ninjaemtff Posted October 22, 2007 Posted October 22, 2007 Ok, I had this call a few months ago, I want to see what care you all would give. Then I will tell you what I did, and what resulted from my care. Dispatched for an assault victim, alcohol involved PD is to be en route. You arrive on scene once assured that the scene is safe. PD has a 39 y/o female. Apparent intoxication, however no apparent injuries. You start your assessment, and upon assessment you find that pt is complaining of neck and back pain and wishes to be transported to the local hospital. Shortly after pt tells you this, she changes her mind, says she does not want to go to the hospital. PD advises her that she can either go to the hospital or jail. Pt states she would rather go to jail then to the hospital. PD takes her into custody and requests a refusal form be filled out for legality. You fill the refusal form out but you are unable to contact command due to being in the mountains with no service. PD requests that you stay on scene because they are searching for the assaulter. You stay on scene and hang out with PD. Well the pt decides she no longer wants to go to jail she would rather go to the hospital first. Redo assessment, upon assessment pt states "I don't hurt anywhere, don't touch me just leave me the f**k alone while we go to the hospital." Pd rides along. The entire way pt tells you she is uninjured, and wants no treatment. How would you treat this pt?
Echoburger Posted October 22, 2007 Posted October 22, 2007 :?: For those that dont know im only 13 so I can assure you that my "treatment + assessment " is not right. :shock: Just for safety I think you should apply C-collar and backboard the pt for safety. Also if the pt is violent you might want to apply restraints per protocol. Get the pt's vitals and treat them accordingly. If there is nothing severely wrong with the pt's vitals I think it would be a low priority transport. Give 02 if sats are below 96%. Re-assess pt's vitals every 15 min. Try to keep the pt calm and radio a report in when you are about 10 min out from the hospital. thats all I can think of .
JakeEMTP Posted October 22, 2007 Posted October 22, 2007 How about getting a baseline set of vitals, monitor the patient en route to the ED and talk to the patient. Talking might allow you to calm the patient down enough to obtain a little more info on whats going on. She might even let you do a thorough assessment. But what do I know. :wink:
ERDoc Posted October 23, 2007 Posted October 23, 2007 This pt does not sound like she has the capacity to refuse transport. I think it was a mistake to fill out the RMA because PD wanted you to. They will not be the ones to get called into court. Personally, I think a small dose of sux (minus the etomide) ought to do the trick while we board and collar her. Then once it wears off let her know you will be more than happy to give her a full dose next time she decides to act out :wink: . As usual, follow your local protocols.
reaper Posted October 23, 2007 Posted October 23, 2007 No refusal do to etoh. Tell her nicley that she can go with you and answer all your questions and let you check her out. OR, she can be tied down to a bb and gagged, for the entire trip ( while you and PD make fun of her the whole way in)!!!
JakeEMTP Posted October 23, 2007 Posted October 23, 2007 OR, she can be tied down to a bb and gagged, for the entire trip ( while you and PD make fun of her the whole way in)!!! LOL! I'd like to go the chemical route, maybe 5 mg of Haldol, but since she is being so co-operative :roll: , I'd just monitor her. However, whilst chatting with the young lady, I would be getting my drugs ready. Since she is wandering around deciding what to do, I think C-spine could be cleared. She's agitated enough without trying to board and collar her.
AnthonyM83 Posted October 23, 2007 Posted October 23, 2007 I would attempt to place her in spinal immobilization. If she physically fought it, I would leave her be and tell her to stay still, as not to compromise her spine any further by having her struggling to get out of it.
ninjaemtff Posted October 23, 2007 Author Posted October 23, 2007 Well, I must admit that I did screw up on this call. I did in fact fill out the refusal form, and had the pt sign the form. However in doing so I made one of the officers sign as the witness and the other sign under the pts name, therefore taking responsibility of the pt. However I do know that I screwed up there. Then whenever she again decided that she wanted to go to the hospital and I did my second assessment, I did not think back to the first one where she told me that she was having neck pain. Therefore I did not place a collar on her or place her on a board. No vital signs were taken because of the way the officer had the pt handcuffed. This officer however did happen to be a paramedic and did not try and correct me in any of my doings. I talked to the pt and got her calmed down, but then something would set her off again, and she would begin to cuss, and kick at me. She was handcuffed behind her back, I attempted to get a bp, however when doing so she elbowed me in the face. While en route to the hospital, she continued to deny any pain. Upon arrival at the hospital the doctor walked over and asked her if she was having any pain at all. The pt stated and I quote directly "Yes my neck and back hurt, they have been hurting me the entire time I told this b**ch this several times and she did not listen to me. I then tried to explain to the doctor what had happened, he would not listen to me though, apparently a drunk is more trust worthy than an EMT, and the officer that rode along did not back me up at all. All in all, I learned a very important lesson from this call. Though she did not suffer any neck or back injuries, every assault victim should be placed on a long board and c-spine should be immobilized. If the person is not under the influence of drugs or alcohol and do not wish to be boarded and have a collar placed on, they can fill a refusal form out for that particular treatment. However, if they are intoxicated, they have no say in it. I guess all I can say is I got lucky that she didn't have any permeant injuries, and that she was so intoxicated she did not remember anything the next morning.
JakeEMTP Posted October 23, 2007 Posted October 23, 2007 I have to tell you, I'm not going to fight or put myself in harms way to board and collar a patient how is walking around just because they're intoxicated. I would just document exactly what happened. The LEO/paramedic is an ass. If anyone should have backed you up it was him. The ER doc was concerned only for the patients welfare. Once he cleared c-spine, I'm sure he'd calmed down. Take it as a learning experience. Remember, not all calls are the same and treat them accordingly. Don't get caught in " the Box".
ERDoc Posted October 23, 2007 Posted October 23, 2007 It sounds like you did the best you could (putting aside having the refusal signed). IN theory you should immobilize this patient, but if it puts you in jeopardy of being harmed you do what you can. No sense in creating two patients out of the situation, especially when you cannot depend on PD backup.
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