Chapter 3: Transport

When the family insists

If a family member insists on transport, this could be the result of fatigue or fear that symptoms can’t be managed adequately at home. They may think that transport to an acute facility is the safest thing to do. Remember, this isn’t a criticism of your abilities.  

In these situations, you can:

  • Refer to your community guidelines, which will outline policies and procedures for contacting other health care providers (for consultation). 
  • Share your specific concerns in a firm yet gentle way. Explain that:
    • Transport may be disruptive to the patient.
    • The patient may die during transport, separated from family and familiar surroundings.
    • There may be delays in the patient being seen at the emergency department.
    • It’s unlikely the emergency department will perform any additional interventions.
  • Review the goals of care with the family.
  • Ask the family to think about what the patient would want.
  • Offer to connect the family with community supports.

Conversation Prompts

"What are your hopes or expectations if we transport to the hospital today? The emergency department may be able to provide comfort care and symptom management, but if she stays at home, we can provide the same care without the disruption of transport. Given her deterioration, I’m concerned she may die in the ambulance without the support of family and familiar surroundings. I believe she’d be more comfortable in her own bed. If she was able to be part of this conversation, what do you think she’d want?"