Poss ETOH AMS Inside vs Outside

[ERDoc]

I think we are missing what Richard asked for. He was looking for links/copies of protocols/SOPs. We should keep the opinions to the original thread, whose author has failed to return, BTW.

[Richard B the EMT]

I have never had On Line Medical Control throw it back to me as discribed in one of the postings. If the OLMC doc says the patient goes, then with the backing of my supervisor, at least one duo of LEOs and THEIR immediate supervisor, the patient GOES.

If, after describing vitals, meds, past history, current events of the injury/illness, and even one time that there was only the bathroom with a lighting bulb in it, for the entire apartment, OLMC states "leave 'em, collect the signature", at least I am covered. It falls on the OLMC's licence. I also do not have to like it, but it's under "Higher Medical Authority".

[fiznat]

We can throw in a list of 'what ifs' from now until next Christmas, but the point still remains that both individuals have an altered mental status, and by definition cannot make a clear and informed decision to refuse treatment based upon their similar condition. We also know that based, on the intoxicant involved; they are at least at risk of further injury.

Quoted for truth.

It doesn't matter how much they had to drink

It doesn't matter whether the drug they took was legal or not

It doesn't matter if they are in a house or in a field, on earth or on the moon

It doesn't matter if they are male or female, black or white, big or small

It doesn't matter who called the ambulance, or even if nobody called

If the patient has altered mental status and is incapable of making an informed decision, that person is going to the hospital. This isn't cavalier, it has nothing to do with "Nazi Germany" The whole concept of informed consent is that if a patient is unable to speak on their own behalf, it is reasonable to assume that they would have wanted (and consented to) proper medical treatment. This is the way it works EVERYWHERE, because it protects both patients and providers in an otherwise sticky and difficult situation.

Leaving confused/altered/semi responsive people at home on the floor with a half-scribbled refusal signature is NOT good patient care and absolutely will get you and your patient in trouble some day.

Edited June 12, 2011 by fiznat

[DwayneEMTP]

...

Quoted for truth....

Who's truth? According to what?

...If the patient has altered mental status and is incapable of making an informed decision, that person is going to the hospital.

Oooops, you forgot to post links to the resources that show that you have the legal right to have this attitude as was asked for in the OP, and reiterated by the Doc...

It really isn't that difficult of a question, right? We're expected, in any intelligent debate, to be able to reference those things that we are debating. Why is it that so many of our most intelligent posters continue to argue this point without doing so?

...This is the way it works EVERYWHERE...

Then it should be the simplest thing in the world to show why it's moral and legal, right? Just because you've been doing it forever, and all of your buddies have been doing it forever doesn't mean that it's right, moral or legal. We're simply asking that you prove your point, yet you continue to refuse to do so.

So far, which surprises me with you, you're simply talking out of your ass. This speech works great for teaching basic classes, but what are the legal parameters for paramedics?

Dwayne

Edited to add the final quote and response.

Edited June 12, 2011 by DwayneEMTP

[ERDoc]

Search this document for the term "intox" and you will find several references.

http://www.emsmdc.com/pdf/patient_refusals_cumulative1.pdf

This one is from NAESMP.

http://www.naemsp.org/documents/EthicalChallengesinEmergencyMedicalServices.pdf

http://www.thesullivangroup.com/risk_resources/alcohol_impaired_patient/alcohol_7_ama.asp

http://www.thesullivangroup.com/risk_resources/alcohol_impaired_patient/alcohol_6_informed.asp

Edited June 13, 2011 by ERDoc

[fiznat]

Then it should be the simplest thing in the world to show why it's moral and legal, right?

Ah Dwayne. Its like you came on here and demanded we all prove to you that the sky is blue. You're in the minority here, the burden of proof should be on you! This seems so obvious to me that I can't believe I went this far, but see below for a bit of law from my home state of Connecticut. I cant figure out how to post a direct link, but if you want to verify it go HERE and search for chapter 319i.

