Paramedic Reflection on Capacity

Paramedic Reflection

Capacity or No Capacity

As part of a double-crewed vehicle I was responding to a green one emergency, a crew had requested a second vehicle for a second patient.
Once on scene it was apparent that the first crew had to leave scene due to their patient being septic.

We were tasked to take a female patient into hospital as she was presenting with tachycardia and dehydration. The property had pigeons and parrots living freely within and the house was not up to living standards. With me was my student who was a technician but at the end stages of his Paramedic conversion course.
The patient refused to come to hospital initially. We explained the risks and why we would like her to attend hospital, but still refused to come with us.
She had been on the sofa for four days, been doubly incontinent and not a great deal to drink or eat.
The lady could retain information, understand the risks of not coming with us and seeking further medical attention and relay all information back to us very articulately. She had not been suicidal, no self harm and not confused.
We were concerned for her health and welfare. Police were on scene to gain entry initially but had no power to remove her from her property.

I stated that the patient had capacity and that it was her decision what she wanted to do; my student stated that she lacked capacity, as she ‘just wanted to stay on the sofa and go to sleep’. Yes this lady was living in squalor, had no running water in the house neither did she have any electricity. I could understand my student’s point of view, but he still didn’t understand that she had capacity to consent and refuse treatment and transport to hospital. I asked for the Rapid Response Paramedic who was still on scene for her opinion and clinical assessment of capacity. She too also agreed that the patient had capacity, but was not ideal to leave at home in these living conditions.

I tried to explain to my student why I deemed her to...