A&E Intervention: Medics can accept refusal from a drunk

[CBEMT]

I agree with Whit. If the pt is over the age of 18, CAO x 3, and refuses, I can't take him unless he told someone he was trying to hurt himself.

So the fact that she outright told the producer ON CAMERA that she took the entire bottle of pills doesn't bother you?

If some patient you're called to never told anyone he wanted to hurt himself, but he's standing on a bridge looking down, is he just looking for something he dropped?

[whit72]

I believe I stated I wasnt commenting on this scenario.

I never stated anything about telling anyone they want to hurt themselves. If I feel they are a danger to themselves or others they lose their right to make a decision on transportation. They go. If you want to sue me have at it.

I ll take my chances in a court of law, rather then get a call in an hour for someone swinging in their basement.

I

[EmergencyMedicalTigger]

So the fact that she outright told the producer ON CAMERA that she took the entire bottle of pills doesn't bother you?

If some patient you're called to never told anyone he wanted to hurt himself, but he's standing on a bridge looking down, is he just looking for something he dropped?

I wasn't specifically commenting on this episode of the show. If you read my comment, it was a generalized statement of when a pt can refuse transport even after he has drank or taken something. Most of the calls I've made the pt has been altered to where he was required to be transported. I was simply stating under what circumstances I wouldn't take some against his will.

[spenac]

I agree with Whit. If the pt is over the age of 18, CAO x 3, and refuses, I can't take him unless he told someone he was trying to hurt himself. Now there have been plenty of times when our wonderful law enforcement officers tell the pt "I am going to take you to jail for something unless you go with EMS." Gotta love officers who don't want to write a report, but want the pt taken somewhere to sober up. And the nurses at the ER love it even more.

If an officer does that tell the officer to get in back and to handcuff the patient as he is still in police custody. Then he can do his report while I do mine and then leave him at hospital looking for a ride back to his car.

[EMTgirl84]

I live in this "podunk" town in Kansas and work with the crew that responded to this call. I haven't seen the show, but that crew without a doubt is one of the best that you could have. I would request them to my home if I knew that they were on duty to take care of my family and I. You have to understand that this is "reality" TV and they love DRAMA! This podunk town is the 5th highest in per capita crime rate in the nation with a population of 122,377. We average around 10-20 calls per ambulance per 24 hour period. Anyways, that was a "county" fire department that responded that is primarily volunteers. I have personally never seen them do anything that I disagree with, but they don't get that many "red" patients...which is no excuse, but they don' have the means to transport anyways...so they were waiting on the ambulance. They can operate at a EMT-B level and just do basic vitals. Law enforcement is always there when we go on a overdose or any kind of psych. or ETOH. They make sure the scene is safe and let us do our thing. They also follow us to the hospital and stay with the patient after we leave. It sounds to me like the ambulance took the pt. without a doubt or question and treated them appropriately..sooo what is the problem? If you think this town in Kansas is so podunk and incompetent...why don't you apply and see how well you can hang?

[Scaramedic]

I live in this "podunk" town in Kansas and work with the crew that responded to this call. I haven't seen the show, but that crew without a doubt is one of the best that you could have. I would request them to my home if I knew that they were on duty to take care of my family and I. You have to understand that this is "reality" TV and they love DRAMA! This podunk town is the 5th highest in per capita crime rate in the nation with a population of 122,377. We average around 10-20 calls per ambulance per 24 hour period. Anyways, that was a "county" fire department that responded that is primarily volunteers. I have personally never seen them do anything that I disagree with, but they don't get that many "red" patients...which is no excuse, but they don' have the means to transport anyways...so they were waiting on the ambulance. They can operate at a EMT-B level and just do basic vitals. Law enforcement is always there when we go on a overdose or any kind of psych. or ETOH. They make sure the scene is safe and let us do our thing. They also follow us to the hospital and stay with the patient after we leave. It sounds to me like the ambulance took the pt. without a doubt or question and treated them appropriately..sooo what is the problem? If you think this town in Kansas is so podunk and incompetent...why don't you apply and see how well you can hang?

Since I was the one who used the word Podunk I shall respond.

