mackeydad

following the original post by medic511 the patient reluctantly accompanied the medic to the hospital, where a routine ct revealed a significant intracranial bleeding. patient was taken 300 miles by helicopter to another hospital, where a small artery was surgically repaired. patient was released a few days later without significant deficit.

apparently none of the problems you mentioned existed in this case. if you search patient refusals of treatment, click on page 2, and drop down to comments by medic511, you can read his complete comments. as written, the patient simply didn't want to go, met all the legal requirements for informed refusal, and by law, should have been allowed to sign an ama refusal and go about his business. i wonder what might occur in cases like these if this patient had stood his ground and chosen the squad car and handcuffs? have any lawsuits occured in such cases questioning the authority of police to force a patient to go to the hospital against his will when he clearly (at least according to medic511's run report) met ALL legal requirements for informed refusal as set forth in the law?

i just finished reading the blog entitled "policy on refusal of care". in an 18 december, 2007 post, medic511 discusses a recent run he he was on. he was called to the scene of an mva and found the driver ambulating, with no signs of injury. he also had no complaints, pains, and seemed fully competent. you can search patient refusal of treatment, and drop down to policy on refusal of care for a full explanation of the run. he decided the patient had to be transported based on mechanism of injury alone and conferred with the on scene police officer, who then told the patient he had two choices. he could either go the hospital willingly in the ambulance, or in handcuffs with the police. this incident bothers me a great deal. the patient met all the criteria for informed refusal and had certainly committed no crime. in this particular case the patient, when faced with these choices, decided on the ambulance. i have two questions here. what do you think the outcome would be if the patient simply stood his ground and again refused? what gives the police the authority to compel a fully competent patient who had already refused to go to the hospital against his will? i would have chosen the squad car and the handcuffs, and my gut feeling is that both ems and the police would have backed off. am i right or wrong?

i begin by offering my apologies to you. many posters probably feel my comments and criticism of you were harsh also. i don't want this to sound like a "me against them" crusade. policies and protocol are developed with the interests of the vast majority in mind, and there will be others who will comply because it is the law. this is good. the more people who wear safety restraints, for whatever reasons, the better and safer our society becomes. my only problem concerns those not in this vast majority, for whom these policies and laws become a major burden upon those who cannot comply. for this reason government offers "exceptions" in order that those with legitimate reasons for not complying do not become "criminals" on the surface it would seem that our E.M.S. would do the same. however, as with everything else, there is a big picture to consider. unlike seatbelt regulations, where exemptions physically hurt only those who chose not to buckle up, that is not the case here. we must consider the safety of the provider, also in the patient compartment. that is why i think the best solution in my case is sedation. this will allow me to be transported, restrained for safety, in a way that meets the safety considerations of the provider. i have been sedated many times with no problems. i have discussed this issue with my P.C.P., at great length, and he concurs that, provided the need is emergent, transportation is necessary, and this is the only way to accomplish same, that he recommends i be sedated. this is far from the optimum, but ANY way trumps NO way. i have always thought that one of the major tenets of emergency, out of hospital medicine, is to offer the BEST CARE POSSIBLE TO ALL OUR PATIENTS. it is my humble opinion that strict adherence to this one size fits all regulation falls short of this tenet. i think continuing this fight within the legal system would only be beneficial if E.M.S. would alter their protocol as a result. you and i would agree that a system which leaves patients desiring care on the streets due to a technacality in the law is far removed from the best system. hes E.M.S.ever been the defendant in a lawsuit brought by a patient not given transport for these very reasons? this is indeed a thorny issue for all concerned. and finally, for laura anne, please continue to be a hand holder. you meet people at the most critical, and stressful times of their lives, and holding their hand says "i care" like nothing else. i apologize again if i offended you in any way. thank you for your comments.

