Consent in First Aid: Can you ignore ‘No’?

Getting consent to treat someone is a topic covered in all our First Aid Training, but it’s something that can be difficult to discuss fully at times, and certainly something that is difficult for us as First Aid Attendants to accept. We’re here to help…. Why would someone, especially someone clearly in need of help, refuse?

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Consider P.R. (not his real name, not even his real initials) a 28 year old male. He has muscular dystrophy and many of his muscles are wasting away. The resulting immobility has also left him with very week bones. 2 years ago, he needed CPR and he received it, aggressively. They broke his back…. He did survive, but lives with a lot of pain every day. He was already confined to a wheelchair, but if not he’d certainly need one now.

Do you think P.R. will freely give consent to whatever you want to do to him? Even if you think it’s in his best interests? You’ll need to have your best negotiation skills ready, and remember everyone has the right to refuse.

In most cultures and societies we have a degree of respect for a person’s ‘space’. You know this when someone from another country gets ‘too close’ or seems ‘too cold’ because they have different rules about closeness & privacy; different boundaries. While the ‘personal space’ varies, it’s generally considered rude, offensive or threatening to touch someone unless the person gives you permission. In fact some of what we do in first aid would be considered assault if you didn’t have permission.

Getting consent

So…. You’ve decided someone needs first aid and you’re going to help. To get their consent, tell them:

  • Who you are
  • That you’re trained in First Aid
  • That you’re here to help

Now, there are several ways to do this, and the method you choose will depend on why you’re there and your relationship to the injured person. Take a look at these two approaches and you’ll see what I mean:

“Hi, it’s Tony. I’m a First Aid Attendant and I’d like to help. Is that OK?”

“This is Tony, the First Aid Attendant. Stay still and I’ll help.”

The first approach requires them to respond and ask for your help. They need to decide if they want help and you’ve specifically given them the choice. In many cases it’s quite appropriate. The second requires no response unless they wish to refuse your help. It assumes you will be helping (unless told not to) and is much more directive. It would be most appropriate when significant injury has occurred and you need to immediately be in charge of the situation.

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What if they can’t respond?

If they really can’t (they’re unconscious) then consent is implied. You can go ahead and treat them.

Here’s the catch. What if they’re seriously injured, refuse your help, and then become unconscious? Help them anyway! Yes, strange as it seems the law assumes they are now in such serious need of help, they would consent if they were able.

What if they refuse?

Well we just said they have the right to refuse, but what to do? There you are as First Aid Attendant, and nothing to do. You’re itching to do the job you’re there for and you can’t.

Well, yes you can. You can always help someone even if they say no! OK, so this time ‘help’ might only mean calling your E.M.S. Let them know the person has refused help. The E.M.S. personnel who arrive will have their own methods and protocols for dealing with the situation. Meanwhile stay nearby. If you think it reasonable you might try ‘reasoning with them’ but still do not try to give the person help by force.

What about kids?

You need to help them, but you need also to consider ‘your relationship’ with them. If they are in your care then you are legally obligated to help to the best of your ability. Hopefully that includes first Aid Training. You do not need the child’s permission to help them. If the child is not in your care, you are not obliged to help. However a good rule of thumb is to treat them the same way you would want to be treated if it were you in need of help.

If the parent or guardian will not let you help the child, call your E.M.S. Let them know that the parent or guardian has refused help. They will have their own methods of dealing with that situation. Remember that the child’s care-giver (including parents and guardians) are legally obliged to give/seek help as necessary for the wellbeing of the child.

If you work in Child Care:

  • You must provide first aid as per your scope of practice
  • You do not need to get the child’s consent to help them
  • If a parent or guardian is present, it is good practice to ask their permission first.

Consent gets Complicated

What if the person is drunk or intoxicated with drugs? What if they have learning challenges and cannot understand? What if they’re irrational due to illness (delusions, paranoia, dementia, etc.)?

If you are there to offer life-saving treatment, you will have to use your judgment. Preferably have someone else with you who can witness what you did and why – and make sure you document the fact that you acted without the person’s consent.

If you are there to offer minor treatments (like say, dealing with a broken arm) then don’t sweat it. Follow the ‘what if they refuse’ steps above.

Best Practice in First Aid

Always err on the side of giving treatment. Presumably that’s why someone called you, came to get you, came to you or whatever. Unless you’re acting outside the scope of your training, then the Good Samaritan Act covers your actions if they are in the best interests of the ‘patient’ at that time. If P.R. collapsed in front of me and wasn’t breathing, he’d still get CPR.

Advance Directives (Living Wills)

Advance Directives document the person’s wishes ahead of time, should the worst happen to them. Advance Directives vary a lot, even varying within the same city. Locally they need to be documented, and signed & dated by an M.D. and reviewed with the person or their representative every year.

As a First Aid Attendant, even if you suspect there’s an Advance Directive in place, can you be sure it meets all of the legal criteria in your location? And have you actually seen it?

Don’t even worry about it. Just do the treatment necessary. In serious situations (like when you’re doing CPR) you’re only extending life to the point where the healthcare team takes over. They can then find and assess the Advance Directive and make the appropriate, professional, clinical decision base on their findings.

Consent Caveats

‘Consent gets Complicated’ is the author’s own opinion based on experience.

This discussion is based around the law in Canada, and specifically B.C. Your laws may vary!

About Tony Howarth

Tony is a First Aid & CPR Instructor Trainer with Sea 2 Sky Safety Training Services and the company founder. Tony started with the British Red Cross in 1994. Has acted as first aid attendant for hundreds of events & treated many hundreds of people as a result. He is experienced in training a wide range of courses. He previously worked as an ambulance attendant with the British Red Cross. He is now in BC as a first aid instructor, and an instructor trainer (one who trains others to become instructors) Finally, Tony works at UBC Hospital as a pharmacist when not busy training safety
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4 Responses to Consent in First Aid: Can you ignore ‘No’?

  1. Pingback: First Aid – a Blog Round-up | Safety un-Limited

  2. Krista Piek says:

    Great explanation of consent in first aid. Hard to find actual provincial regulations/laws around first aid specifically. ( I am also a first aid/CPR instructor)

  3. Dan says:

    So ‘no means no’ but does silence mean yes? My first aid teacher today told us not to ask, but rather to direct and said if they don’t say no, that’s still consent. I have trouble with that morally, but I’m curious about the legality around that…

    • Tony Howarth says:

      Hey Dan,

      Great question! I should think it’s a grey area in law. One could argue ‘they didn’t say no’ which another could argue ‘there was no explicit consent’. We discussed above the implied consent when unconscious – but I can’t tell if that applies anywhere outside of B.C. Canada. As first aid & ambulance attendants with the Red Cross in the UK, we were taught as you say, basically to assume consent. As in “Stay still. We are here to help,” and not really wait for any objection. Here in Canada now, we teach this (above, in the post) information about consent in the “workplace course”, and sometimes discuss it in other courses if students ask. In treating thousands of people over the years, I have to say the only ones for whom the ‘assumption’ approach didn’t work were on various street drugs – there were times that was a big negotiation process. Not to say that is or isn’t legal!

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