Sec. 17a-543. (Formerly Sec. 17-206d). Procedures governing medication, treatment, psychosurgery and shock therapy. (a) No patient shall receive medication for the treatment of the psychiatric disabilities of such patient without the informed consent of such patient, except in accordance with procedures set forth in subsections (B.), (d), (e) and (f) of this section or in accordance with section 17a-543a, 17a-566 or 54-56d.

(B.) No medical or surgical procedures may be performed without the patient's written informed consent or, if the patient has been declared incapable of caring for himself or herself pursuant to sections 45a-644 to 45a-662, inclusive, and a conservator of the person has been appointed pursuant to section 45a-650, the written consent of such conservator. If the head of the hospital, in consultation with a physician, determines that the condition of an involuntary patient not declared incapable of caring for himself or herself pursuant to said sections is of an extremely critical nature and the patient is incapable of informed consent, medical or surgical procedures may be performed with the written informed consent of: (1) The patient's health care representative; (2) the patient's conservator or guardian, if he or she has one; (3) the patient's next of kin; (4) a person designated by the patient pursuant to section 1-56r; or (5) a qualified physician appointed by a judge of the Probate Court. Notwithstanding the provisions of this section, if obtaining the consent provided for in this section would cause a medically harmful delay to a voluntary or involuntary patient whose condition is of an extremely critical nature, as determined by personal observation by a physician or the senior clinician on duty, emergency treatment may be provided without consent.

This is just an example, but there it is. Black and white state law. Now go prove to me the sky is blue.

EDIT-- and before you complain that Connecticut is entirely inhabited by Nazis, here's one I found from Mississippi:

SEC. 41-41-7. Implied consent to medical treatment where emergency exists.

In addition to any other instances in which a consent is excused or implied at law, a consent to surgical or medical treatment or procedures, suggested, recommended, prescribed or directed by a duly licensed physician, will be implied where an emergency exists if there has been no protest or refusal of consent by a person authorized and empowered to consent or, if so, there has been a subsequent change in the condition of the person affected that is material and morbid, and there is no one immediately available who is authorized, empowered, willing and capacitated to consent. For the purposes hereof, an emergency is defined as a situation wherein, in competent medical judgment, the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a consent would reasonably jeopardize the life, health or limb of the person affected, or would reasonably result in disfigurement or impairment of faculties.

Edited June 13, 2011 by fiznat

[DwayneEMTP]

...Ah Dwayne. Its like you came on here and demanded we all prove to you that the sky is blue.

One of the most idiotic things I've seen posted here in a long, long time. Soon you'll be saying, "Cmon, grmmar isn't impotent..I didn't cum to be judged...." When did you decide that you were in love with generalities and began refusing to discuss specifics?

I didn't demand anything. I gave an opinion stating that I wouldn't transport a certain population of apparently intoxicated patient. Some of you then, as you are now, claim that based on that opinion that I am simply too dumb to breath. I asked you to support your argument with the legal precedence that you have been using to take these people against their will, at which point y'all turned into a bunch of pussies and either ran away or began speaking in generalities.

You're in the minority here, the burden of proof should be on you!

Yikes...I'm not even really very sure how to address this... Please tell me that that statement was made in jest?

The bill of Rights

U.S. Constitution

Detention while in the guise of public authority.

...This seems so obvious to me that I can't believe I went this far,...

I'm sorry I've wasted your time. It's has become obvious that you are much to intelligent and experienced to waste you time with such topics.

...Black and white state law. Now go prove to me the sky is blue.

Are you truly suggesting that I should attempt to prove to you that you have a right to be unmolested and/or removed against your will from your own home without a a legal precedent being invoked? Really?

Holy shit man...it's like your little brother stole your computer and is trying to post under your name or something...What's up?

