Legal/ethical question

[JCicco345]

I wouldn't have them arrested, but it would obviously be noted, can't pretend it didnt happen. If the cops are on scene then its thier problem, if not once you turn over care and give the report to the RN or MD, it becomes thier problem. Plus, these are two totally diffrent scenarios.

[AnthonyM83]

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?

Nope I wouldn't, but this isn't about having someone arrested. It's about someone later asking you how you thought it wasn't pertinent to include possible drug use for a seizure patient...why not do it since the cops aren't going to be reading your PCR.

[Asysin2leads]

The correct way to document this would be to state "Strong suspicion of drug overdose" if that is what your presumptive diagnosis is.

The way I swing on this issue is, I'm not a cop, while I work closely with the police and I am mandated to report certain crimes (child abuse), reporting evidence of a crime such as drug use in my capacity would be a violation of patient confidentiality.

I have had heroin users toss their needles in the sharps container before we enter the ER, there have been many a pot pipe, crack pipe, and and little baggies disposed of in my presence after a physical exam. Drugs are illegal, you also really shouldn't do them, but it's not my place to enforce drug laws.

[Doczilla]

"Hmmmm... these are some nice works here. Let's toss in a wrench..."

While the stacks of cash are irrelevant to the patient's condition (though a strong predictor of future penetrating trauma), the drugs are an important clue. Just because he has a seizure disorder doesn't mean he hasn't been doing drugs and isn't suffering an OD. I have to disagree that the differential diagnosis is one line only. Stimulants cause seizures, and the end stage of most lethal toxic exposures is "seizure, coma, death" (except benzos, which is "coma, death"). It belongs on the run report. And it will do absolutely nothing in terms of bringing the illegal activity to light, since the cops won't see the report and it would violate pt. confidentiality if the hospital said something.

Now does the apartment look like a meth lab? That's a hazmat scene. Great danger to everyone else in the building. Cops must know, canaries must go in (sorry, "Highly Trained Hazardous Materials Technicians"), and the place has to be searched and deconned.

Agree that pulling a hissy fit and screaming for 5-0 by radio is not going to do me a lot of good, especially considering that I'm wearing a nametag. I would, however, whisper something to a cop friend that they "might want to give that place a look". Sorry, but even drug dealers should know better than to call the medics to their own apartment without making at least a passing attempt to make it not look like a Quentin Tarantino movie. Geez, they're just asking to be caught. They should talk to the street level pushers and further explore the services of the "homeboy ambulance service" (door-to-er service in a stolen car, no waiting.)

'zilla

[deacon]

Interesting dilemma, my suggestion is to secure and manage your patient, transport in a timely fashion as per your protocols, and do one of two things:

If there is no one else there (in terms of residents) ask fire to watch the apartment form the outside and have LEO come and secure the scene as your patient was unable to secure it prior to transport.

If there are occupants in the apartment, leave a less than valuable piece of equipment behind, a penlight, cheap stethoscope etc., have a LEO return to the scene to retrieve this for you.

As medical personnel, we are not legally obligated to report these findings, and unless the drugs and paraphernalia have a pertinent part to play in the history they do not need to be included in the PCR. As human beings, I would suggest that we find a mechanism to at least alert Law Enforcement of your observations in such a way that you are not a direct party to that alert.

[ebemt]

I would report it in order to prevent further damage to the patients health. Yes I acknowledge I'm not the police, however I feel it is a personal responsiblity.

[AnthonyM83]

I would report it in order to prevent further damage to the patients health. Yes I acknowledge I'm not the police, however I feel it is a personal responsiblity.

Might such a philosophy cause larger damage to the population's overall health if people are scared to call for medics in emergencies or delay on it until a problem gets really bad (not just drugs, but also immigration issues or at college parties were underage drinking was present, and so on).

[Dustdevil]

Might such a philosophy cause larger damage to the population's overall health if people are scared to call for medics in emergencies or delay on it until a problem gets really bad (not just drugs, but also immigration issues or at college parties were underage drinking was present, and so on).

I don't have a problem with that. All three deserve to die. 8)

[AnthonyM83]

Yeah, especially the 20 yro drinkers...

Exceptions to all rules, but in general let's keep people friendly towrad us

[Dustdevil]

Exceptions to all rules...

Yeah, if they're hott.