Except in cases of emergency or necessity, all medical treatment is preceded by the patient’s choice to undergo it if they are of adult age. However, to be binding, a refusal of treatment must be informed, cover the situation that has arisen and the person must be deemed competent. If the patient has provided a valid refusal, the paramedic must respect the patient’s wishes. When attending to a patient who expressly refuses ambulance treatment or transport, the paramedic is required to conduct an assessment to determine if the patient is competent and has the capacity to make the decision. This assessment is referred to as a VIRCA assessment.

Please note: All patients aged 12 years or younger are excluded from the PnT process. Unless the patient’s legal guardian refuse ambulance transportation of the child, transport should be advocated. Parental refusal must be documented and signed for by the legal guardian.



The decision to either consent or not to consent to the proposed treatment, including transport, must be a voluntary decision made by the patient themselves, and must not be unduly influenced by health professionals, friends or family. The refusal would not be valid if it were later found that the decision was based off falsified or misleading information.



The patient must receive sufficient information about the proposed treatment, including transport, to enable them to make an informed decision including what the treatment is and its benefits, risks, and potential consequences of not carrying out the action.



Any refusal of treatment and/or transport needs to be relevant in that it relates to the action that has been recommended.



The patient needs to demonstrate capacity to understand the information presented to them, relevant to the nature and consequence of the action, and be able to make a reasoned decision.



Should a patient refuse a treatment/transport, and if that decision is deemed valid, the patient has to be provided with relevant advice or recommendations to promote comfort and safety in the absence of medical care. This may include the engagement of friends, or, family, other healthcare agencies or providers (e.g. a GP, or locum service) or a scope to identify when the ambulance service should be called back.

PCR Documentation:

The 'Patient Not Transported' form and PCR (Patient Care Record) forms should be completed in the event of a patient declining transport. Thorough documentation is necessary to convey the above to support the officer in respecting patient autonomy:

  • Reasons to suspect the possibility of significant injury.
  • Appropriate efforts made to persuade the patient to seek medical aid.
  • If the patient has declined.
  • What advice was given to the patient as to the possible consequences?
  • What advice was given to the patient and/or significant others as to what to do in the event of any deterioration?
  • Time spent with the patient in examination and discussion.
  • If possible obtain the signatures of the patient and /or bystander plus a witness to verify the advice given and the time spent at the scene.

Key Terms & Links


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Clinical Services

Responsible Manager
Head of Clinical Services


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Clinical Resources Website

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