Injury at the MX park

[nuEMSgurl]

You are serving as medical command at one of the largest Motorcross tournaments in your state and are called to the scene of a "biker down." On arrival, you see a 16 year old male lying on the track. He is alert and oriented to time and place and tells you that he only fell off of his bike, and based on his location and time that he had not gone through any jumps (again, no great fall). However, you note that he is not moving his left arm, which is rotated at the elbow. You ask both him and his father if he is to be transported via ambulance. Both say yes.

Your state is a "you call. we haul" state, so if they call 911 for anything from a tick bite to a cardiac arrest, if they say that they want an ambulance to take them, you take them.

Your partner proceeds to splint the elbow while you contact dispatch, request the second unit to respond, and establish communication with that unit while it is en route. The second unit arrives within six minutes of your call. They load the patient onto the cot, but just before they put him in the ambulance, he changes his mind and decides to go to the hospital by car. Your partner verifies that they DO NOT want the ambulance and informs the patient that they can do some things en route (ie, IV establishment). You notify dispatch so that they can notify the hospital that he is coming by car. At that point, your supervisor gets on the radio and asks if you rendered any treatment. You state that you splinted him. Your supervisor says that you can't do that and orders you to call him immediately.

Was there anything that your crew missed? What reasons would the supervisor have for his reaction?

[Just Plain Ruff]

hmmmm first off I think your supervisor is incorrect. but I'm not sure what he's incorrect about as you haven't told us what he told you when you called him.

A patient can refuse all or any part of the treatment. The patient can agree to transport but they can refuse all care except transport. They can refuse an iv and meds but allow oxygen.

Please give more information as what we have is incomplete.

And once that splint is on you had better not take it off. That would be negligent.

[Dustdevil]

hmmmm first off I think your supervisor is incorrect. but I'm not sure what he's incorrect about as you haven't told us what he told you when you called him.

Exactly. You "can't do" what? Treat him? Release him? Call the hospital?

The one thing you absolutely can NOT do is keep him from leaving. If he says 'bye bye,' it's game over. Forget about it and go back to watching the races.

[nuEMSgurl]

The information you have there is complete...all the sup did when we called him was tell us we couldn't do that. Splint was left on-taking it off would do more harm than good and as was stated earlier they could get us for negligence if we did.

[medic001918]

Your supervisor is absolutely wrong in this case. The patient (or his parent in this case) understands the decisions they are making with regard to his health and well being and are choosing to accept responsibility for that decision. To keep this patient in your care after they have decided they don't want your services would be kidnapping. They didn't refuse treatment, they refused transport. There is a difference. This is a fundamental understanding of care and one that your supervisor most definatly should have an understanding of.

Shane

NREMT-P

[becksdad]

I agree with the others who state the supervisor is wrong. As long as a parent/legal guardian refuses either care or transport, you cannot force them. WITHOUT a parent or guardian present, then implied consent applies to minors. However, whenever confronted with a relatively minor illness/injury to a minor, we usually try to take the time to contact parents before or during transport. If we are confronted with a situation where a minor is uninjured (say, in a minor MVC), we always attempt to contact parents. If unable to get ahold of parents, they go with us or LE.

For your own protection, though, I would be certain that the parent in this instance understands that refusal of continuing care is against medical advice, document this completely, obtain LEGIBLE signatures from the parent and a credible witness (again, LE make good witnesses). Once you have done that, you are not responsible for anything that happens to the patient. You have offered not only treatment, but transport services as well; you have attempted to pursuade them to accept your continuing care, and have explained reasons why they should accept this, and possible consequences of refusing. You have done everything you can. This is NOT patient abandonment.

[Timmy]

Thats motocross guys for yah lol. Your lucky if you got him in the back of the ambo lol. Im a motocross medic and sometimes ride with the boys as well. When they refuse treatment I normally just explain the risks and get them to sign the refused treatment form then its there fault what happends to them next. But i can also see were there comeing from, if your seen with the medic then your sometimes seen as weak. But nywayz. What you did was right.

[Dustdevil]

The information you have there is complete...

Sure, if by "complete" you mean completely unintelligible. :roll:

all the sup did when we called him was tell us we couldn't do that.

So answer the question. Can't do WHAT??? What specific action did your stuporvisor tell you that you could not do?

[fiznat]

Agreed, what did he say you couldnt do?

...And why is this in the ALS section?

[Asysin2leads]

I was kind of wondering why this was in the ALS section too. Okay, so the person is splinted and then says nahhhh I don't want to go. Now remember, splinting is not exactly an invasive procedure, Boy Scouts do it all the time.

Lets talk about something known as false imprisonment. False imprisonment is defined as imprisonment of someone without legal authority. To prove a false imprisonment charge, you need to prove intent to commit the crime (radio transmission), the act (if you carried it out), resulting confinement, lack of reasonable escape, and absence of legal authority (which you don't have unless you are also a police officer moonlighting as an EMT.) It's a civil tort and something you can get sued over. Feel free to share this with your supervisor.

I know all of this from an episode with a friend of mine who is admitted to the bar in two of the most litigious states in the nation, when we were at a casino in one of the said states. For some reason one of the security guards got it into his noggin that I was underage and had a fake ID, and decided he would hold it until his supervisor came to look at it. Said friend then explained the concept of false imprisonment (as in I could not be reasonably be expected to leave the premises without my ID), and he gave it back, and we got some nice comps too. Lawyers suck unless you're gambling with them.