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

[crotchitymedic1986]

OK, here we go again. Lets step out of our box for a second, and ask what is the minimal an ER Doctor would do before he would "let the patient go", and like it or not, the patient has presented to you for care/evaluation, whether they called or not. If I put on my crocks and a spaghetti stained scrub shirt on (crotchity MD), I think I would do the following:

1. Atleast a Blood Alcohol Level (cant do that on the ambulance)

2. A Drug Screen to make sure alcohol is the only culprit (cant do that on the ambulance)

3. A glucose stick (we can do that) followed by a chem panel (electrolytes), possibly ABG (to prove not hypoxic -- cant do either on the ambulance)

4. Now if he has no signs of trauma and denies trauma/fall, I probably wouldnt do a CT Scan or MRI, but we all know Docs that would and do (cant do that on the ambulance).

So if ER Docs, with all of their training, arent comfortable releasing drunks just because they can stand and can annunciate most words, why are we so quick to say SEE YA !

Every time you leave a drunk behind, you are one step closer to a lawsuit -- your choice.

[stcommodore]

I've been released by Medical Command on several alcohol overdose/alcohol consumption relatd calls in the past. Obviously the circumstances varied from "friends called for ...." to other things. Other homeless/drunk related calls the person typically walks away, we imply they walk away or we just take them in. All bets are off when you include falls, trauma, etc with ETOH. Any MOI w/ETOH is a trauma patient in most of the trauma centers.

[Just Plain Ruff]

OK, here we go again. Lets step out of our box for a second, and ask what is the minimal an ER Doctor would do before he would "let the patient go", and like it or not, the patient has presented to you for care/evaluation, whether they called or not. If I put on my crocks and a spaghetti stained scrub shirt on (crotchity MD), I think I would do the following:

1. Atleast a Blood Alcohol Level (cant do that on the ambulance)

2. A Drug Screen to make sure alcohol is the only culprit (cant do that on the ambulance)

3. A glucose stick (we can do that) followed by a chem panel (electrolytes), possibly ABG (to prove not hypoxic -- cant do either on the ambulance)

4. Now if he has no signs of trauma and denies trauma/fall, I probably wouldnt do a CT Scan or MRI, but we all know Docs that would and do (cant do that on the ambulance).

So if ER Docs, with all of their training, arent comfortable releasing drunks just because they can stand and can annunciate most words, why are we so quick to say SEE YA !

Every time you leave a drunk behind, you are one step closer to a lawsuit -- your choice.

I have a real hard time with allowing a drunk to refuse transport. I have an even harder time allowing a drunk to refuse if they have any type of trauma.

But many doctors you call on the med radio or ER will not force you to transport to the ER because they are worried about liability of forcing or "kidnapping" a patient.

This mindset makes me nervous.

If the doctors in the er won't let the patient presenting with the same symptoms as they are presenting with me, why do they have no problem in forcing transport.

But unfortunately we are up against a rock and a hard place in what happens, we have to abide by the doctors thoughts and opinion and make sure you get on a recorded line. Hard to do when you have a cell phone only.

It falls on you as a medic to write the most detailed and informative report you can write in order to justify why you let a head trauma/etoh person refuse and you didn't transport them. The defense attorney will surely ask why you did not force transport? Better have it backed up in your report that the doctor did not force transport.

[CBEMT]

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?

Happens every day here. Do-gooders with cellphones don't realize the skell they're calling for is on the same street corner every day. Hence why some of them end up at the ER 5-6 or more times a week.

If I hauled every person with ETOH on board in on the offchance that they have a lurking head bleed, I'd do precious little else. CYA medicine is part of the reason healthcare is such a disaster.

Head injury + booze, yes they go. If they can walk, talk, and don't want my help, have a nice night.

Edited September 9, 2009 by CBEMT

[wrmedic82]

Some great points. But the question I have for some is, if they are AOx4, at what point can you force someone to be transported to the hospital?

I can understand CYA and every possible situation that could happen as a result of ETOH intoxication. But at the same time what about the legal aspect?

Edited September 9, 2009 by wrmedic82

[FireMedic65]

Some great points. But the question I have for some is, if they are AOx4, at what point can you force someone to be transported to the hospital?

I can understand CYA and every possible situation that could happen as a result of ETOH intoxication. But at the same time what about the legal aspect?