What is disappointing and scary is that you truly believe that "Everyone knows this is a fact so I'm sure it's fine" is a good way to practice medicine. Again, you are one of the first ones that I would have expected to say, "Holy shit! I've been doing it because they told me it was ok in medic school, but I don't know what gives me the legal right to do so.." But you, and everyone else with your opinion chose instead to either run away, or just continue to bluster about, "It's so obvious that a provider of my caliber really shouldn't have to be bothered with these silly conversations." You seem to be a different person than you were before. A year or two ago you would have been really interested in the morals/ethics of paramedic medicine. It would have been important to you to know why. Now you seem more concerned with showing the Basics on the board that you are above such topics.

I'm going to have to reread your blog and see how it's changed. You've gone from being one of the most humble, intelligent, introspective providers I've known to this, "Fuck it. It's not important if it's right because I never get jammed up over it." super medic...or maybe it's me that's just not growing as smart and as good as fast as you are. If that's the case, I really hope that I continue to fail to keep up.

Dwayne

[fiznat]

Are you truly suggesting that I should attempt to prove to you that you have a right to be unmolested and/or removed against your will from your own home without a a legal precedent being invoked? Really?

Did you miss the state statutes I posted?

I never once suggested the law needn't exist. I only stated that it is a difficult and arduous process to go through all of the statutes to find it. I finally broke down and did it, and all I get in response from you is personal attacks. You go on and on about how important it is to you to see the legal standard, and yet when I post it you somehow can't comment on it? What's up?

I'm not going to take the bait with all the other stuff you posted in regards to me personally. I've managed to participate in this discussion without making personal attacks. How come you can't do the same?

Edited June 13, 2011 by fiznat

[Kiwiology]

If some bloke is PFO (pissed and fell over) it's one of three choices

- Take home

- Leave with the Police

- Take to hospital

If there is somebody at home who is responsible enough for the Ambulance Officers to leave the patient with, off home we go.

If not, then it'd be ace if the Police take him back for detox ... trouble is the Police do not want him just as much as we don't want him.

Should this situation occur then he is left in the hallway on a trolley for a couple hours until he sobers up.

Now, should this guy take a swing at us, vomit all over us, cop me a gob full of abuse or his scrote mates are giving us agro well then he is being left with the Police no two ways about it.

[DwayneEMTP]

Did you miss the state statutes I posted?...

I didn't, the one you posted simply doesn't apply to this conversation. And I didn't ask you to scour the world for their laws, I, and others, asked which YOU USED, right? Shouldn't you, when doing something as terribly serious as taking away someones liberty, as removing them from their own homes when they've broken no laws, be at least slightly curious what gives you the right to do so? Shouldn't you have at least part of your justification on the tip of your tongue?

In addition to any other instances in which a consent is excused or implied at law, a consent to surgical or medical treatment or procedures, suggested, recommended, prescribed or directed by a duly licensed physician, will be implied where an emergency exists (Where one obviously exists! Not where one MIGHT be but you can't be sure without several thousands of dollars to rule it out!) if there has been no protest or refusal of consent by a person authorized and empowered to consent or, if so, there has been a subsequent change in the condition of the person affected that is material and morbid, and there is no one immediately available who is authorized, empowered, willing and capacitated to consent. For the purposes hereof, an emergency is defined as a situation wherein, in competent medical judgment, (Which they've defined above as a licensed physician) the proposed surgical or medical treatment or procedures are immediately or imminently necessary and any delay occasioned by an attempt to obtain a consent would reasonably jeopardize the life, health or limb of the person affected, or would reasonably result in disfigurement or impairment of faculties.

My highlights in blue and red.

It's clear that there must be an emergency need. This does not give you the right to take them to rule out a medical need.

And even then you can see that this doesn't apply to you unless you get instructions from your medical director, and even then not if you, after a thorough, professional assessment believe a non lethal dose of alcohol to be the most likely cause of the altered mentation. Also, as I and others have mentioned, but you again choose to ignore, there are plenty of drunk people, in their own homes, that we can reasonably assume are just going to sit and drink. We won't save them from that, we have no realistic belief that there is a stroke hiding behind the booze, nor do they claim to be a danger to themselves or others other than by possible acts of stupidity, which is not limited to those that are shitfaced.

