I was told that some medics did not transport a patient after administering Narcan.
Although the team was aware of the drug's relatively short half-life, they did not seem to think they could mandate transport to the hospital with police on the scene.
They felt comfortable leaving the patient behind and justified the code 7 due to the patient having an extra dose of Naloxone on-site if needed.
Could you clarify if this is ok?
We apologize for the delay in replying to your submission. Great question regarding the use of Narcan and the patient's right to choose further treatment and/or transport.
The decision to treat is based on your clinical assessment, the patient's presentation, and informed consent. When a patient is unable to consent and is experiencing a life threatening emergency, we accept implied consent and compel providers to intervene unless otherwise state by a substitute decision maker. To answer your question more completely we rely on the ALS PCS Consent to Treatment in Non-Emergency Situations, and Consent to Treatment in Emergency Situations.
Patients experiencing an overdose are considered to be in an emergency situation. The provider uses clinical judgment before administering treatment. If the patient regains full capacity, based on the aid to capacity assessment tool, and is no longer experiencing an emergency situation then the patient is required to consent to further treatment or services. Patient's have autonomy and can choose to decline transport. During this refusal process we encourage all paramedics to discuss the patient's clinical situation, the risks associated with their situation, and discuss a care plan if the patient chooses to decline transport.
This is a complex process that requires careful consideration for what is known about the patient's condition, what is unknown, and what reasonably foreseeable risks the patient care expect. We encourage explaining to the patient the risks of deterioration, warning signs to look out for, and discuss a care plan for after you leave the scene.
The key concepts in the refusal of service process are, a) capable patients have the right to refuse, b) patients have the right to make an informed decision about their care and be explained the situation (known or unknown), the risks associated with that situation, and c) have a care plan. If these elements are in place, the patient has the right to refuse. If they do not have capacity, escalating the call to a Supervisor or Police to help make the best decision for the patient would be prudent.
To summarize, is it ok to not transport a patient after administering Narcan? Yes, as long as they have capacity to make an informed decision, they are made aware of the risks with refusing service, and have a care plan for after you leave. In all cases, we encourage patients to seek further medical attention and it is ultimately up to the patient to decide.
Happy to discuss further if you are interested.