What you need to know about AMA and the 12 lead ECG...

 

What is an AMA? Against medical advice is a phrase pertaining to a patient’s decision to discontinue therapy despite the advice of medical professionals.

 

Document… Document… Document!

 

Obtaining a defensible AMA:

Does the patient have the capacity to refuse care – are they capable of making a decision? Can the patient understand and communicate a rational decision? A&Ox4 is not good enough… You need to evaluate and describe the following:

• Perform a thorough patient assessment
• Evaluate for signs of drug and/or alcohol intoxication, physical or mental conditions affecting judgment (hypoxia, hypovolemia, etc. may affect a patient’s decision-making capacity)
• The patient must have the ability to understand the information being provided by you
• The patient must be able to appreciate the significance of the information and the consequences
• The patient must be able to engage in reasoning – uses logical processes, weigh options, etc.

The primary purpose of obtaining a 12 lead ECG is to screen for cardiac ischemia. A normal 12 lead ECG does not mean that the patient is not having acute ischemia, injury or infarction! The patient may be in the early stages of the AMI and the infarction is evolving or the infarction has progressed passed the “acute phase”.

So, if you have educated your patient, describing how a normal 12 lead ECG does not exclude them from serious injury, permanent
disability and/or death, evaluated their decision-making capacity and performed a patient assessment – make base hospital contact and run the case by the base hospital physician – do not assume the liability!! Remind the patient of the benefits of transport!