Campus EMS Legality Questions

[medichopeful]

Hi all,

I don't think this exact situation has been brought up before, but if it has, let me know.

I'm a student at a medium-sized (<10000) university, where I volunteer as an EMT-B. I was promoted/elected last semester to the rank of "Training Officer," so I'm in a pretty good position to bring about changes in the actions and policies of the EMS unit.

There are a lot of things that I want/need to work on over break, but one of the major things is legality.

Here is the situation. As it stands now, there are a few options for patient release after EMS has made contact with them:
1) The patient signs a refusal and it's witnessed by another party
2) The patient is released to the care of a roommate or friend of the same sex, and is told to stay in their room (this is for alcohol intoxication)
3) The patient care is transferred to the FD, who provides emergency transports for us (we're unaffiliated) to the local hospital
4) We transport the patient (non life-threatening conditions) to the hospital ourselves

Options 1 and 4 are pretty cut-and-dry. In the case of 4, we make sure we get the signature of the nurse in the ER/ED.

Options 2 and 3 are a little bit trickier. With option 3, it has always (even before I started working there) been the case that we would just verbally transfer care to the FD, who would take the patient. This is something that I would like to fix, and would like to require a signature on (get a signature from the FD staff who shows up, just to show we transferred care. thoughts on this?

Option 2 is the one that's really concerning me. After we evaluate the patient, sometimes the decision is made that they will just be released to their roommate to keep an eye on them. This is usually the "found sort of drunk by security, but is basically just drunk, nothing else major." (Though it would be better if they were forced to go to the hospital, but unfortunately that's not an option). When this is the case, the campus police take custody of the patient and that's basically like our patient transfer. They then pass them off to their roommate.

I don't come from a legal background, so I'm asking for guidance. Does anybody have any input on the legality of this or how to fix it if it needs to be?

Thanks all,
Eric

 

[Shishkabob]

For option 3, getting a signature, even for your own protection, is not necessary in my experience. Many FDs, including VFDs around here, who don't transport, don't have a patient sign anything. If a government entity doesn't do it to protect themselves, I doubt you'd have to.

Granted I don't know the legalities or specific for my state, let alone yours, but again that's what I see around here for non-transporting first response groups.



Now, option 2 is a lot more tricky. They are arguably not able to refuse treatment or transport for themselves, and the roommate is not a legal guardian.... That's walking on thin ice right there, regardless of what common sense dictate with slight intoxication.

 

[Chimpie]

Now, option 2 is a lot more tricky. They are arguably not able to refuse treatment or transport for themselves, and the roommate is not a legal guardian.... That's walking on thin ice right there, regardless of what common sense dictate with slight intoxication.

But if the roommate is willing to sign, at that point they are saying they are the guardian, no? Or can it be phrased that way?

 

[Shishkabob]

The tricky part is you're letting someone not legally able to refuse treatment, to actually refuse treatment, which is akin to letting a minor refuse because their 18yo friend says they should.


PS-- Yes there are altering levels of intoxication, just doing generics here as yes, not every (or even most) intoxicated people need to go to the ER.




Now, since the OPs agency DOES transport, I would assume they have med control. If they have med control, I say get them on the phone, discuss it with the doc stating that the patient is "slightly" intoxicated and they don't want to go, and that the roommate is willing to watch the patient.

The doc would probably be willing to let them stay, then all you have to do is give the usual "IF you don't go to the hospital you'll spontaneously combust" talk and you should be good to go.

 

[zmedic]

I think you need some sort of guidelines, ideally from your medical control, on how drunk someone can be an not need to be transported. Where I worked on the ambulance the patient had to be able to ambulate without assistance three steps. Then they could go to an alternate destination (like detox or jail or wherever). It's not really a refusal, because someone who is mild to moderate intoxicated doesn't need medical care or ED transport.

Maybe also have a list of questions that should be asked (how much drunk, when the last drink was etc.), to prevent situations where someone downs a few four Lokos just before you get there and are still going to be absorbing when you leave.

 

[medicdan]

See PM.

