Another Ethical Question

[DwayneEMTP]

If the Dr. attempted to provide medical care to the patient, then he needs to be reported, just as if a surgeon showed up smashed. In your trip sheet do you not have to report that CPR was in progress when you arrived? Its one thing to see him in the living room with a 20 rolled in his nose and reporting him, its quite another if hes providing care

So, are you saying then that if you showed up on scene with no CPR in progress and the doc, or partner explained they withheld care because they were baked, that you wouldn't have an issue then?

Dwayne

[mobey]

All my reports always said "Bystander CPR" or "Pre arrival CPR" in progress.

Never inserted a name or needed to, I believe you are taught that in EMT schools as well.

Actually this brings about another "what if".

Quakefire is talking from a BLS perspective....... We now have a physician on scene who can provide ACLS.

In this instance I would be reporting "Physician XXXXX on scene assisting BLS crew" Then when you write up the ACLS care that was performed it CYA.

Or.... would you let him perform ACLS?

I honestly would need to be in the position..... I still think I would unless he said "I am high". I am not really sold on the fact I can tell if someone has done Coke or not. If he had had a few beers with the boys, I would still trust his judgement as long as he was not stumbling, slurring drunk.

I am sure others here can attest to how fast you sober up in these situations.

I too have done a code while drunk, I was in a bar when the owner dropped.

[Quakefire]

Moving along with the same idea, what if she didn't code, what if something the drugs were cut with, or something else caused an anaphalactic (sp?) reaction. For epi I need orders, I have a M.D on scene high as a kite telling me to give epi, should I still call med control or trust his judgement. If he wants to take charge of the patient, do you let him?

[spenac]

Moving along with the same idea, what if she didn't code, what if something the drugs were cut with, or something else caused an anaphalactic (sp?) reaction. For epi I need orders, I have a M.D on scene high as a kite telling me to give epi, should I still call med control or trust his judgement. If he wants to take charge of the patient, do you let him?

If I'm on scene with a doctor I am not comfortable with I stay in charge of the patient. If required to call medical control for epi ( I'm not required ) I call them. This doctor is not medical control, he is off duty.

[Laura Anne]

:shock: Sounds kinda messed up all around. Did she live, btw?

I would not report the Md due to it not being your priority, but I would stop him from doing any other medical care once you're on scene. His personal life is just that....personal. Many of us have been in a situation where we have been off duty and under the influence. It our own choice as to what we do-morally and ethically. You cannot pass judgement, you should not be biased, you are NOT repsonsible for his private life.

Now when it comes to the person(s) in question being on duty and attempting to provide care in an ER and/or other medical environment, then it becomes a legal issue on which you can better act upon.

My two cents..... 8)

[crotchitymedic1986]

so do you consider an EMT or Doctor who uses heroin or cocaine on a regular basis fit for duty ? If you knew a particular surgeon was alcoholic or drug dependent, would you let them do your surgery ?

[Arizonaffcep]

so do you consider an EMT or Doctor who uses heroin or cocaine on a regular basis fit for duty ? If you knew a particular surgeon was alcoholic or drug dependent, would you let them do your surgery ?

No I don't consider them fit for duty, nor would I let this "surgeon" work on me. If I had a repour with this doc, I would try to approach it from that side, and have a person to person discussion. If things needed to be elevated, then that's what might be called for, but my preference is to handle it person to person before anything else.

[Christopher.Collins]

Theoretical: The doctor is busted, and you catch grief for NOT reporting it.

There is no clear path here, as I see it.

A now former member of the department was the patient, for a drug overdose in his own home. He worked with the senior tech on the responding ambulance. A newbie tech wrote up the report, including the admission of the illegal recreational pharmaceutical usage by the off duty member, the senior on duty tech didn't "clean up" the call report to "protect" the off duty member, and everyone ended up in trouble.

I was not on the crew, or that call, but had, and have, worked with all involved. I had no prior knowledge the now former member was using.

I dont see why anyone was disciplined in this situation (based on what you have stated). The newbie doccumented their findings and the patients addmision to recreational drug use. The senior technician did not try to convince any fabrication of the story. The only thing I can see happening (again based on whats given) is that maybe the probie wrote drug use as a diagnosis rather than quoting the patient... but I dont see that being the case. Im not sure if it only covers harrasement claims and certain situations but the "Retaliation" act under EEOC may have protected them from disciplinary action. They did their jobs and while its unfortunate another member was doing what they were... its not the responding crews fault.

~~~~

Ive been faced with a somewhat simmillar situation myself. With an agency I worked with in the past; my partner and I were called to the local PD for a prisoner psych evaluation. As much as I hate this word, it was dispatched and we responded in a "routine" manner as we would for these calls. Quickly my partner and I identified the patient as a fellow co-worker. It was a bit difficult to restrain emotions but we did so and also realised that we have to be really carefull how we approach this situation... the patient knows their rights and our standard of care. With a sudden onset of chest pain we requested ALS assistance but more specifically we called for a supervisor as so if any accusations of negligence were made there would be someone of power overseeing the opposite. After the transport I spent quite a bit of time on that PCR..., I spent alot of time on that PCR and had my partner and Supe/Medic review it.

[mobey]

so do you consider an EMT or Doctor who uses heroin or cocaine on a regular basis fit for duty ?

No

Was that the original question posed?....... No :roll:

[Christopher.Collins]

Moving along with the same idea, what if she didn't code, what if something the drugs were cut with, or something else caused an anaphalactic (sp?) reaction. For epi I need orders, I have a M.D on scene high as a kite telling me to give epi, should I still call med control or trust his judgement. If he wants to take charge of the patient, do you let him?

This is where, in my personal and proffesional opinion good documentation comes into play. If I suspect the good doctor to be under the influence then he has no buisness giving me orders, regardless of if he is my med-control or not. Maybe its not my job to make a diagnosiss, but if he is obviously or even seemingly unfit to do his job or give orders then Im willing to take the fall for treating him as such. Med control is a phone or radio call away, its also a recorded line where even with poor doccumentation I have proof that I was given an order to administer or not administer a treatment.

Quite frankly, in a room full of persons under the influence I would have the police moving or removing people from my immediate area anyways (safety you know).

edit (added): In terms of reporting my finding him in this manner and not being my patient. It may not be my business to report him and I would respect that. But the moment he starts barking orders then he will be treated otherwise. That patient is my responsability as is any outside interferance on my scene. Regardless of if he is a doctor or just a plain joe junkie it will be documented that someone tried to give me orders on how to treat my patient. I would explain in detail that they identified themself as a doctor but, regardless of if he is telling the truth or not because of his current state of mind his orders were ignored.