually reviewing the Policy and Procedure Webpage.
• Any MCFRS personnel may forward a proposal to their Division Chief via the chain-of-command, to establish, revise, or modify a current policy or procedure.

This quiz covers essential protocols for EMS providers regarding patient refusal of treatment and the process for downgrading from ALS to BLS transport. Participants will learn about the documentation required and the importance of patient assessment and communication. Understanding these protocols ensures safety and adherence to medical guidelines.