They will simply be transported by you, against their will, to the hospital where the Doc and nurses will ask what's wrong, determine without all of the fancy tests that have been argued are necessary for every dizzy or altered person, and then send them home, often walking, only now with at a minimum several thousand dollars of debt that you gifted them with simply because they chose to get drunk at home and you feel that they have no right to do so. I'm truly, (genuinely, no insult intended) confused how you can be proud of that or consider it patient advocacy.

Did you miss the state statutes I posted?...I never once suggested the law needn't exist....

No, in fact over and over you claimed to have the legal right to take these people. But after being asked a gazillion times to produce it, or reference it, you refused to do so, as you've again failed to do here. You say that you've not insulted me, but if you believe that I can not read, or understand well enough to see that this document does not make your case then you insult me and everyone else that takes the time to read it.

...Did you miss the state statutes I posted?...I only stated that it is a difficult and arduous process to go through all of the statutes to find it....

Can you paste from the post in which you made that argument? I don't see it and don't remember it. So when the next guy claims that ECGs are 90% accurate for predicting acute MIs he should also then find it too cumbersome, and be terribly insulted because we might ask for a source? We should simply roll over because he claims it 'like asking to prove that the sky is blue?" And at that time, will you not understand him to be calling you a moron?

Did you miss the state statutes I posted?...I finally broke down and did it, and all I get in response from you is personal attacks...

Your attitude from the start at, "This thread is a waste of time." through, 'this is so obvious I can't believe I'm even coming back to it" have been insulting and arrogant. I'm sorry that you can no longer see that in yourself. That is where you and I are different Fiz, I know that I push buttons, that sometimes I should be gentler, and other times I just completely screw the pooch and take responsibility for it. You just seem to have come to believe that you really are that much better than everyone else.

Did you miss the state statutes I posted?... You go on and on about how important it is to you to see the legal standard, and yet when I post it you somehow can't comment on it? What's up?..

What you posted doesn't apply to the situation. The calls that the thread was addressing, at least past Lone Stars post, related to people alert, but not legally able to sign a refusal. I was exhausted from asking you to prove your point, something that in the past you'd seemed to relish doing. I wasn't going to respond to the cited document because it was so obviously not relating to anything in this thread.

Did you miss the state statutes I posted?...I'm not going to take the bait with all the other stuff you posted in regards to me personally. I've managed to participate in this discussion without making personal attacks. How come you can't do the same?

......Ah Dwayne. Its like you came on here and demanded we all prove to you that the sky is blue.

.....You're in the minority here, the burden of proof should be on you!..

...This seems so obvious to me that I can't believe I went this far,...

...Black and white state law. Now go prove to me the sky is blue...

Couching your insults in passive aggressive camoflage only makes them more insulting to me. And if you don't see the arrogance then go back and read them in their original context...

I've always been one of your biggest fans, but yeah, asking you direct questions that you felt I didn't deserve answers to, being told that what I consider a valid argument it so stupid that it's akin to 'having to prove the sky is blue' and then being given a proof that is obviously not a proof, I got really pissed off. Nothing wrong with that....being pissed is a temporary condition for me yet it gets me fired up and makes me think.

My intention with the comments and 'insults' was to try and shake you out of what I believe you will one day look back on as a weak, impotent and arrogant facade intended to pass as intelligent debate. I've hated it when I did such things and was grateful when others have taken me to task for it. You are simply in a different place where you fail to see that any shortcomings may be applied to you in any way. And that does make me sad.

What is maybe even sadder is that the two best, most intelligent posts in this thread came from LS and Ugly, neither ALS providers. Pretty smart shitheads though...

Have a great day brother...I look forward to you thoughts...

Dwayne

Edited because I tried to reply to Kiwi too and it posted them together and cause me to have to many quotes or some such shit...will get yours in a little bit Kiwi...

Edited June 13, 2011 by DwayneEMTP