INVOLUNTARY TRANSPORT
DESIGNATION OF CONDITION
New Mexico has a straightforward Emergency Transport Act (NMSA 24-10B-9.1 amended in 2003) that allows any New Mexico licensed EMT to insist on involuntary transport of a patient who lacks capacity and is suffering from a life-threatening or disability-threatening condition and is refusing that transport. The act requires that the EMT is acting in “good faith” which means simply acting in the patient’s best interest. For details on managing a patient who is refusing transport see REFUSALS in this section.
EMPHASIS ON PATIENT CARE
I. The criteria for emergency transport are several.
A. The EMT is licensed in New Mexico at any level.
B. The EMT is acting in “good faith”
C. The EMT is acting under “medical direction”. It is not clear from the Act if this includes acting under protocol or the need for on-line medical direction. Obtaining on-line medical direction in these situations is strongly advised.
D. The patient is incapable of making an informed decision about their condition and the need for transport. This is a determination of “capacity”.
E. The patient is likely to suffer “death or disability” if not transported.
F. The patient is transported to an “appropriate facility”.
2. It is necessary to determine if the patient can be safely taken against their will and transported with the resources available. Safe restraint may require multiple persons including EMTs and law enforcement personnel. Consider calling for additional resources if necessary.
3. Every effort should be made to convince the patient of the seriousness of their condition and the need for transport to an appropriate facility. This is most commonly an emergency department in a hospital.
4. If the patient’s lack of capacity involves severe agitation, combativeness, and/or violent threats or behavior, sedation may be medically indicated. See SEDATION OF AGITATED PATIENTS WITH MEDICATION in this section for guidance. Sedation because of the patient expressing anger or disagreement usually is not a medical indication.
5. Restraint
A. Ensure that the patient can be safely restrained.
B. Use the minimum amount of force necessary to restrain the patient.
C. If the process of restraint triggers severe agitation, combativeness, or violence, consider sedation as possibly medically indicated.
D. Transport the patient in as much of a position of comfort as possible allowing for adequate breathing and circulation. Never place a patient prone or apply force to the head, neck, chest, or back.
E. Apply monitoring equipment if feasible and monitor the patient’s condition during transport. Treat any medical emergencies appropriately.
6. Special Circumstances
A. There may be patients who cannot be safely transported against their will because of a lack of resources, the strength of the patient, the risks involved in attempting involuntary restraint from the patient, family, or bystanders, or other risks as determined by the EMTs on scene. Assume your actions will be on someone’s video and act accordingly in a professional and compassionate manner.
7. Documentation
A. A situation involving involuntary restraint and transport requires careful documentation of the patient’s assessment, condition, risks, capacity, and the benefit to the patient of involuntary restraint and transport. The service medical director should be alerted to the involuntary nature of the call so it can be reviewed.
DESIGNATION OF CONDITION
New Mexico has a straightforward Emergency Transport Act (NMSA 24-10B-9.1 amended in 2003) that allows any New Mexico licensed EMT to insist on involuntary transport of a patient who lacks capacity and is suffering from a life-threatening or disability-threatening condition and is refusing that transport. The act requires that the EMT is acting in “good faith” which means simply acting in the patient’s best interest. For details on managing a patient who is refusing transport see REFUSALS in this section.
EMPHASIS ON PATIENT CARE
I. The criteria for emergency transport are several.
A. The EMT is licensed in New Mexico at any level.
B. The EMT is acting in “good faith”
C. The EMT is acting under “medical direction”. It is not clear from the Act if this includes acting under protocol or the need for on-line medical direction. Obtaining on-line medical direction in these situations is strongly advised.
D. The patient is incapable of making an informed decision about their condition and the need for transport. This is a determination of “capacity”.
E. The patient is likely to suffer “death or disability” if not transported.
F. The patient is transported to an “appropriate facility”.
2. It is necessary to determine if the patient can be safely taken against their will and transported with the resources available. Safe restraint may require multiple persons including EMTs and law enforcement personnel. Consider calling for additional resources if necessary.
3. Every effort should be made to convince the patient of the seriousness of their condition and the need for transport to an appropriate facility. This is most commonly an emergency department in a hospital.
4. If the patient’s lack of capacity involves severe agitation, combativeness, and/or violent threats or behavior, sedation may be medically indicated. See SEDATION OF AGITATED PATIENTS WITH MEDICATION in this section for guidance. Sedation because of the patient expressing anger or disagreement usually is not a medical indication.
5. Restraint
A. Ensure that the patient can be safely restrained.
B. Use the minimum amount of force necessary to restrain the patient.
C. If the process of restraint triggers severe agitation, combativeness, or violence, consider sedation as possibly medically indicated.
D. Transport the patient in as much of a position of comfort as possible allowing for adequate breathing and circulation. Never place a patient prone or apply force to the head, neck, chest, or back.
E. Apply monitoring equipment if feasible and monitor the patient’s condition during transport. Treat any medical emergencies appropriately.
6. Special Circumstances
A. There may be patients who cannot be safely transported against their will because of a lack of resources, the strength of the patient, the risks involved in attempting involuntary restraint from the patient, family, or bystanders, or other risks as determined by the EMTs on scene. Assume your actions will be on someone’s video and act accordingly in a professional and compassionate manner.
7. Documentation
A. A situation involving involuntary restraint and transport requires careful documentation of the patient’s assessment, condition, risks, capacity, and the benefit to the patient of involuntary restraint and transport. The service medical director should be alerted to the involuntary nature of the call so it can be reviewed.