Combative Patients Refusing Treatment?

[AnthonyM83]

I was wondering what guidelines people use for combative patients who refuse treatment, with an emphasis on drunk patients.

Let me give an example to start off the discussion.

30 year-old male is victim of assault. Punched violently with loss of consciousness (per bystander). PD calls EMS. But patient was heavily drinking prior to assault and aggressively yelling, swatting at, and pulling away from EMS, saying he doesn't trust them. It's clear he's inebriated, not totally in touch with the situation, and definitely not able to make an informed decision (whether or not he's AO3). Laceration to forehead is visible, but will not let you examine further (pupils, pulse, etc).

What procedures do you guys have? Will you utilize PD to take them to hospital by force? What authority would PD use to do that if he's in his own home drunk, not having violated any crimes.

Obviously, if it's a known altered diabetic, we're more likely to go hands-on, restrain, and give dextrose/glucogon, but what about not so clear-cut cases, like drunks?

I ask because I know of two people with family members who were mistaken as drunk only, but actually had severe trauma (on top of being legitimately drunk) that led to death...and encountered a similar situation recently.

[ninjaemtff]

If he's fighting, we have PD assist us. They use force if it gets to that point. And most of the time they will cuff him. We request that if they cuff the pt that they do so to the rails on the litter so we can still do everything that we need to. In situations like that we don't enter until PD is there, and we make PD go along with us, just in case anything happens. If they are cuffed PD is with us. End of story.

[Lucky~13]

Patient may not be A&Ox3, but if he/she is uncooperative and COMBATIVE, the patient is not your problem. But rather the problem of your fine local, county, or state PD.

But if they should insist the problem rests with you, they metal clipboard solution usually works.

EDIT: To clarify

Will you utilize PD to take them to hospital by force? What authority would PD use to do that if he's in his own home drunk, not having violated any crimes.

Protective custody can be implemented if its in the patients/publics best interest. Even if no crime was committed. Good luck ever getting them to do it though.

Obviously, if it's a known altered diabetic, we're more likely to go hands-on, restrain, and give dextrose/glucogon, but what about not so clear-cut cases, like drunks?

Drunk doesn't mean squat. If they are altered, they are altered. The causes don't mean much if your trying to restrain the patient.

And get out of the thinking that one type of patient is more worthy of you then another. Drunks require your care just as much as diabetics.

[Timmy]

Midazolam!!

[AnthonyM83]

Protective custody can be implemented if its in the patients/publics best interest. Even if no crime was committed. Good luck ever getting them to do it though.

I think it's because cops aren't sure under what authority to do it. When called to a scene, they've seen confused/hesitant due to know knowing under what authority to hold them (provided they aren't on a psych hold).

Diabetics and drunks both get our help, but we're more likely to try to restrain a diabetic, since that's usually a quicker fix...just hold him down long enough to inject dextrose/glucagon.

[Lucky~13]

I think it's because cops aren't sure under what authority to do it. When called to a scene, they've seen confused/hesitant due to know knowing under what authority to hold them (provided they aren't on a psych hold).

That's their job to know. EMS knows medicine, PD knows the law, and the monkey's know how to put water on fire and cut stuff with robo scissors. If I showed up on scene and didn't treat the pt because I didn't know my meds or drug dosages, I don't think I'll be working much longer.

[Flasurfbum]

That's their job to know. EMS knows medicine, PD knows the law, and the monkey's know how to put water on fire and cut stuff with robo scissors. If I showed up on scene and didn't treat the pt because I didn't know my meds or drug dosages, I don't think I'll be working much longer.

Ignorant fool.

[Flasurfbum]

If he's fighting, we have PD assist us. They use force if it gets to that point. And most of the time they will cuff him. We request that if they cuff the pt that they do so to the rails on the litter so we can still do everything that we need to. In situations like that we don't enter until PD is there, and we make PD go along with us, just in case anything happens. If they are cuffed PD is with us. End of story.

Avoid the silver bracelets if at all possible.

They are great at first, but once on that cot, use a soft restraint (Kling, cravat, soft restraint) or leathers.

Further harm can come to the patient from the handcuffs, and guess who will be held responsible?

[tskstorm]

I've spoken with NYPD on matters similar to this dozen's of times.

It goes like this ....

IF PD OR FD are on scene, and it is an EMS call, or there is a patient as the primary concern (there's no fire or PD matter going on) EMS has full and complete control to direct, and instruct PD and FD for the best interest of the patient.

IF PD wants a reason to take a combative patient into custody, remind them suicide is a crime and if this patient doesn't get the appropriate treatment they could die.

In protocols around here we are allowed to restrain a patient in three situations, 1 protect the patient from themselves, 2 protect ourselves from the patient, 3 if PD directs us too/asks for our assistance.

[Arizonaffcep]

In AZ, we can contact medical control, and let the doctor "rule" that they, the Pt is not able to make a decision to refuse treatment. This has happened to me once (she wasn't combative, but belligerent), I contacted my base hospital, and they Dr. made the decision that she was not able to make that decision on her own (due to ETOH and being in a rollover, not to mention that she wasn't A&O X 4). PD on scene stated they weren't going to force her, but with the Dr.'s order of not being competent to make her own decision, the Dr. can then order PD to place the Pt. in custody.

It's not used very often, but in AZ if even if the Pt is A&O x 4, but EMS belives they are not able to make a rational decision about medical care, you can contact the base hospital and get the doc to say they aren't mentally able to make the decision. They are usually pretty good about going along with it (the docs, not necessarily the Pts).