Ok, this should be a fun one.

[EMTDenny]

So, today was my last day of a 3 day job orientation for my new part time EMT position. I am not going to go into detail

of how everything went cause I will be saving that for another post.

Around noon, we started talking about documentation. Blah blah blah and so on falling asleep... etc you know...

Then we got to the topic of RMA. Now here comes the fun part and please Anyone can give their opinions cause it was a hell of

a conversation that woke me right up.

One of the new EMT said. "My partner and I who ride as EMT and a paramedic responded to a call of a drug addict who OD

themselves with opium's. My partner( the paramedic) gave narcane and of course the PT was now alert. The Pt said Oh I want a

RMA Thanks for helping me... EMT and paramedic said, she looks A&Ox3 sure" Now that started a major debate! It was

intense. The orientation instructor was furious at what he just heard. He is a paramedic, health specialist from OSHA something

like that and risk management. He Said " If I knew or find out who that paramedic is, I will have his card in a heart beat"

Of course, during the argument the instructor was saying and most of the paramedics in class also that after narcane is given the PT

needs to go on some 6 hour watch cause they can go into an arrest and needs to be transported to the hospital. this surely looks like

the paramedic was just being lazy. and not following protocol at all. The EMT strictly brought up this conversation cause he thinks

the PT should not be force to go to the hospital if they do not want to. Which led to that insane topic.I mean seriously Implied consent

was being thrown at him the whole time of the conversation. I just wanted to share that story cause it had me on the edge.

Denny

Edited February 23, 2012 by EMTB.Denny389

[Eydawn]

Denny... I'm having trouble reading what you're saying.

During orientation, an EMT who is already riding with the service brought up a situation in which the instructor thinks they erroneously let the patient sign a "refused medical assistance" form?

I don't think you can force someone to go to the hospital if they really don't want to... but I'm not in your area, so maybe "found down" = ride in whether they like it or not...

Can you clarify this above situation any? It's ALMOST to where I can figure it but not quite...

Wendy

CO EMT-B

[EMTDenny]

During orientation, an EMT who is already riding with the service brought up a situation in which the instructor thinks they erroneously let the patient sign a "refused medical assistance" form?

I don't think you can force someone to go to the hospital if they really don't want to... but I'm not in your area, so maybe "found down" = ride in whether they like it or not...

Wendy

CO EMT-B

What was told, and what I heard.

Emt and paramedic responded to a over dose call. "My partner the paramedic gave narcane to the PT. Once the PT woke up after a while the PT kept asking us to not take her to the hospital. We took it to out best judgement since the PT was A&Ox3 they were able to sign the RMA and not be taken to the hospital" I am not a paramedic but after giving narcane is it alright to RMA the PT if they asked? With out even calling medical control?

I don't know if that cleared it up.

Edited February 24, 2012 by EMTB.Denny389

[HERBIE1]

Bad. Not many details here- as in how the patient presented, what the call was for, initial vitals, respiratory rate, etc.

For the sake of argument, let's say the patient did not present with agonal respirations, but maybe an altered mental status, lethargic, etc. You administer the Narcan, they become fully alert and oriented. Fine.

So- how much of the opiate does the patient have on board? Are these legal drugs or something like heroin? How much was ingested? How many pills? What else did the patient consume? Was the heroin laced with anything- ie Fentanyl? What was the purity/strength of the drug? Is there alcohol present or other illicit substances? How much Narcan was given?

In other words, you have no idea how much of the drug may still be in the patient's system. The Narcan may have reversed just enough of the OD to improve mental status and respirations, but there is still plenty of opiates still in the patient's system, which means that once the Narcan wears off, the action of the drug returns. I've seen it happens many times- we restore a person's respiratory drive- only to have it knocked out again when the Narcan wears off.

Bottom line- these people are NOT competent to refuse transport. They need to be monitored for awhile at the ER until it can be determined the are no longer under the influence.