You made my point with the sentence in red, county is not town honey. Also if that is the way your system practices medicine then I hate to tell you this but, your podunk. Waiting for ANY patient to go unresponsive who has verbalized suicidal ideation and then followed it up with popping a bottle of Trazadone is ludicrous. Every minute treatment is withheld a few million more brain cells die, five days in the hospital says enough to me. If she was promptly treated she might not have spent five days in ICU. Before you defend your system and their actions I suggest you study the physiology of an overdose. While your buddies with the county VFD stood around with their proverbial thumbs up their asses she absorbed more and more of the toxin (Trazadone). In other words she became sicker and sicker until her body failed enough that she lost consciousness.

Think about it this way, if she was standing there with a .38 jammed under her chin would the FF's or LEO's wait until she pulled the trigger to try and help her. She is conscious and alert, she's just refusing treatment right? She has the right to refuse doesn't she? Obviously the answer is no, she loses her rights when she expresses or attempts to harm herself. The law is written that when someone is not mentally capable of protecting themselves then law enforcement and EMS must step in and help them. The departments in question failed to do this and deserve more than just a rip on a EMS forum. I would not be surprised to see a lawsuit coming out this, I can just see some ambulance chaser drooling while watching this play out on TV.

I'm sure your system is great, but every system in open to criticism and in this case probably deserves it. Sorry if you don't want to hear it, but in my opinion someone dropped the ball on this one. No big deal, it happens all the time except this time it was on TV and it gave us something to bitch about. If your system is as good as you say then they will do something about this. If they don't, well in the words of Dust: they suck!

Finally if your read my post you will see I complimented the crew that responded, my problem was with the VFD and PD. Unfortunately your system includes them also.

Peace,

Marty

[Niftymedi911]

"can hang"

Funny you should mention that......

I honestly wouldn't apply, because if you state that 1 24hr truck runs anywhere from 10 to 20 calls a shift that obviously shows that the agnecies administration needs a real wake up call. Not to mention they don't give a damn about the safety of the crew or the patient for that matter. If you've ran 18 calls in a 24 hour period (I'm sorry but you're gonna have to send someone else if it was one of my family members) and each call last roughly 45 to 1 hour, you've been up the entire shift in between breaks in emergency traffic and time spent out of service at the ER's while you finish paperwork and offload. I know there are "nation wide shortages" of medics etc. Honestly, why would I want to get my arse kicked if I could work for a service get paid 3 times as much and work maybe 5 to 6 calls a shift? I've been in that situation before and it sucks arse. So I "can hang" It used to be like that here before the new admin rolled in. They've put up 5 or 6 new stations and have implemented a first responder system (ALS FD) that can run Alpha/Bravo (medical priority dispatching) responses without always having to tie up an ambulance (public assist, fall down and go boom, no transport required, minor MVA's, etc). By the way I might add that all 22 FD's are independant fire districts in the county. It's not a metro based system. We've dropped our call volume by almost 15 % believe it or not. We still handle over 80,000 calls a year for a county wide system and to be honest last duty day I ran 7 calls and transported 4. Last call at 2000. Slept the rest of the night until shift change. It's not very bad at all.

[WendyT]

Ok boys, what was the outcome for her, so she was on a vent and? :roll:

[whit72]

Hey nifty,

Must be nice to only have five calls in a 24 hour shift that average an hour, what do you do for the other 19 hours your getting paid?

I average ten to fifteen calls a 24 hour shift they average around 45 minutes. There is still plenty of time for napping and eating if you so choose. We dont get paid to sit around, we get paid to run calls. Thats why we have five days a week off thats when you rest.

As far as being able to function on little or no sleep its part of the job and not difficult to overcome, thats why there is a 24 hour dunkin donuts on every corner. To assume that people who work busy shifts cut corners or are not competent is bullshit. If you would like to call someone else because we have been up all night. Thats you perogative.

I would likely take a provider that works a truck that runs close to 7000 calls annually, over one that does 1500 and is well rested and well fed. Not to say that the slower provider is lazy or incompetent. I wouldnt jump to those conclusions. Thats my experience and I would trust my life or the lives of my loved ones in any of their hands, sleep or no sleep.

I know with all the experience an education you have at the tender age of twenty, its easy to pass judgement on a entire group of providers, or EMS systems. Assumption will not get you very far in EMS and maybe you should wait till the ink dries on your ticket before casting your infinite wisdom on the rest of us.

Just somthing to ponder with all the time you have on your hands.

Sorry if that sounded harsh. My dog just shit on my floor so I might be projecting some of my anger.

[whit72]

Ohhhhh...That sounded harsh, sorry about that. You get the jist.