 

[EMSLaw]

As far as the situation where the patient is transferred to the FD - I don't think you need a signature there. Someone's scrawled name on the run sheet isn't going to be that great of a help, anyway. Just note in your PCR, "Patient transferred to ALS/BLS unit 123, who assumed responsibility for patient care."

I'm not entirely sure I'm comfortable leaving a patient with his or her roommate in the situation you've described. Unfortunately, I suspect it will take a bad outcome before the University changes policy. I don't suppose your Student Health Center is open 24-7 or has the capacity to keep these people for observation?

 

[b2dragun]

I think leaving a drunk is cool to an extent, there has to be a line. For us we can leave if they can walk with the assistance of not more then 2 ppl and are ao3. We then have them sign an ama and document on a non-transport sheet. As for transfer of care to FD, as long as the pt is being transferred to someone at your level or higher you are cool, complete a non-transport form.

Situations like these are CYA...document, document, document.

Think of it this way, when you do transport do you have the RN or MD sign?(might be different there) but we don't unless the pt is unable.

 

[brentoli]

Option 2 is the one that's really concerning me. After we evaluate the patient, sometimes the decision is made that they will just be released to their roommate to keep an eye on them. This is usually the "found sort of drunk by security, but is basically just drunk, nothing else major." (Though it would be better if they were forced to go to the hospital, but unfortunately that's not an option). When this is the case, the campus police take custody of the patient and that's basically like our patient transfer. They then pass them off to their roommate.

What is your MD's opinion on this? Our protocols state anyone who appears under the influence is not able to refuse for theirselves.

The ETOH destracts the person from any potential problems they may have. Pain and all of their senses are decreased, so if something really is wrong, they won't be able to tell you.

1) Why is security calling you for them?

2) Why can you not make them go to the hospital?

3) Is it an actually police officer, or a security officer that takes the person?

 

[medichopeful]

What is your MD's opinion on this? Our protocols state anyone who appears under the influence is not able to refuse for theirselves.

The ETOH destracts the person from any potential problems they may have. Pain and all of their senses are decreased, so if something really is wrong, they won't be able to tell you.

1) Why is security calling you for them?

2) Why can you not make them go to the hospital?

3) Is it an actually police officer, or a security officer that takes the person?

1) Security calls us if they're vomiting or have some other medical condition going on. A lot of the time if it's just a simple "stumbling around on a Friday night," they won't call us and will instead PBT them and release them to a friend.
2) This is where it can get tricky. If they are heavily intoxicated and are not oriented, then they will most likely be going. If they're intoxicated/throwing up/etc., but they are of sound mind (oriented, able to answer questions, etc.) we really don't have too many options. Granted, the police could take them into custody but that doesn't really happen. I feel the system's broken.
3) The way it works is this: Anytime someone is found stumbling or drunk, a police officer from the college is called over (they're actual police officers, it's a state university and they have full police powers). If necessary, EMS will be called over. The officer is the one who (in non-transport cases) is the one who takes "custody" of the patient from us. The patient is basically going from ISO (security guard, not police) to police to EMS to police to roommate, if they're being released (I hope that makes sense :wacko

Thanks for the responses everybody! I'll respond to the rest tomorrow when I'm not so tired.

 

[dmc2007]

My campus service operates in a very similar manner to yours. We have three possible dispositions:
1) Pt wants to refuse. We assess and determine the patient is competent to refuse care. We obtain a refusal.
2) Pt has a non-life threatening condition that meets parameters for transport in our vehicle*.
3) We transfer care to one of 911 ambulance company for the town we're located in. We don't obtain a signature, but do record the unit number for our records.

As for releasing the patient to a roommate, I would think this is could be a liability nightmare if something goes wrong. Either the patient is mentally competent enough to refuse treatment, and can be left to their own care, or they're not, and need to be cared for until they are. I don't see room for a middle ground, at least legally.

I'll be shooting you a PM a little later on.

 

[jjesusfreak01]

Intoxicated patients need to go to the ER if they are not capable of or willing to sign a refusal. Nobody gets left on scene without a refusal unless they are diabetic (and there are no complications and they have someone to watch over them).