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

[VentMedic]

Florida actually has two State Statutes that cover involuntary commitment;

Baker's Act which concerns primarily mental health issues

This act has been under scrutiny for being over used when other forms of implied consent could have been used for medical care. Ex. police officer Baker Acting elderly patient with head injury in MVC. The pt legally may still have to serve 3 days of involuntary commitment in a mental unit after recovering from injuries. Sometimes it's dropped if hospital stay is more than 3 days. However during this time of "declared mental incompetency", greedy family members can gain control of assets with an attorney and simple pen stroke.

http://www.flcourts.org/gen_public/family/...in/bakeract.pdf

Marchman Law which is for alcohol and other substance abuse issues related issues. This is the one the ER usually uses to get people with a serious alcohol/substance intoxication checked into the clinic for 3 days.

Florida's "Marchman" law on the involuntary commitment of substance abusers.

http://www.cga.ct.gov/2000/rpt/olr/htm/2000-r-0858.htm

SUMMARY

Florida enacted its involuntary civil commitment law in 1993. PA 93-39 is called the Hal S. Marchman Alcohol and Other Drug Services Act and can be found at FSA § 397.301 to 397.998. It has nine different parts; part five is devoted to involuntary admissions procedures. The other parts include sections on client rights, voluntary admission procedures, and inmate substance abuse programs. We have attached a copy of the entire act.

Florida permits a person to be admitted for treatment against his will in three different circumstances: (1) a law enforcement officer may have him placed in protective custody if he exhibits a need for treatment in a public place or in a way that attracts the officer's attention; (2) any responsible person with knowledge of a person's substance abuse may have him admitted in an emergency if he is likely to harm himself or others or he is so impaired that he cannot recognize his need for treatment; and (3) a spouse, relative, guardian, or three adults with knowledge of the person's substance abuse may petition the court for involuntary treatment.

[MAGICFITZPATRICK]

This is how its done in NYC

1 Head to toe lift

2 roll stretcher into ambulance

3 Call dispatch

4 turn on lights

5 Step on gas

[Jon_E]

The two dumbasses in the fire rescue jackets just made us all look bad, on national television no less...thanks guys! Volunteers I bet. They'd better be, cause they aint worth sh#t. Lets wait until she goes unconscious? WTF! The patient is intoxicated, therefore is not allowed to make a decision for herself. Her cousin even told them that. Those two obviously dont know their jobs, they need ALOT of continuing ed. hours. I think they should be taken off the volunteer roster. I know I'm not comfortable having those two retards coming to my house. Anway, again, the patient does not have the right to refuse care. She needed to be given an option. Either come with me, or go with the police officer. 9 out of 10 times they come with you. The one time they dont, LE arrests them, and makes them come with you. Good god. I hope those two idiots are fired.

[RaceMedic]

First i did not watch the show nor do i ever watch it my comments are solely based on what i have read in this thread

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

I know this system and it is no different than many others. In this case, and in many other larger cities, county VFD's do cover areas in the city. These are areas where the city has grown around smaller townships. these townships maintain their little areas roads and yes even fire protection and also respond to medical calls as first responders. as EMTgirl posted, these are Volly crews with NO TRANSPORT capability or ALS PROTOCOLS, what would they possibly have done prior to the ALS units arrival ? take vitals? ok so you have a PT thats awake still with a set of vital signs.... hmmm sounds great, not that i would mind that but as far as being able to treat an overdose as a B thats all they could do, they have NO MEDS, IV's, OR the certification to administer either. I guess they could really piss off the PT and compound the problem for the medics that did arrive by forcing O2 on her if she was in fact refusing.

So what would you all have done for this apparently uncooperative PT at the BASIC level with NO TRANSPORT OR ALS capability before ALS arrived ? I read a lot of critacism but no suggestions

[Freaknuggetz_chick]

well, up here we have what's the called the mental health act: if someone is a danger to themselves or others (eyewitness, notes, anything questionable) then ems has a right to transport against the patients will. or have them arrested by police and taken in that way. then there's all kinds of other laws in regards as to what the hospital does with them later, how long they can hold them, etc etc. i had an attempted suicide, 3 different stories, multiple variations of how many pills etc patient took, and with no way to verify we transported. doc released patient before my paperwork was done, trusted the patient (doc is patients fam doc as well, kinda handy in the rural setting).

as for what could the VFD do, you have a woman, a&ox?, refusing transport etc. from the sounds of it they cant transport anyways, well, they did what they could: stayed and waited for transport car, incase anything happens. crappy situation, but i doubt they had the meds/tools to fully treat the patient anyways. hell, i've sat with patients that i wanted to start IV's, O2 etc on, but they were just competent enough to refuse me, so whatever. its their choice.

question: why would VFD members restrain a suicidal patient just for vitals until transport truck arrives? better to be calm and patient (unless person is actively trying to hurt themselves or others of course!). and i dont think it is unfortuneate that the KS system in question here utilizes VFD etc. nice to have some educated hands on scene before the bus rolls up, even if its just a bit of O2 and calming people down. when its CPR and AED, it can make a huge difference. think about it.

[Asysin2leads]

Another reason that educational standards and training are key to a successful EMS system.

When some of us get on the EMT-B program and medic mills, what a lot of people don't realize is that it isn't so much more the patient's sake, but for the provider's sake. Maybe I'm getting old, bitter, and cynical, but lately, I care a lot more about the people wearing the uniform than the patient, and currently, many of the programs that leave you wearing a patch of some sort do nothing more than set you up, and this situation is a prime example of it.

I don't fault the responders so much as I fault the system. Obviously, the two responders with the Fire/Rescue jackets somewhere along the line got it into their heads that they were fully prepared to handle 911 emergencies. It is readily apparent that they are not, and now they are the laughing stock on national TV. It is not fair to send well meaning people half cocked out into the world into situations where police officers, psychiatrists, and ER physicians would shudder at the thought of. From my experiences with all three, the intoxicated, uncooperative patient who may or may not be a patient is one of the big litigation nightmares, and if you are dealing with it, you had better be crystal clear on what to do.

IMHO, there are no perfect answers to this. If you let her pass out you can get charged with nonfeasance, if you do intervene, you can be charged with violating their rights. If you have to make a decision, its better to err on the side of being charged with violating someone's rights, rather than standing around waiting for someone to pass out. A court is more likely to be sympathetic if you violated someone's rights but were genuinely acting in their best interests, rather than standing around in your Fire/Rescue jacket while she passes out.

[firedoc5]

Today is one of those days I didn't feel like reading through each and every post, especially the long was, but...The way it has been, or is around here is that if someone is so drunk 911 was called they were almost to the point of passing out. If she was still up and around when we got there and she refused tx. we'd at least hang around, usually killed time on the back porch where she didn't know we were until she did pass out. Then we could step in. Now if she became coherent again and refused, especially physically, she was given the option. Either go with us to the ER or detox or go to jail. Normally it was off to the ER.

[backwoods2]

i dont think a medic or emt should be able to get a patient refusal from someone who is drunk because they are not of sound mind and they might not be telling the truth about how they really feel

[Dustdevil]

i dont think a medic or emt should be able to get a patient refusal from someone who is drunk because they are not of sound mind and they might not be telling the truth about how they really feel

But, if they are not competent to refuse, are they competent to consent?

Seems to me, if you're incompetent, you're incompetent, period.

[SC MedicMike]

If a person is incompetent when sober, does that make them competent when they're drunk?