Got really drunk and Paramedics were called

[Lone Star]

Yeah, I think you're right. I love this argument!

I think where you and I disagree, and this may be due to our difference in age maybe, is on personal liberties. This person did not call for you (Again, assuming the drunk that wants to refuse not the OP and the rufees) nor is there reason to believe that the call was made by someone that had this persons best interest at heart, as a seemingly caring, intelligent person would have a hard time confusing an arrest with slurred speech and altered mentation. Therefore you had no right to assess this person, and you no longer have any right to be in their home.

Having come into contact with this person gives you a moral, hopefully, responsibility to try and make sure that they are reasonably safe to the best of your ability but does not give you the power to remove them from their home against their will. It just doesn't!

From those of you saying, as you have Fiz, that "they are going...done deal" by what legal authority are you going to do so? You can't use implied consent on a person that didn't call you and doesn't want to go. They have no obligation to be able to consent or not, they are in their home.

It's confusing to me that more people aren't offended by the contention that some of you seem to believe that having a medic cert also gives you the right to violate a persons right to be free and safe in their own homes.

Does it not give you pause at all that this person did not request help, that they don't want it, that the person that did request it was obviously drunk or damaged as it was called in as an arrest, so basically you are in this persons home in the first place against their wishes? It doesn't make you stop and think for one second that perhaps you've become part of the problem instead of part of the solution?

And if you take this person against their will, how do you justify not stopping and assessing every drunk you see. If you witness a fender bender, do you then force all occupants into your ambulance because they are not smart enough, or educated enough, or have the necessary experience to know that in a small percentage of such accidents that a pathology caused the accident or that in a minute population there will be hidden injuries? I mean, surely you must. Your argument is that because you're smarter and more educated that you have the right to force people into what's best for them, or is this only a drunk thing for you all? I mean ignorance of consequences is ignorance of consequence whether self induced, brought on by pathology or simply inherited by upbringing, right?

Why protect some and not others? What is the litmus test for those that you will force to be proved to be pathologically free and those that you won't?

Dwayne

The issue I'm having with this response Dwayne is this:

When I got whacked on my motorcycle, I didn't call for help...I was unconcious. Since I only remember waking up in the ambulance as we turned into the hospital, does this mean that I can sue the ambulance company and the attending crew for kidnapping because I didn't call and therefore didn't consent to be treated? Or was treatment rendered under implied consent?

As far as being awake on scene, one of the guys in my Paramedic class was one of the fire department first responders; and has since ripped on me for telling him over and over "Don't cut the leather, man!", which implies that I was alert and oriented enough (even though I don't remeber it) to know what was going on. Since he indeed cut my leather and treated me against my wishes, does this give me grounds to sue? Was I ACTUALLY 'alert and oriented', or did I still qualify for 'altered mental status'?

Just because the OP isn't the one that called the ambulance ISN'T sufficient grounds to negate 'implied consent'.

[cosgrojo]

Love this conversation fellas... I'm kibbying in my chair reading your banter.

100% agree with Dwayne's ideological stance. Have long felt that we are too cavalier with the public's civil liberties. I personally don't understand the CYA treatment modality... feel that it is backwards thinking, promotes poor assessments and lack of critical thinking within the first responder universe.

I'm sure you are sensing it... BUT...

I completely agree with Fiz that there are a lot of situations that could come back and bite the provider in the buttocks... and worse turn out to hurt the patient's health and well-being... and none of us wants that. Personally, I work for a private company that would hang me by my toenails, assault my body with papercuts and shower me with lemon juice if I signed this guy off. In fact, my employer has gone to great lengths to inform us that we should take every person that loosely meets the criteria for a "patient" to the hospital. While I am offended by the policy and feel slighted by the implied slight against my ability to assess a given situation... I like my paycheck... in fact I require it.

In these cases I rely on my relationship with local fire and PD. If PD is convinced that he is "just a drunk" (and I've done my due dilligence), I may be able to call this a "Police Matter" or "Domestic Matter," and clear without patient contact. I'm going under the premise that he never called us and does not really fit the criteria for a "patient." If someone called an ambulance and transported me back when I was in college and getting knackered on a regular basis... I'd be still paying off those medical bills!

Great conversation, and I agree with you both... which is weird because you two appear diametrically opposed on this one. I guess I'm a bit wonky myself... should never have taken that shot of everclear...

