Should We Have Transported...?

[P_Instructor]

The activation of EMS for a suicide attempt with verbal comfirmation and some physical evidence makes this situation very serious and puts question on the patient's intent and mental capacity for making a rational decision. With or without alcohol, this makes this person's decisions suspect and ground for professional evaluation.

The alcohol compounds the issue but is not the sole bases for questioning a person's decision making capabilities. It can either mask or enhance what a person's real intentions are. It is also very possible that this person could sober up and get serious with their intent to kill themselves whereas in their drunken state, they couldn't get it right or other emotions were playing with them. Sometimes being intoxicated actually keeps people from facing reality and killing themselves.

Bonus points to you my EMS brother!

[funkytomtom]

That's kind of what I was afraid of. I was actually out there for a ride-along/interview trying to get on with this service, so I didn't really want to "rock the boat." Maybe I should have. The particular provider that was in charge on this call has earned somewhat of a reputation for laziness and lack of concern for pts (why do assholes like that get promotions?). It seems he's always looking to get a refusal so we can take off. He also got off shift in about an hour, and all our transports are at least four hours. One of the other emts on the call seemed to think this was the reason he wanted to leave the guy. I'm not sure what medical direction had to say, as this same crew leader was the one on the phone with them as we were in the motel room. I also realize that an ASA overdose probably wouldn't affect vitals until much later. This really bums me out. Just to be sure, if he is alert and orientedx4, denies that he was ever suicidal, but admits to taking 20 asa, and alcohol and a mostly empty pill bottle are found on scene, we take him?

Edited September 22, 2009 by funkytomtom

[rock_shoes]

I would definitely have taken this patient in for a psyc evaluation. Even if the patient only admitted to taking 20 ASA that still amounts to 10 times the recommended dose. Also you found the ASA bottle to actually be empty in addition to the patient having consumed alcohol. This patient gave up the right to refuse care the moment they called for emergency services and stated they intended to engage in self harm.

As for the police refusing to perform an arrest for mental health reasons that's a bit of a sticky situation. Personally I would take the officer in question aside and explain a few things. Number one. If I indicate to an officer that a patient needs to go in for a psyc evaluation and that officer refuses to make the arrest, the officer in question becomes liable for any actions the patient may take to harm themself after refusing care. If the officer still refused to make the arrest, (after explaining the liability issues I think this is unlikely) I would make contact with medical direction, explain the situation, and let my medical director have a chat with the uncooperative officer.

I've never had to do any of these things myself. When it comes to patient care, all of the officers I've dealt with have been very helpful and cooperative. Did your partner or other members of the service you were out with have inter-agency issues with the PD? It seems to me like more was going on than just a lazy partner and stubborn officer.

[Richard B the EMT]

Many notations here, red flags due to ETOH involvement, the suggestion in dispatch info of the aspirin, and suicide.

Definite need of On Line Medical Control, and perhaps the LEOs.

Local protocols, rules, regs, and laws will dictate, as mine are OLMC, supervisor and LEO involvement.

I'd be thinking transport for further evaluation by higher medical authority, with the above mentioned involved.

Edited September 22, 2009 by Richard B the EMT

[HERBIE1]

Agree with everyone. The fact that he admitted to taking 20 ASA, that is well beyond anything therapeutic, and even though it may have only been a suicidal "gesture", the end result could be the real deal. Couple that with the ETOH and he is NOT a competent patient to refuse. I agree with getting supervisors involved- both PD and your own. Advise medical control, and make it clear the patient is going one way or another.

Years ago I had a young woman who "only" took a bunch of Tylenols-thinking they were harmless because they were OTC. Her OD was aimed at getting back at her cheating boyfriend, and she claimed she didn't really want to hurt herself. We transported her and I later heard her liver was failing and she would probably need a transplant. Pretty severe consequences for someone who didn't really mean to hurt herself.

If the situation was clearly explained to the LEO's- as in, as the doc stated, the problems with ASA OD's that will crop up later, AND the fact that you have no idea what else this guy took- recreational drugs or RX's, this is a lawsuit waiting to happen, I'm guessing they might have felt differently about taking him into protective custody. Emphasize that he is NOT legally capable of refusing.

