ETOH intoxication- How do you clear if your not going to transport?

[wrmedic82]

You respond to a 45/m Man Down (3rd party caller). Upon arrival at patient's side you get a strong alcohol-like odor. You are able to arouse the patient easily. The patient admits to ETOH consumption and states he fell asleep. Patient denies any medical complaints, and refuses any treatment or transport.Patient is AOx4, GCS 14 How would you choose to clear the call?

Edited September 8, 2009 by wrmedic82

[mobey]

'Round here we have to call police to clear the patient of any wrongdoings after we determine no medical involvement.

So technically we are "turning over" the patient to police.

[FireMedic65]

If they alert and oriented, they can make their own judgment. If they are not, they cannot make that call for themselves. If they refuse transport, I'd have at least medical command back me up, and most likely call the police in since this person shouldn't be out walking around and driving.

[CBEMT]

Knock 25 years off of that, and that's much of my weekend. If alert and oriented, vitals check out, blood sugar checks out, there are no interacting medications or concerning medical history, no ongoing profuse vomiting, and the history of his ETOH intake suggests his BAL has likely peaked, we allow the patient to sign a refusal.

If I believe that the patient is incapable of understanding what a refusal of care means, and doesn't just want me to go away, I will transport.

Edited September 8, 2009 by CBEMT

[scubanurse]

If they alert and oriented, they can make their own judgment. If they are not, they cannot make that call for themselves. If they refuse transport, I'd have at least medical command back me up, and most likely call the police in since this person shouldn't be out walking around and driving.

i second that... but that dude had a GCS of 14, and was alert and oriented so I'd probably (probably because I was not there to make the call based on instinct and gut feeling) let him sign the refusal... would be nice to have PD there to witness though if possible.

[FireMedic65]

I don't let any intoxicated person go away on their own.. If they later walk out into traffic, get smashed by a car... it could come back to me.

[aussiephil]

We have all seen what is described here, only the time & place may vary.

I will ask but one simple question.

What are the differences beteen a patient with a head (brain) injury & someone who is described in this thread?

What was described above has happened here. The pt was in custody & left in custody. He was found deaed from a sub arachnoid haemhorrage the next day. He had no obvious external signs of trauma, but further police investigations showed he had bee staggering & fell earlier in the night. He looked like he was sleeping, he roused easily. He died.

Now, what is your answer?

[mobey]

We have all seen what is described here, only the time & place may vary.

I will ask but one simple question.

What are the differences beteen a patient with a head (brain) injury & someone who is described in this thread?

What was described above has happened here. The pt was in custody & left in custody. He was found deaed from a sub arachnoid haemhorrage the next day. He had no obvious external signs of trauma, but further police investigations showed he had bee staggering & fell earlier in the night. He looked like he was sleeping, he roused easily. He died.

Now, what is your answer?

Of course that is always the question.... especially since alcoholics are prone to chronic subdurals and encephalopathy.

But my answer remains the same.

A thourough assessment is definatly required as well as verification of alcohol intake, but it is still a risk nonetheless.

Really... any patient we see could have a aneurism about to burst, or a subdural, or the beginning of a nasty infection that may cost them a limb, or, or, or, you see a pattern I am sure.

The reality is.... (especially in remote locations such as mine) you have to manage your call load, and that may mean taking a risk now and then.

[tskstorm]

There are a lot of things to consider here, If I as a 3rd party call 9-1-1 and say there is an EMT/MEDIC not acting right inside their ambulance/or their station, and another ambulance responds, the first thing I ask myself is there even a patient here? What is the 3rd party caller basing the need for an ambulance on? What makes this individual a patient? If someone calling 9-1-1 for another individual automatically makes them a patient, why isn't every homeless/undomiciled person called for all the time, and automatically taken as a patient?

Someone who is drunk and sitting/sleeping on a street corner are they a patient? OR are they a nuisance to the person who owns the store and the store owner just wants them gone?

If someone is sleeping, and we wake them up and they say they were just sleeping, nothings the matter, they want nothing to do with us, we clear it one of two ways, the first, 10-90 no patient/unfounded, the second way is 10-93A RMA refused all walked away.

Even if a person is intoxicated whether it be ETOH or illegal substance, if they are A&O, it is their choice whether or not they need a hospital, or EMS it should not be the choice of Joe Blow citizen. From an EMS standpoint, we should only be forcing those to the hospital that are in an immediate life threat/concern. Is ETOH really that large of a concern if someone is still A&O ?

[DwayneEMTP]

My response would depend largely on where he was found.

I had this call and had to argue with my partner and the police defending my decision against transporting, as the pt was found in her living room.

If I found this pt under the interstate, I would attempt to transport for his and others' safety. In their house, where do I find the right to force transport?

Dwayne