I just used forms of the word "slight" with only 3 words seperating them... please... somebody give me a negative reputation mark for that.

I stink.

[ERDoc]

I think there are 2 questions which may be getting grouped as one.

1. Do we have a patient? Just because an ambulance was called doesn't mean there is a pt. People see drunks sleeping on the sidewalks all of the time where I live. They call EMS without ever checking to see if they are in fact sleeping. One of my partners saw one poor drunk so many times that he suggested the pt find a hidden spot to sleep in so that people would stop calling 911 for him. How many MVAs have you been called for where there was no one that needed an ambulance?

2. If there is someone we think should be a pt, are they compos mentis? This means are they of sound mind and judgement in the eyes of the law. Unfortunately, the law seems to think that if someone is non compos mentis (not of sound mind) that healthcare providers should be responsible for them. You can be non compos mentis for a variety of reasons such as illness or intoxication. So, someone that is intoxicated can be non compos mentis and therefore may not be able to make their own decisions, regardless of whether they are A&OX3 or 4. They have to demonstrate clinical competence to make their own decisions. Here is a link from the NEJM that discusses this. I would have to say, based on what info we have, that the original pt in this thread did not seem to be clinically competent.

Now, going back to the first question, do we have a patient? It's hard to say from the given info but I would have to say yes. The OP was found unconscious. Could he have been sleeping? Sure, like I said, it happens. How do we know he doesn't fall. There are plenty of examples of drunk people having serious injuries without any other signs than being drunk. I had one just the other night. He started drinking. He woke up the next morning when he was found on the floor by his family. He doesn't remember what happened and has no complaints but is still obviously drunk. A few CTs later and he is found to have a 15mm subdural and a C5-C6 subluxation. You should fear alcohol like you fear coumadin. Do not underestimate its power. Yes, most drunks are simply that but with that attitude you can become complacent and miss something, especially with the number of drunks we all see.

Unfortunately, even if they are drunk and have no injuries but you don't transport them and they hurt themselves afterwards, you will get sued. We, as in the US, have made it so that someone else is responsible for the actions of a drunk person.

Honestly, it sounds like the OP is looking for a lottery ticket..er...law suit. Not going to happen in this case since no harm was done.

[DwayneEMTP]

Now, before I continue let me make it clear that I've muddied the water here. There was a thread about someone responding to a home in response to someone reporting an arrest. Upon arrival a drunk couple was found and refused treatment/transport. Somehow I got this thread confused with that one, so my comments have been in regards to that scenrio, not this one. In no world would I come upon an unreponsive drunk, while assessing come to believe that, though he was able to speak, that his simply being conscious would be grounds to leave him all the while simply assuming that he was/is a drunk. I hope we're clear on that...grin. I'll answer these questions and then go and see if my argument still fits in the other thread if I can find it..

...

When I got whacked on my motorcycle, I didn't call for help...I was unconcious. Since I only remember waking up in the ambulance as we turned into the hospital, does this mean that I can sue the ambulance company and the attending crew for kidnapping because I didn't call and therefore didn't consent to be treated? Or was treatment rendered under implied consent?

No man, you'd had a traumatic event and obviously required help that you were unable to ask for. You were injured, not in your own home, and not rationally refusing treatment and transport.

...As far as being awake on scene, one of the guys in my Paramedic class was one of the fire department first responders; and has since ripped on me for telling him over and over "Don't cut the leather, man!", which implies that I was alert and oriented enough (even though I don't remeber it) to know what was going on. Since he indeed cut my leather and treated me against my wishes, does this give me grounds to sue? Was I ACTUALLY 'alert and oriented', or did I still qualify for 'altered mental status'?

I think that in your normal, walking around state you qualify for altered mental status. Be that as it may, I've had people say all sorts of things to me when partially and completely 'awake' though injured or ill. The same way that saying little shouldn't qualify you as a candidate to lose your liberties, saying a lot certainly won't show you to be pathology free during a thorough assessment.

...Just because the OP isn't the one that called the ambulance ISN'T sufficient grounds to negate 'implied consent'.

Of course not, and I don't believe that you truly think that that is the crux of my argument. Surely you don't believe that it's my contention that if a child drowns and is therefore unable to call for help that he would of course wish for us leave him face down in the water?

I believe that the Doc made the point crystal clear, at least for my way of thinking. The first thing that should be done is to determine if there is a patient. We, though we have many significant tools in our belt, don't have the right to simply snatch people out of their homes because we have a protocol that says we should.

