Legal/ethical question

[flight-lp]

"Well the clock on the wall said 3:15, March edition of People magazine is on the coffee table, there is an unknown brown stain on the carpet............." You could document all day long, but why. There is no need to, its not pertinant unless you see evidence of the act (powder on pts. nose for example). Why create a situation that potentially doesn't exist?

[Nate]

Ask someone on scene that you don't like to "sample" the substances and then turn then in for suspected drug use.

[MedicRN]

"Well the clock on the wall said 3:15, March edition of People magazine is on the coffee table, there is an unknown brown stain on the carpet............." You could document all day long, but why. There is no need to, its not pertinant unless you see evidence of the act (powder on pts. nose for example). Why create a situation that potentially doesn't exist?

Then why document the existence of snow in an arrest found outside in the dead of winter (did they arrest while outside or arrest because they were outside too long - I don't know, I didn't observe it) or the bent steering wheel in a code red trauma with a flail chest (I don't know, I didn't see the the person's chest slam the steering wheel).............

[kimweldon]

I'm just curious as to why the FD would not have told the PD about the suspicion of drugs in the house. They would not have a pt confidentiality problem.

I would have noted on the PCR, "various powdery substances and green leafy substances present on coffee table. Pt denies (or admits) any recent drug use...." I definitely would NOT have noted the stacks of money on the PCR. That has nothing to do with Pt care.

But as questioned earlier, I would have given a nod towards the potential drugs to the lead FD person on scene.

[vs-eh?]

Relating to the initial case...Those of you who are deciding to document more than whether or not the patient admits to doing drugs that night are asking for future trouble in this case and in any future similar cases. In my opinion there is absolutely no relevance to the amount of drugs/paraphernalia/cash in the apartment and to the patient as presented. The initial case is pretty straight forward aside from the environment and the environment itself does not reasonably apply to the patients complaint. Again if the patient was grossly obtunded, GCS 3, arrested, etc...Then yes, I would likely make a comment regarding the amount/range of suspected substances, because you are potentially dealing with a far greater amount of differential diagnoses. This patient, as presented (and obviously aren't too post-ictal anymore) does not reasonably apply.

Then why document the existence of snow in an arrest found outside in the dead of winter (did they arrest while outside or arrest because they were outside too long - I don't know, I didn't observe it) or the bent steering wheel in a code red trauma with a flail chest (I don't know, I didn't see the the person's chest slam the steering wheel).............

These environmental conditions (aside from the absolute and relative severity of the patients condition) DO apply to further treatment and differentials both in and pre hosiptal. Hypothermic arrests or predisposal to flail chests are not know underlying medical conditions. Environmental conditions would have directly contributed to there occurrence. Does smoking weed lower the seizure threshold for those with underlying seizure disorders? I dunno, but again, he had a known disorder and if he denies doing drugs then what else are ya gonna do?

Oh ya, probably a good thing FD didn't say anything. Thankfully you are probably with a smart enough engine not to stick there nose in were it doesn't belong. Give a "nod" to the captain? LOL, ummm no...

[Dustdevil]

I'm just curious as to why the FD would not have told the PD about the suspicion of drugs in the house.

They might. But that's their business. That would be a question for www.firehouse.com .

Personally, I think it's a fair trade. I get a pocket full of cash. The patient doesn't get reported. Everybody's happy!

[island emt]

PCR = 'Patient found in postictial state. White powder in baggies and a green leafy substance in bags noted near patient. Syringes also noted. Several large stacks of cash noted on table.'

No determination as to the contents of anything is made or asserted with the above statement. It is an objective observation of the surrounds when you found the patient.

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. What nobody has mentioned here is SCENE SAFETY . just because the FD is there doesn't make this a safe scene. back out call for PD & wait. then they can deal with the drugs, the criminal activity & watch my back for when his buds with the weapons come out of the back room.

[Dustdevil]

His buds are the ones that called the ambulance.

His buds want him out of there. I am only too happy to comply.

The appearance of cops in this mix is more likely to produce violence than to prevent it.

[vs-eh?]

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.

You already have the possible (read: likely) cause...The patient has an underlying seizure disorder and he has been off his meds for 2 days. If that wasn't the case, then yes, drugs may be higher on your differentials. You putting "seizure" in quotes leads me to believe that you believe this is either BS or is a drug related incident. Again, just because the patient is in the apartment, doesn't absolutely equal them doing drugs. Also if the patient denies doing drugs then what are you going to do?

The appearance of cops in this mix is more likely to produce violence than to prevent it.

Agreed.

[Ridryder 911]

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