Refusal of Medical Aid (RMA)

Revised and approved by the ACEP Board of Directors December 2007 titled, "Refusal of Medical Aid (RMA)," replacing policy "Patient Nontransport"
Approved by the ACEP Board of Directors December 2000 titled, "Patient Nontransport" 

The American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) believe that each emergency medical services (EMS) system should develop medically directed protocols regarding patients who are assessed in the out-of-hospital setting and subsequently refuse medical treatment and/or transport. A significant number of requests for EMS response result the Refusal of Medical Aid (RMA) by the patient. RMA should occur only in the presence of direct medical oversight or detailed off-line protocols. Appropriate educational programs targeting EMS personnel, physicians, and the public should be in place before implementation of this policy.

Key elements of these protocols should be to:

• Require Decisional Capacity for all patients who RMA.
• Address specifically the assessment and documentation of Decisional Capacity.
• Address the importance of appropriate documentation.
• Address patient consent issues.
• Address minors who refuse transport.
• Develop appropriate patient educational materials to be given to all patients who are not transported.
• Ensure that decisions are made in the best medical interest of the patient rather than primarily representing the interests of the provider.
• Integrate Performance Improvement programs to evaluate outcomes of patients who are not transported and monitor compliance with Decisional Capacity assessments.