i do not mind answering. anyone desiring information about my claustrophobia, ask away.. my condition is such that whenever i find myself in tight quarters where my freedom of movement is restricted, it is like a signal is sent to the brain saying, "we have got to get free. everything, even life itself, will cease if we fail. worry not about anything else. every available sources of energy--your mission is to prevent restraint at any cost." at this time the "trigger' for lack of a better term, assumes complete control and is concerned with nothing else but stopping and getting free from, the restraint. NOTHING ELSE. NO OTHER THOUGHTS EXIST. if my own mother were attempting to hold me down, apply restraining straps to me, etc.., i would fight her, bust her head with a brick, anything to stop her with ABSOLUTELY NO THOUGHT GIVEN OR ANY CONCERN FOR her safety. i admit and fully realize that this is extreme. hard to believe, yes i admit that too. impossible, oh i wish that were so. unfortunately, it is nightmarish reality!! i offer this information to attempt to help you understand my situation and my actions. if any medical provider, police officer, or anyone else, tried to apply restraints to me they can expect the same result. it doesn't have to involve an actual restraining device either. if i am a passenger in an automobile and there happen to be two other people occupying the bench seat, crowding me where i cannot move freely, the trigger kicks in. i had to undergo cardiac bypass surgery and before i even consented i made my surgeon aware of my situation and he said he would pass the information on to staff who would be treating me. everything was okay until post op in recovery, i began to regain consciousness. immeadiately, i became aware of the respirator down my throat. not fully realizing its purpose my hands rushed to rid myself of it. but my hands did not respond. i tried again only to discover both my wrists were restrained, and the trigger was activated. with whatever energy left to me i began an agitated struggle to free them. my nurse heard the commotion, came over and tried to calm me. when my struggling increased, alarms on my monitors started going off. my blood pressure rose, as did my heart rate, oxygen level, and anxiety. the nurse sedated me, i became calm again and went back to sleep. i must be sedated to tolerate any medical test requiring me to be in close quarters. this fact completely rules out some tests, and make all the rests very difficult. i am completely fine anywhere as long as i can move my legs and arms, raise my body and sit up, and have ample room. i am fine in a car as long as there is ample room and i am not restrained. finally i wish to comment on a few things some of you have wrote. yes i do have a medical problem, but it does not make me special or to feel that way. i know i am not superman and yes, i know i am not being safe. i do not want nor expect EMS responders to break the law or inhibit their safety. i am simply a person with a medical problem that severely limits my options, who wants to be treated for whatever injuries i may have, in a way which is tolerable to me AND SATISFIES ALL OTHERS. based on your comments i feel the simple solution is for me to be sedated. then i am able to be restrained as i should be, and my providers did not have to put themselves in any danger. i realize this is long, but i both welcome your comments and repeat my willingness to answer any other questions you may have. thank you.

yes, it does sound harsh, and IT IS harsh. and yes it certainly is called life. but "life" is also the reason for patients dying because they cannot afford the surgery to cure it, and also the reason for massive employee layoffs and plants moving to foreign countries for cheaper labor in the unending search for the "bottom line". this is all called life but does that make it right? what is destroying the delivery of medical care in the united states is not the fault of the patient, nor the emergency caregiver. it lies in our legal system. to think that, in making a run where the patient states that they FULLY understand their situation and the risks they are taking, and still refuse care, the provider can be sued for negligence for not providing the medical care the patient did not want, and be held liable is a DISGRACE. that being said, we return to the question at hand. i am a human with frailties and medical conditions, the majority of which are beyond my control. i did not ask to be claustrophobic. it is just something that happened. before anyone asks, yes i have had extensive treatment in an attempt to rid myself of this condition, and for reasons unknown to the therapist or me, it has failed. so that leaves me the victim of a MVA with injuries for which emergency care is summoned. after all the physical examinations,histories, and investigations have taken place, the EMS makes the determination i must be transported to the emergency room. it has been recommended that i go, i do not refuse, i want to go, but because of a technacality of our laws, i cannot. i have never doubted the advantages which wearing seatbelts offer. i wish i could wear mine. i am not against mandatory usage laws nor primary enforcement, but all states i am aware of which have adopted mandatory safety belt usage laws contain EXEMPTIONS to cover people who cannot wear seatbelts for medical reasons. is there a reason why our EMS cannot offer these exemptions? this would save people like me tons of anguish and pain. i do not possess the knowledge to diagnose or treat myself, so therefore i refrain from so doing. i ask only that when deciding what is the best option for the patient, that this be done by making use of ALL pieces of the puzzle, including what the patient can tolerate. is it better to leave a patient at roadside to fend for himself than to treat/transport him? i hear most of you already saying that it is not the responder not offering care but the patient not accepting it. on the surface this is indeed hard to disagree with, but disagree i must, because your decision is based on flawed evidence that the patient is making a "choice" not to accept treatment. this cannot be farther from the truth. you must understand that it is NOT a choice when i refuse and resist restraint application, it is a fact of life. claustrophobia isn't something you can turn on and off depending on the situation. it is not something a person chooses to be. YOU JUST ARE. there is something very fundamentally wrong with a system that will not make exceptions in order to offer care to ALL individuals. it is true that it is not our fault, but it is also true that it is us who must fix it. thank you and may God bless you all. i wish to say to laura anne, please tone down that attitude. you are not SUPERMAN, nor WONDER WOMAN either. and please do not be offended as this is constructive criticism. you come across as a "big know-it-all with a huge superority complex". and i wager that this is far from the truth, and a mistaken impression. i realize the laws are important and what you put at risk if you break them. i find it hard to disagree with your reasoning. what makes this an even more complicated issue is the realization that i know and accept the advantages seatbelts offer and agree that i should wear mine. this is very difficult for me, as i accept your premise and realize you are right. but i do not feel that you understand my problem and the reality resulting from it. understanding and compassion for people, not derision, will make you a far better medic than you obviously already are. finally, answer this question for yourself----------how many of your past actions and decisions made as an emergency care provider would have been different if you did not have the need to worry about the possibility of being sued?

