Poss ETOH AMS Inside vs Outside

[fiznat]

[Timmy]

Just an intresting article I came across...

http://www.cbp.com.au/Portals/0/240409MACNew%20-%20Newsflash%20Insurance%20Group%20April.pdf

Edited June 16, 2011 by Timmy

[DwayneEMTP]

Just an intresting article I came across...

http://www.cbp.com.a...oup%20April.pdf

Outstanding reference Tim! It makes both arguments thoroughly it seems. At least for the part that I read. I look forward to reading it all later when I have time.

Thanks man..

Dwayne

[uglyEMT]

It is a good reference yes. One thing I would like to mention for those that read it though... the patient had a head injury as well! In what we have discussed thus far we were talking strictly intoxicated no obvious injuries or suspected injuries. If it was me, having a head injury would have trumped the ETOH and you would be transported.

It is a very good article though especially because it is a court case and its findings. Also it is in plain speak.

[Lone Star]

Georgia State Protocols (Section 1, page 6 states:

PATIENT REFUSES TREATMENT

We recognize that patient refusals represent a difficult, almost impossible, medical – legal paradox. An appropriate policy must allow refusal of treatment by obviously lucid and rational individuals. However, we must be vigilant for those individuals who are incapacitated by means of substance abuse (i.e., drugs, and/or alcohol), medical condition (i.e., hypoglycemia), or trauma (i.e., head injury).

We recognize that, if a patient refuses and therefore is not given an appropriate screening evaluation/examination, it may be impossible to uncover incapacitation in seemingly “normal” appearing persons. This leaves open the possibility that a person needing treatment will refuse treatment.

The purpose of this policy is to provide a baseline for the EMS agency and its evaluators that recognizes the delicate balance between individual’s rights and appropriate EMS response.

Adult patients who are in full command of their mental faculties have the right to refuse treatment even when the refusal is imprudent by accepted medical standards. This only applies to patients who are mentally competent and capable of deciding for themselves. This is not the case with the patient who is neurologically depressed, mentally unstable (either chronically or acutely), or is gravely disabled, which means that he/she is unable to provide for the basic needs of life.

In situations of a mentally competent adult refusal, the following steps should be taken:

1. Explain in comprehensible terms the need for treatment and the consequences to the patient of declining treatment, (i.e., you may die; you may never walk again, etc.). Explain to the patient what treatment is to be done per protocol (such as Oxygen, IV’s, and backboard, etc.). Also, explain to the patient what treatment may be done at the hospital such as x-rays, ECG, blood test and physician evaluation.

2. Sometimes other steps can help in getting a patient’s acceptance of treatment:

A. Removing a patient from the public or embarrassing scene.

B. Involving family members or friends as needed or requesting that the patient be allowed to respond to questions privately.

3. If the patient still declines care, meticulously document what you advised the patient (i.e., you may die, you may never walk again, etc.) and all indications of the patient’s alertness, full orientation and capacity to repeat back the explanation given.

Have the patient do this in front of another person, preferably in the presence of a police officer or ambulance crew personnel and document the results of that request and the name of the person who witnessed the event of the refusal.

4. If the patient should deteriorate or lapse into unconsciousness, the pre-hospital provider may render any treatment deemed appropriate.

Note: Whenever possible contact medical control for cases in which patient refuses treatment/transport.¹

1. Brown, M.D., Stuart, Patrick O'Neal, M.D., and William M. Billings. "Adult and Pediatric Emergency Pre-Hospital Protocols." Georgia Department of Human Rsources, 11/2007. Web. 16 Jun 2011. <http://ems.ga.gov/pdfs/ems/Adult%20&%20Pediatric%20Pre-Hospital%20Protocols%201-15-08%20Web.pdf>.

[Richard B the EMT]

Timmy, the link to the article about the New South Wales LEOs and EMS Officers had one line that kind of summed up the situation: Damned if you do, Damned if you don't.

I recall one situation where an EMS team, an EMS supervisor, an NYPD patrol car team, and their sargent, were trying to talk a man from a car accident into going.The man had an obvious head injury of a bruised and bleeding forehead, and an "outie" "spiderwebed" windshield, obviously hit from within the car. I was only aware of the call, as I'm a friend of the EMS supervisor, but was passing by while I was off duty. I don't recall the field outcome.