When a patient with a terminal illness has a suspected hip fracture and requests not to be transported, what is the recommended EMS action?

• A. respect the patient’s wish and do not transport.
• B. encourage hospital.
• C. force transport.
• D. administer pain medication only.

Answer: (B)

The main idea is that even for someone with a terminal illness, a suspected hip fracture typically requires definitive evaluation and ongoing care that only a hospital can provide. EMS should act to advocate for appropriate treatment by encouraging transport to the hospital, while still offering comfort measures and discussing goals of care.

Hip fractures are usually not managed safely at home. They require imaging (like X-rays) to confirm the fracture, pain control, and often surgical planning or interventional care. In addition, the hospital can connect the patient with palliative or hospice services to ensure the patient’s comfort and align care with their goals. Encouraging transport gives the patient access to these necessary evaluations and treatments, and provides an opportunity to address pain and suffering in a setting equipped to manage both the fracture and any other terminal-illness considerations.

Respecting a patient’s wish not to be transported is appropriate only if the patient demonstrates capacity to make that decision and has an advance directive or DNR that specifies not to pursue hospital-based care. For a patient without such directives, and with a condition that needs hospital care, the best course is to encourage transport. Forcing transport is ethically unacceptable, and giving pain medication alone would neglect the need for diagnostic imaging and definitive management.