i guess your position would be to leave me at the scene! you think it is absolutely ridiculous for a paramedic to bargain and compromise with a patient to give him the best care possible. believe me, i sympathize with the position that the legal climate of this country has created for emergency medical providers, where your number one concern in any run is to "cover your own ass". but i had no part in this, but i am paying the price just the same. there is no way i would bring suit against you for allowing me to be transported in a way which is tolerable. i certainly would, however, attempt to gain whatever legal recourse possible, if in my case you attempted to restrain me against my will, and subjecting me to the nightmare and whatever might befall as a result. far better to just leave me at the scene. at least there i will only need to deal with any injuries incurred in the accident, and not be burdened with the aftermath of whatever extra injuries sustained as a result of the actions of an overzealous medic attempting to avoid legal action. i really do not fault you as this legal climate was caused by you either. we surely and WE MUST create a better way, one satisfactory to both patient and provider.

to start i realize allowing a patient to be transported to the hospital is a serious problem for a responder. not only is this a violation of the law in almost all states, it also greatly increases the chance of injury to the patient. that is what makes my situation such a problem. my claustrophobia is such that i cannot tolerate restraint of any type, as long as i am conscious. being partially sedated for calming is not sufficient. simply the knowledge that i am being restrained causes severe anxiety attacks and i will vigorously fight any attempt at restraint. all of this is beyond any physical control of mine. the only way i can be restrained is to be unconscious. being fully aware of my condition and the protocols of every EMS unit makes the possibility of restraint application such a concern to me. adding fuel to the fire is the very real possibility of being thought to be "lacking capacity" and taken against my will. it makes no difference how seriously i may be injured or how ill i may be, for the simple KNOWLEDGE of being secured will start all this in action. the crux of my problem is--------i must be allowed to ride to the ER completely unrestrained or be rendered unconscious so i may tolerate being strapped---------A SITUATION NEITHER OF US DESIRES. thank you for listening and i would appreaciate any comments or suggestions.

you mentioned claustrophobics and state you do not routinely put the straps on. i am very claustrophobic and cannot wear the seatbelts in my personal automobile. this makes being transported by EMS personnel very difficult. our local service states that they will NOT transport anyone to the hospital without them secured. if i were injured and you were one of the EMT'S making the run and felt it necessary i go to the ER, what would be your response when i informed you that i could not tolerate being strapped down? my claustrobia is very real and very uncontrollable, and would refuse transport if not accomodated.

i currently do not wear seatbelts as i am extremely claustrophobic and cannot tolerate them. i am also currently undergoing therapy for this, and hope it will soon be a thing of the past. i am one person who would be dead today if i had been belted in the night i experienced my one and only traffic accident. will be glad to supply details if anyone is interested. now, does this mean one should not wear seatbelts? NO!!!!!! it is hard to argue with all the statistics and pleas from the medical community that wearing seatbelts can not only save you from being listed in the obits, but also can result in less severe injuries. i freely accept that all people should wear seatbelts, but they don't. laws mandating their use have definitely resulted in more people buckling up, but has not, and most probably will not, ever approach 100%. i still have problems with the government mandating their use and would love to see research as to the number of chronic non-users who have begun to wear seatbelts directly as a result of being pulled over and given a ticket for non compliance. at any rate, i whole heartedly agree that everyone should wear their seatbelts, and am convinced enough that i taking steps which will enable me to wear mine.

what noone has brought up in this situation is this---what is your recommendation if the patient is conscious and alert, and vehemently objects to being stripped?