Where are they located? At home, at a bar, walking down the street? Surely if I am drunk, I can answer questions properly, I can tell you where I am, my bday and who the president is. But can I walk straight? Am I falling over? If I am home, and I am falling over, big deal and put me in my bed on my stomach. If I am at a bar, or walking down the street, unable to walk straight and falling over. I sign AMA because I told you my name and Lincolns bday, then I stumbled into traffic later and get waffled by a truck. I can sue you, and win.

[aussiephil]

I have a real hard time with allowing a drunk to refuse transport. I have an even harder time allowing a drunk to refuse if they have any type of trauma.

But many doctors you call on the med radio or ER will not force you to transport to the ER because they are worried about liability of forcing or "kidnapping" a patient.

This mindset makes me nervous.

If the doctors in the er won't let the patient presenting with the same symptoms as they are presenting with me, why do they have no problem in forcing transport.

But unfortunately we are up against a rock and a hard place in what happens, we have to abide by the doctors thoughts and opinion and make sure you get on a recorded line. Hard to do when you have a cell phone only.

It falls on you as a medic to write the most detailed and informative report you can write in order to justify why you let a head trauma/etoh person refuse and you didn't transport them. The defense attorney will surely ask why you did not force transport? Better have it backed up in your report that the doctor did not force transport.

We are fortunate here in that these patients are classified now under the mental health act & , if we believe they are not making a decision that a 'normal' person would make, we can the enforce transport under the mental health act & force treatment without consent, for their own benefit. I have only seen it used once, but it was without ramification & was needed at the time.

[Chief1C]

If they're competent, then I guess they can refuse; if not; then it's the same for any AMS or ALOC patient. I certainly wouldn't let them alone if it was clear they would be driving.

[HERBIE1]

"But many doctors you call on the med radio or ER will not force you to transport to the ER because they are worried about liability of forcing or "kidnapping" a patient."

I have never encountered a doctor who was truly worried about that. In my experience, docs are far more concerned that an unsuspected injury or illness goes untreated by allowing someone to refuse transport.

On the other hand...

As long as you paint an accurate picture of a fully competent and oriented patient who is aware of possible consequences to their refusal in your radio report, I have rarely encountered resistance to allow a refusal.

OK, here we go again. Lets step out of our box for a second, and ask what is the minimal an ER Doctor would do before he would "let the patient go", and like it or not, the patient has presented to you for care/evaluation, whether they called or not. If I put on my crocks and a spaghetti stained scrub shirt on (crotchity MD), I think I would do the following:

1. Atleast a Blood Alcohol Level (cant do that on the ambulance)

2. A Drug Screen to make sure alcohol is the only culprit (cant do that on the ambulance)

3. A glucose stick (we can do that) followed by a chem panel (electrolytes), possibly ABG (to prove not hypoxic -- cant do either on the ambulance)

4. Now if he has no signs of trauma and denies trauma/fall, I probably wouldnt do a CT Scan or MRI, but we all know Docs that would and do (cant do that on the ambulance).

So if ER Docs, with all of their training, arent comfortable releasing drunks just because they can stand and can annunciate most words, why are we so quick to say SEE YA !

Every time you leave a drunk behind, you are one step closer to a lawsuit -- your choice.

When I first started in EMS, I worked on the streets and in ER's. We used to have a blood alcohol lottery and try to guess the levels of inebriated patients. Everyone who came into the ER who appeared to be intoxicated had serial blood alcohol levels drawn on them and only when they dropped below the legal limit, they would be discharged. These days, especially with regular drunks who everyone knows well, many times no levels are drawn because these people appear to be stone cold sober with levels that would put most of us into comas and can actually experience DT's with levels around 200. The reason they are in an ER- they can no longer walk and are a danger to themselves, not simply because they are intoxicated. These people are actually drunk basically 24/7, but sometimes they simply over do it and end up in the system. Once they sleep it off, become functional and stable again, they are discharged.

Wrong- maybe, but in a busy urban ER, you could tie up every ER bed waiting for someone's levels to drop to below the legal limit and have no room for MI's or CVA's.

[aussiephil]

But many doctors you call on the med radio or ER will not force you to transport to the ER because they are worried about liability of forcing or "kidnapping" a patient.

Maybe it is time to get rid of Med control & allow EMS to run as a professional autonomous body instead of reporting back to someone who cannot eyeball the pt. This is a relic of yesteryear that, with education should be removed & allow those on the streets to treat & make appropriate decisions regarding the patient in front of them.