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

[VentMedic]

State policies on consent

http://www.jems.com/jems/31-5/103993/

Although implied consent is referenced in the most recent curriculum for EMTs, it's expressly stated for application only in some states, including but not limited to California, Florida, New York, Hawaii, Kansas, Missouri, Montana, New Mexico, South Carolina and Texas. The law in these states allows EMS personnel to transport an incapacitated or intoxicated person against their wishes with the approval of either online or offline medical direction, depending on the state.5 Title 29, chapter 401, section 445 of Florida Statutes is a prime example. It states that a health-care provider may examine, treat and transport a person, even against their wishes, if that person is intoxicated, under the influence or is experiencing an emergency condition, and a normal patient would reasonably undergo examination, treatment or transport.

[ERDoc]

In the system I grew up in, we were vollies and PD would respond to all scenes (no FD thankfully). It was pretty clear in NYS that any suicide or intox was incapable of refusing. If you had a problem, you called medical control and they were to talk to the person as assess if they had the capacity to refuse. If they did not have the capacity, you had to transport. It became a problem at some point because the police would not assist in forcing the pt to go. One too many unlawful imprisonment lawsuits and a memo came out saying that they were not to assist except in the case of a violent pt. So the jolly vollies were left on their own trying to get a pt to go. Kind of ironic. They were the ones least capable of dealing with it and they were the ones that had it dumped on them. Glad I started working the other side of medical control.

[zippyRN]

I was thinking the same thing tonight...why didn't someone suggest an involuntary commitment? I believe she was from Kansas if anyone can shed light on the law there..

intoxication is normally a reason for mental health services to refuse to assess someone and you have to rely on 'common law' powers or the legislation relating to drunkenness to detain / treat etc the intoxication

[brock8024]

I thought that once someone tried to take their life they where no longer able to make their own decisions. I might be wrong but I ran on a man that had taken some pills and the cops where ther cuffed him and we treated.

[Dustdevil]

5 Title 29, chapter 401, section 445 of Florida Statutes is a prime example. It states that a health-care provider may examine, treat and transport a person, even against their wishes, if that person is intoxicated, under the influence or is experiencing an emergency condition, and a normal patient would reasonably undergo examination, treatment or transport.

Of course, then you have to be careful to assure that your state statutes actually deem EMS to be "health-care providers." Some do not include EMTs and medics in that definition. If not, you're screwed.

[zippyRN]

I thought that once someone tried to take their life they where no longer able to make their own decisions. I might be wrong but I ran on a man that had taken some pills and the cops where ther cuffed him and we treated.

epends on hjow the law views

1. competence

2. saying some one is not competent

3. who can say someone is not competent (police? Health professional? - does EMS caount as a health professional;? specific mental health trained health professionals / social workers?)

and finally whether other legislationcan be used initially to detain and treat someone who is intoxicated ( i.e. nick them 'drunk and incapable' and take them to theEmergency dept where they can be assessed )

[whit72]

Not commenting on the case presented here. I dont really know the situation.

When did it become a medical emergency to be intoxicated, or un-lawful. If you are over 21 not a threat to yourself or others, not incapacitated enough as to not being able to protect your own friggin airway, or sitting in the middle of the road pissing yourself and reciting the lines from a christmas story.

I like to party a little, do I need an intervention? Mental health evaluation? A bed in an ER thats already strained, understaffed and full of people that for the most part require hospitalization.

If your not underage, not a threat to yourself or others. You dont require a bed in the ER or a cell at the police station.

Then again medicine is now driven by liability. If there is a chance you might be held responsible. You have to err on the side of caution. Its bullshit.

So I have to get up every twenty minutes to haul a drunk to the ER because everybody is worried about getting sued. Even though the guy has no business being in an ER. There not babysitters, and I am not the party train.

[EmergencyMedicalTigger]

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.

[medic001918]

Not commenting on the case presented here. I dont really know the situation.

When did it become a medical emergency to be intoxicated, or un-lawful. If you are over 21 not a threat to yourself or others, not incapacitated enough as to not being able to protect your own friggin airway, or sitting in the middle of the road pissing yourself and reciting the lines from a christmas story.

I like to party a little, do I need an intervention? Mental health evaluation? A bed in an ER thats already strained, understaffed and full of people that for the most part require hospitalization.

If your not underage, not a threat to yourself or others. You dont require a bed in the ER or a cell at the police station.

Then again medicine is now driven by liability. If there is a chance you might be held responsible. You have to err on the side of caution. Its bullshit.

So I have to get up every twenty minutes to haul a drunk to the ER because everybody is worried about getting sued. Even though the guy has no business being in an ER. There not babysitters, and I am not the party train.

I'm inclined to agree with Whit on this matter. The presence of alcohol use alone doesn't mean that someone is not capable of understanding the consequences of their refusal. There's a difference between someone who's incapcitated due to alcohol use and someone who is just having a good time. Ultimately, it comes down to judgement and documentation of how the call went down. A patient could certainly make a good case if he was able to understand his actions and decisions, and was forced to go to the hospital anyway.

If someone has threatened harm to themselves or someone else, that's a different matter entirely and then the hold of the patient becomes more on a psychological issue rather than the issue of intoxication. This is the kind of case where they could transport. She took an overdose of medication in an attempt to harm herself. That changes it more to a suicidal or psych issue and they are absolutely correct in transporting her. To not intervene with this patient would be negligent.

Shane

NREMT-P

[brock8024]

I will agree that just because you have been drinking does not mean you cannot make desicions. But once you decide to take your life then you can not.