Input on SOP "gray area" call

[irme]

Except a physician can do it legally and over the phone (at least where I'm from). EMS cannot (again where I'm from) force patients to go to the hospital that meet the criteria as outlined in this case. They are not under any "mental health act" or anything. The MD in this case (unless I'm reading this totally wrong) has knowledge of this patient and was likely involved in the reason why EMS was called. The MD and family both likely knew that the patient would refuse.

See that’s where I beg to differ. We have two possible scenarios 1) The pt is being annoying but completely competent. 2) The pt is not competent and needs transport as obviously her judgement is impaired.

You think that she falls under scenario 1 but in reality it is impossible to place her into that category and to do so would be so assumptive on your part that you start to walk towards showing negligence.

If however you chose to talk to her about the reasons she needs to answer your questions appropriately and that if she does so she will illustrate her ability to make informed choices and then she can decide exactly what she wants to happen to her. You are far more likely to get an appropriate response from somebody that is lucid and does not have impaired judgement.

Alternatively continue to assume away,..

[mshow00]

Thats just it... medical control ditched us... told us we were on our own... my partner is a push over sometimes and let them off the hook with that..

[streethealer535]

I think it sounds like we are all coming to the same conclustion...

My only question is what was the final outcome??? Did the patient continue to refuse treatment in the ED? Was there a Mental change due to dehydration or mental defisency? was the patient released back to the SNF? Just wondering how it all worked out...

JJ

[spenac]

When we walk into the room she states she does not want or have to go to the hospital. When we try to ascertain her mental status by asking her age she replied with "look in my chart." and then every time from that point on when we asked her a question she would reply "it is my right not to answer".

Sorry if already stated. I am to lazy to read all posts.

This is easy. Take her. She is A&O X 0. She did not give correct answers so she is not capable of making a rational refusal. I would write out each question asked and her answer. I would also include that you were told she has mental problems per who ever told you. IMHO there was no need to waste medical controls time. Load her and go.

If you actually think she is mentally there and just being hard headed explain to her that she has to answer your questions or she will not have a say in her care.

[mshow00]

Final results: We transported her to the hospital, and they treated her as they saw fit, regardless of her refusing they started an IV(b/c my partner did not) and fed her fluid and flat out ignored her protesting(ED Doc. said she was AMS) dispatch called us 10 8 b/c of a 10 50 roll over 15 to 20 miles north of us(status 0 and no one closer) so how it went after that.... dunno

[Richard B the EMT]

Seems you did what you had to, followed your protocols, perhaps went a tiny bit overboard as patient advocate, but I think we all do at various points of the job. Sounds like, ultimately, youse done good.

[mrmeaner]

The only thing I have to add is regarding med control. The impression of your patient's LOC I got from your first post is very different from the impression after subsequent posts. I don't know how your conversations went with med control, but this would be a case showing the importance of "painting a picture". You may have very well given a perfect report, but if not, maybe this will help next time.