Legal/ethical question

[Dustdevil]

The same if he has an impaled object, or lacerated penis etc... Rectal bleeding non-traumatic would be examined and possibly tx differently, not searching for tears, etc. but medical in nature.

Not me. That would be one of the extremely rare cases where I would be happy to have a basic for a partner.

[Burnzonemt]

After reading the initial post my first concern is the patient. Scene safety is behind us seeing how that we've already walked into the room, got the story from the FD and the pt.'s "buddy". Who knows who is watching this scene with that much drug paraphernalia laying around. I'm thinking just get out of the apartment with your patient as soon as possible. I don't want to deal with anymore of his "buddies" than I have to. I'm pretty sure that PD will only aggravate the situation.

That being said though, my county is small enough that the local police or sheriff's office is probably already watching this location. In my area it is a lot more likely that PD will be on scene instead of FD. They LOVE ems calls to these locations and are more than willing to "lift assist" if they think drugs might be involved.

As for documentation, will only give hints to the PD if they are on scene and haven't picked up on it yet. Probably nothing in my PCR either. Who's to say that the bags weren't full of flour? :? Most likely not, but what if? It was drilled into me in class and by my current ems director that our service can tell the police very little about our pt. They largely have to pick up on it on their own. Example: You ask the patient if s/he was drinking prior to the wreck, and you "happen" to nudge the officer as they are answering. One of the officer's told the class that they want us to share info with them, and the SO just won't know where the info came from. My concluding thought is word of mouth only, and then very carefully with even that. EMS director is waving the HIPPA club and threatening to fire us otherwise.

[akflightmedic]

Simple I call P.D. for lift assist. they can determine then, what they want to do. They know when I call there is a reason. Done it before , will do it again. Sorry Ak have to disagree with if some had rectal bleeding due to anal sex...YES I chart mechanism of injury. Sorry, that is the part of the history of the patient. The same if he has an impaled object, or lacerated penis etc... Rectal bleeding non-traumatic would be examined and possibly tx differently, not searching for tears, etc. but medical in nature.

Be safe,

R/R 911

I did not say DONT chart mechanism...I asked would you report it to the local authorities since it is against the law in most states...I was reaching for a situation which is sarcastic enough to prove my point. In your example, the pt TOLD you he had sex, therefore it is relevant. If it is relevant to the condition of the pt, by all means make mention of it but do it in a way that is non accussatory. Just because he is there in the presence of the drugs does not mean he had anything to do with them, therefore it should not be mentioned or implied in the report. You did not test the stuff so you do not know without a doubt what it is. Yes, it may be painfully obvious but you still can not assume.

[AnthonyM83]

It's different when it's something you find out from access you had while treating a pt

No, I don't think it's that much different. You "sliding scale" of what you decide to report is different, but there'll still be some things you do and some things you don't, even while on-duty. If you recognized one of the guys in the house a murder suspect or you saw a map of a terrorist bombing on the kitchen table or some other extreme example, you'd still report it, despite you being EMS. Now, I believe in having some level of trust and confidentiality with patients, so they're not scared to call 911 for a medical, but see it all depends on the crime.

Also, yes by being EMS got you into their house, but they invited you in. There was time to move him into the hallway before FD arrival if they had that much drug content inside.

[AnthonyM83]

Might I give an unofficial, off the record heads up to the local cop on the beat about it?

That's what I was thinking for this scenario. Next time you're on a medical and one of the cops you're buddy buddy with rolls up, if you have time you can give him the hot tip...help him with a felony stat

You have a postictal seizure patient that needs to be transported. You would be negligent in your care waiting on scene for law enforcement.

Not that I'm promoting this option, but I'm sure if he decided to go this route, he wouldn't wait on the patient just for LE to arrive. It should only take a few seconds to request PD assistance as he gets stuff out of his med bag. Now, if you retreated and waited for them to clear the scene, that'd be different.

[AnthonyM83]

I have to go along with medic RN on this one. in describing the scene , noting the existence of what appeared to be drugs at the scene of a "seizure" patient you are providing a possible cause to the M.D.

If it comes out that you were there and saw all the drugs and the patient ends up having complications due to drugs, I can see someone asking you, "You mean you were there with a downed patient and saw drugs and paraphenlia all around...and it didn't occur to you that this MIGHT be relevant in your medical report? Hello?" If the report is confidential from law enforcement, I would probably briefly describe a little of what I saw. I'll try to protect the patient, but honestly I'm not going to be OVERLY concerned about protecting their privacy if they're big time drug distributers.

[JCicco345]

I would definetly make a note in the PCR, because if he has been using drugs that would be directly related to his care. ALso i'd make sure PD was responding, here we get them on just about anything anyways. But i'd defenitly make sure they came, i know thats not our job, but its still the right thing to do.

[Guest]

See, maybe that's still my naiveity (is that even a word?) but that was exactly my point. Its not our responsibility, but like any other criminal activity, it needs to be stopped.

Anyways, for the situation in hand, my precepting crew at the time didn't tell the police anything, nor did I. I don't think the fire department did either. It's interesting to see tho how those who work in larger cities have a "its not our business" attitude whereas those from smaller communities are more of the "where's the cops?!?" ...

Zach

[BEorP]

No, I don't think it's that much different. You "sliding scale" of what you decide to report is different, but there'll still be some things you do and some things you don't, even while on-duty. If you recognized one of the guys in the house a murder suspect or you saw a map of a terrorist bombing on the kitchen table or some other extreme example, you'd still report it, despite you being EMS. Now, I believe in having some level of trust and confidentiality with patients, so they're not scared to call 911 for a medical, but see it all depends on the crime.

Also, yes by being EMS got you into their house, but they invited you in. There was time to move him into the hallway before FD arrival if they had that much drug content inside.

It's completely different when something is related to treating a pt... if a pt tells you they just shot up, are you going to have them arrested?

[vs-eh?]

Anyways, for the situation in hand, my precepting crew at the time didn't tell the police anything, nor did I. I don't think the fire department did either. It's interesting to see tho how those who work in larger cities have a "its not our business" attitude whereas those from smaller communities are more of the "where's the cops?!?" ...

Your crew was smart. I also agree about the larger city, smaller community comment...I have a feeling that the majority on this forum work in the latter...