Also, I'm truly curious to see by what legal right you would do so. If someone says "I won't wanna bro unnnywhere wi ouuuuuu!" And you understand that to mean, "I won't go anywhere with you." then you no longer have a right to take that person against their will. Just wait 5 minutes and they'll fall asleep and you can take them then. You can show that they are not legal able to sign your refusal paperwork, but you have no legal grounds to take them if they don't agree to go with you and are able to voice that lack of agreement in any way, right?

You can get the police to threaten them, get them to arrest them and take them while in police custody, you can get social services involved, or you can simply pick them up and throw them on the cot, like most do, and claim that they couldn't speak to you when you found them...but if you do the last, you should be jailed.

Are we splitting hairs in this conversation? Yeah, maybe. But I've seen a bunch of providers, and have heard from more here it seem, that roll up on an apparent drunk, know that a refusal is impossible, know that they will be calling or called for again before the night is out, so throw them on the cot, take them to the hospital, all the time ignoring the words coming out of their mouths. All in the guise of 'making sure they're cared for." And to me, this is the most debased behavior possible for someone that is supposed to be a patient advocate.

Fiz...contrary to what you believe man, I don't sacrifice my rights by getting drunk in my own home. No matter how bad you want to believe that I do.

Dwayne

[hatelilpeepees]

OK, you dont have to transport because the patient didnt call, how many 1 year olds call 911, how many illegal aliens call 911, how many passed out drunk college kids call 911 ? Cookbook medicine ---- how many 55 year olds with Chest Pain and dyspnea, but a normal EKG do you leave behind because you don't just treat symptoms ? Anyone who is altered, should be transported PERIOD.

[Lone Star]

Now, before I continue let me make it clear that I've muddied the water here. There was a thread about someone responding to a home in response to someone reporting an arrest. Upon arrival a drunk couple was found and refused treatment/transport. Somehow I got this thread confused with that one, so my comments have been in regards to that scenrio, not this one. In no world would I come upon an unreponsive drunk, while assessing come to believe that, though he was able to speak, that his simply being conscious would be grounds to leave him all the while simply assuming that he was/is a drunk. I hope we're clear on that...grin. I'll answer these questions and then go and see if my argument still fits in the other thread if I can find it..

Same thread, post #5 (OMG! It's my post! )

I guess that makes me guilty of laying the groundwork for this thread to end up going straight to Hell in a hand basket....50 lashes with a wet shoelace!

I think that in your normal, walking around state you qualify for altered mental status.

That is possibly one of the nicest things you've said to me, buddy!

I believe that the Doc made the point crystal clear, at least for my way of thinking. The first thing that should be done is to determine if there is a patient. We, though we have many significant tools in our belt, don't have the right to simply snatch people out of their homes because we have a protocol that says we should.

Where do we draw the line with the intoxicated patient? How do we ascertain the patient who is just 'buzzed off his ass' or a patient suffering from alcohol poisoning?

Also, I'm truly curious to see by what legal right you would do so. If someone says "I won't wanna bro unnnywhere wi ouuuuuu!" And you understand that to mean, "I won't go anywhere with you." then you no longer have a right to take that person against their will. Just wait 5 minutes and they'll fall asleep and you can take them then. You can show that they are not legal able to sign your refusal paperwork, but you have no legal grounds to take them if they don't agree to go with you and are able to voice that lack of agreement in any way, right?

Herein lies the crux of the issue...

If they're too drunk to be considered compos mentis, does their refusal actually carry any weight? After all, if they are not competent to make such legal decisions, how can we actually abide by their decisions in the first place?

[DwayneEMTP]

...OK, you dont have to transport...

See, this is where your mentality and mine will never be able to find common ground. I never HAVE to transport. I LIKE to transport. I love caring for patients, I like working with the hospitals, it causes me twice as much work to leave this patient as it does to transport him. In no way is my argument based on a desire to escape transporting.

...how many 1 year olds call 911, how many illegal aliens call 911, how many passed out drunk college kids call 911?

Are you drunk? I have no idea what your point is here.

... Cookbook medicine...

Certainly seems to be what you're advocating.

...how many 55 year olds with Chest Pain and dyspnea, but a normal EKG do you leave behind because you don't just treat symptoms?

Every one that tells me to go fuck myself after my very best effort, and the best efforts of everyone I can bring to bear.

...Anyone who is altered, should be transported PERIOD.

