Refusal of medical assistance

Refusal of Medical Assistance (RMA) is a term used in emergency medical services (EMS) to describe situations where a patient declines some or all medical treatment in the pre-hospital setting, such as during an ambulance response. In some parts of the United States, it is known as “patient refusal”, Refusal of Medical Aid (RMA), or Patient-Initiated Refusal (PIR).

The concept of RMA is specific to EMS and involves patients choosing not to receive care during an ambulance or emergency medical response. It is part of a broader phenomenon of patients refusing, delaying, or limiting medical treatments, which can also occur in other medical settings, such as hospitals or clinics. In some systems in the United States, pre-hospital refusal of medical assistance rates as high as 26% have been reported.

Background

Refusal of Medical Assistance (RMA) is a process that ensures the continuum of care in emergency medical services (EMS), aligning with the responsibilities of ambulance squads. In a typical emergency call, the ambulance service will assess and transport the patient to an appropriate facility. The ambulance squad's duty towards the patient begins with patient contact and generally ends with transfer to the emergency department of the receiving hospital.

However, emergency calls may terminate in other ways. For example, an ambulance service may cancel their own services if the patient becomes violent, compromising scene safety.