[EMTDenny]

Bottom line- these people are NOT competent to refuse transport. They need to be monitored for awhile at the ER until it can be determined the are no longer under the influence.

Extremely good point you got there. Those detail were left out while the EMT was explaining the story to us. Evidently that paramedic did not care. Then again, we do not know the other side of the story.

I also want to apologize in advance. I could have written a better post then the one I just posted. I did not know the edit feature can only be use once.

[ERDoc]

We've been through this before. These people absolutely CAN refuse transport. It doesn't matter what was wrong with them before or what they will be like in 30 minutes. If they are competent to make their own decisions at the time they refuse you CANNOT take them. It is your job to try to convince them otherwise, but ultimately if you assess them and they understand the risks and benefits and they have the capacity, there is nothing you can do to make them go. To force them to go is basically kidnapping. Having the capacity to make such a decision also means more than being A&OX3 or 4. They have to understand what is wrong, why you want them to go and what the consequences of not going are. Denny, your instructor may want to review the law before he gets himself or one of his students in trouble.

As for contacting medical control, that all depends on your protocols/jurisdiction.

[EMTDenny]

We've been through this before. These people absolutely CAN refuse transport. It doesn't matter what was wrong with them before or what they will be like in 30 minutes. If they are competent to make their own decisions at the time they refuse you CANNOT take them. It is your job to try to convince them otherwise, but ultimately if you assess them and they understand the risks and benefits and they have the capacity, there is nothing you can do to make them go. To force them to go is basically kidnapping. Having the capacity to make such a decision also means more than being A&OX3 or 4. They have to understand what is wrong, why you want them to go and what the consequences of not going are. Denny, your instructor may want to review the law before he gets himself or one of his students in trouble.

As for contacting medical control, that all depends on your protocols/jurisdiction.

This is another good point. But couldn't the lawyers of the pt side have a field day with this if the pt family gotten involved and decided to pull up the PCR to look at what happen. The PCR shows, yes the Pt was clearly competent after NARCANE was given and died hours later? The lawyers would go thru every detail and side affect of that drug and turn everything on the unit that was called to the call. It sucks but it happen I hear.

that was the point the EMT was trying to make. Forcing the pt to go to the hospital is more like kidnapping. I find this interesting cause I really don't want to do something like this.

[tcripp]

Dennis - Doc is right. Any patient who oriented to self/date/location/date/president/dimes in a dollar/etc can refuse treatment/transport. If you are uncomfortable with that...get law enforcement to assist. They will have their own set of rules, but the fact that there were drugs involved may change the game just a tad.

FYI, we had a fairly young man (in his 30s) with a brand new pacemaker/defibrillator, which kept going off. When it wasn't firing, he would pass out, but not long enough for us to transport. He adamantly refused transport. We had no option but to let him go but we documented the hell out of that report. County Deputy happened to be on scene (other reasons and he was the one who actually called for us), but he had no reason to haul him in...he had not broken the law. We left the guy on the side of the road. Deputy would not let him drive his vehicle (unsafe driver at that point), so he was on his own.

I'd also like to suggest you watch your spelling and punctuation. It does make it difficult to follow.

(BTW, it's narcan.)

Toni

edited - I missed a comma

Edited February 24, 2012 by tcripp

[EMTDenny]

I'd also like to suggest you watch your spelling and punctuation. It does make it difficult to follow.

(BTW, it's narcan.)

Yeah i know, I wanted to make changes but I used up my edit....

[ERDoc]

I'll agree it's a shitty situation to be put in. Sued by the family or sued by the pt. Which is worse? If you let them RMA and something happens, yes, the PCR will be looked at. That is why it is so important to document everything. This also why on a NYS PCR there is a place for a witness to sign the RMA. If you can, have the family be the witness and make sure you explain everything to them so that they understand why you can't make the person go.

EDIT: Spend enough time on the scene for the narcan to wear off and let him go unconscious again. Load and go, and give another dose of narcan (if needed) once you are closer to the hospital.

Edited February 24, 2012 by ERDoc