Ok, first, you're an idiot. Second, as I've asked over and over, by what legal authority will you force this person into your ambulance to be transported if they are able to speak their wishes and physically resist?

[DwayneEMTP]

...

Same thread, post #5 (OMG! It's my post! )

Yeah, I should have known....

...That is possibly one of the nicest things you've said to me, buddy!

Stop in man...I hate it when you're happy. But you're getting harder and harder to piss off the further you go in your education..it's frustrating....

...Where do we draw the line with the intoxicated patient? How do we ascertain the patient who is just 'buzzed off his ass' or a patient suffering from alcohol poisoning?

We can't, but this patient didn't call me into his home, he didn't ask for my help, he never asked for my assessment of his life or current condition. I have no right to go into someones house and begin drawing lines anywhere. And in our country we have, as adults, the right to refuse to be molested, BY ANYONE, in our own homes as long as we're breaking no laws. I don't know the magic numbers, I only know that he is a free American, at least when some of my EMS comrades are not in his home, and I have no right to remove him against his will if I believe that he is what he claims to be, drunk. He has not come subject to my Command simply because I lay eyes on him...that is so ridiculous that I'm...flummoxed...

If I believe that it is otherwise, then I need to involve the family, the neighbors, and even the police if necessary to get him the care that I believe that he would want me to give him. Otherwise I've met very, very few drunks capable of resisting that were so completely gone that they didn't have the mental ability to explain their wishes to me. Altered mentation, negative significant history, vitals acceptable for situation, BGL w/n/l, afebrile, we can reasonably assume that his is just drunk, just like he told us. Checking those things? I do that to be a nice guy and a decent medic. I HAVE NO RIGHT to even do those things!

...Herein lies the crux of the issue...

If they're too drunk to be considered compos mentis, does their refusal actually carry any weight? After all, if they are not competent to make such legal decisions, how can we actually abide by their decisions in the first place?

It doesn't matter! He didn't call for help, a reliable person also didn't call for help, we had no right to be in his house once we discovered these things. Now, we can coax him into letting us check him and make sure that he's ok, or like most, lie to him and tell him he's going to jail if he doesn't get into the ambulance. But he has no legal obligation to remain legally alert and oriented so as to be able to sign and swear to legal document 24 hrs a day while in his home! I'm sorry if that somehow offends you'alls sensibilities, but it's a fact!

And least, but possibly not the last, by what legal authority are you deciding whether to abide by it or not? The fact that you've (general) been pushing drunks around and hauling them out of their homes against their will, and against the law for your entire career does not a legal precedent make.

What legally gives you the right to decide this for this man when he in no way solicited your opinion?

Dwayne

[Lone Star]

Stop in man...I hate it when you're happy. But you're getting harder and harder to piss off the further you go in your education..it's frustrating....

Remember pal, I'm the monster you helped create! So in your own wise words, "Suck it up, cupcake!"

In all seriousness though...back to post #5:

Granted the guy's girlfriend called us, and she was pretty intoxicated herself, I'm not comfortable with the idea of just giving the guy that many chances to guess the right answer (or make the questions easier) in order to be able to say "Yep, he was alert and oriented enough to leave him here!"; but by the same token, I realize that there was a bare minimum that we could actually do for the drunk in the field. He wasn't in distress, he wasn't complaining of chest pain or shortness of breath; in fact he wasn't really complaining of anything except the fact that she called us and we obviously woke him up!

I don't know what benefit he would have had by being transported to the E.R. either...

Would he have benefitted from being arrested so that we could cart him to the hospital simply because he was the only call we had that shift? Again, probably not...

Ultimately, I wasn't in the position to have to make that call, and I'm really not educated enough to try to sit back and 'armchair quarterback' my preceptor's thought process or mentality concerning that call.

I'm not trying to be 'intentionally obtuse', nor am I out to bust someone's chops because they don't agree with me; I'm simply trying to learn where certain lines are drawn so that I can define the box I have to play in....

[ERDoc]

What legally gives you the right to decide this for this man when he in no way solicited your opinion?

I agree with much of what you say Dwayne, unfortunately the law is what legally requires us to decide for this man. Because he is intoxicated he is considered non compos mentis and therefore cannot make his own decisions. Courts hold bars responsible if they serve alcohol to someone and then that person gets hurt or hurts someone else. Casinos are responsible for making sure people who drink don't lose too much money. It goes on from there.