At my full-time service, signing-off patients is a responsibility reserved for the paramedic, and there’s a reason for that.
While the importance of a well-conducted sign-off is primarily medical-legal in nature, at the heart of the risk is a concern for the well-being of the patient. There doesn’t appear to be a huge amount of literature on EMS sign-offs, but what there is suggests that we should aggressively encourage patients to be transported and that, although the risk of patient admission/death may be minimal, sick people still sign-off.
Regardless, every sign-off needs to be both performed well and documented well. This post, from ALiEM, discusses how doctors sign patients out AMA, but I think we can use the same approach in the pre-hospital world.
After writing this post, I created a “macro” of sorts that incorporates elements of this article as well as specific language from my service’s sign-off that I put in my narrative. I would encourage you to create your own, but if you would like an example, my documentation can be found here.