I realize that being a rider puts you in a tough spot but God forbid if this guy decides to finish the job by some other method , you are on the hook as much as the people who were getting paid to be there.

One question- Any idea who made the original call for help for EMS and/or PD?

[P_Instructor]

Dispatched to a suicide attempt at a local motel, dispatch tells us pt called a hospital and told them he had taken 200 aspirin and was "tired of living." We arrive and talk to pd briefly. Apparently his story has fluctuated between 2 and 200 aspirin and he is now saying he took 20, "just for attention," and has now thrown them all up. We enter the room, and while my other two partners assess the pt, I look around the room and in the bathroom for any pills, pill bottles, vomit, etc. Nearly empty Aspirin bottle and half full vodka bottle found, I re-enter the main room to assist. Pt's vitals are well withing normal limits (I don't recall exact numbers) and stable. He says he never said he was tired of living, but that he said he was "tired of living in this particular place." Pd contacts the hospital to confirm and hospital states that they cannot as there was no recording. I recall distinctly that when the subject of transport was brought up, pt was adamant about not going, and threw the word "lawyer" around quite a bit. We asked him what he was going to do if we left him, and he said he planned on going to work and was not, and never had been suicidal. He did admit to taking 20 aspirin with vodka however, but didn't see that as a suicide attempt, just a try for attention. Crew leader has him sign a refusal and we leave.

I personally consider that a suicide attempt, and was not comfortable leaving this guy alone. The crew was split half and half on taking him in when we talked later. Crew leader says that because there was no hard evidence of suicide on-scene, pt denied, and pd wouldn't take custody, there was nothing we could do. From reviewing my book it seems that this is one of those gray areas where there is no real answer. If we feel he is a threat to himself, we can take him in, although I'm sure this opens us up to lawsuits? Any thoughts?

funkytomtom - - using this for a class project. Got responses from ex and inexperienced B's and I's, some volunteer, some part-time, some full-time, from rural to urban areas. If you send me a private message with email address, I can and been authorized by the individuals to send you their responses. Might be fun to see the differences. P_Instructor

[EMT Martin]

The activation of EMS for a suicide attempt with verbal comfirmation and some physical evidence makes this situation very serious and puts question on the patient's intent and mental capacity for making a rational decision. With or without alcohol, this makes this person's decisions suspect and ground for professional evaluation.

The alcohol compounds the issue but is not the sole bases for questioning a person's decision making capabilities. It can either mask or enhance what a person's real intentions are. It is also very possible that this person could sober up and get serious with their intent to kill themselves whereas in their drunken state, they couldn't get it right or other emotions were playing with them. Sometimes being intoxicated actually keeps people from facing reality and killing themselves.

Agreed, wholeheartedly. I've got a repeat offender in my jurisdiction, who consistantly 'tries' to kill himself...but we take him everytime. I just make sure that the state and local law enforcement officers know that I want him cuffed or that I'm going to restrain him myself if they won't do it. It'll be that one time I think he's 'okay' that he'll flip out and attack my crew...

But, yeah, I find most suicide attempts to be someone's attempt to get help because they need it. Best to let them go to the hospital for an overnight evaluation.

[funkytomtom]

Well that's just great Herbie, the call was made by the hospital which the patient contacted. Apparently he took the pills, and called the hospital "just to have someone to talk to." In retrospect I am in total disbelief we didn't take this guy in. Three issues, 20 aspirin is a suicide attempt no matter what the pt says, even if it wasn't they are still potentially sitting in his belly and bound to cause problems, and third, he was drunk. I will NOT give this crew leader much in the way of trust if I do end up getting hired on. I will now go beat myself up...

[joesph]

Had a very similar case this spring pt denied making self harm threats and refused care LEO actually took her into custody after pt attempted to flee and became aggressive. Then after a mental health care counsel by phone they released pt and sent them on there merry way. In our area if LEO dosen't back up the protective custody we don't have a leg to stand on.

[Mateo_1387]

I realize that being a rider puts you in a tough spot but God forbid if this guy decides to finish the job by some other method , you are on the hook as much as the people who were getting paid to be there.

What makes you think he will be held liable? This guy is doing a ride along only as an observer for an interview. I do not see where he is responsible for the medical care.