According to Which Criteria Should a Return EMS Trip of Long Duration and Distance Be Deemed Ethically Justifiable?

Assessing and adequately documenting a patient's decision-making capacity is a responsibility and skill required of all emergency medical services (EMS) personnel. However, emergency medical technicians' and paramedics' training in a patient's refusal of EMS transport is often limited to evaluating that patient's alertness and orientation. This commentary argues that this approach is too narrow and outlines the obligation of prehospital care personnel to examine the patient thoroughly, obtain a complete set of vital signs, explain prospective risks and benefits of EMS transport, determine capacity, and express support for the patient. Finally, the commentary outlines what it means to appropriately document a prehospital interaction with a patient and express respect for decisions of patients with capacity.