Vehicle accident

[emergancyjunkie]

Ok you roll up on scene and find a car on its side with the occupants walking around your patient is a 19 year old female with slight bleeding on her hand from an abrasion was the front passenger of the airbags were deployed windshield was cracked but not evident of you patient hitting it with her head. She does not want to go to the hospital. Vital signs are 122/72 pulse of 152 and respriations of 22. What do you do

 

[DesertMedic66]

Put a little gauze pad on her hand and have her sign AMA.

 

[beefaroni]

Get her number

 

[emergancyjunkie]

Ok but your protocol state that Medical command for an ama has to be contacted due to vitals upon contact they state that you should try and convince her to go to the er and put a c collar on her if she goes due to the moi

 

[emergancyjunkie]

Get her number

Nice

 

[Veneficus]

Ok but your protocol state that Medical command for an ama has to be contacted due to vitals upon contact they state that you should try and convince her to go to the er and put a c collar on her if she goes due to the moi

Many years ago I was made aware of an EM study that demonstrated patients refuse less often when they speak directly with online med control.

So hand the phone to the girl and let the doc convince her himself. That way if she is not convinced, nobody can blame it on your effort.

If the med control line is recorded, more the better.

 

[Remeber343]

I would cardiovert. Right after cut the roof and roll the dash.

 

[NYMedic828]

Ok but your protocol state that Medical command for an ama has to be contacted due to vitals upon contact they state that you should try and convince her to go to the er and put a c collar on her if she goes due to the moi

Idk how it is by you but over here mechanism of injury alone is not a ruling for spinal immobilization.

Her vitals are fine...

Her respirations are a little elevated and her HR is up there but its not so high for a 19 year old girl who just rolled a car and is freaking out.

Would have stayed with her for a little while, bandaged her hand and if she doesn't wanna go tell her sign here.

The report should clearly state where she is signing that she has been told to go to the hospital and regardless of her best interests has decided not to.

If it bothers you that much to RMA her, call the doc. Then its off your shoulders.

 

[Medic Tim]

I would cardiovert. Right after cut the roof and roll the dash.

don't forget to call for a chopper

 

[NYMedic828]

http://www.youtube.com/watch?v=YzYxz_uvtSI

 

[DesertMedic66]

Ok but your protocol state that Medical command for an ama has to be contacted due to vitals upon contact they state that you should try and convince her to go to the er and put a c collar on her if she goes due to the moi

Then contact Medical Control. If she doesn't want to go then you can't force her to go. Try to talk her into going, if still no then have her sign AMA.

 

[Remeber343]

Moi shouldn't be a reason to use c spine. I'd throw her on the monitor after doing a physical exam.

 

[Akulahawk]

Ok but your protocol state that Medical command for an ama has to be contacted due to vitals upon contact they state that you should try and convince her to go to the er and put a c collar on her if she goes due to the moi

Then contact Medical Control. If she doesn't want to go then you can't force her to go. Try to talk her into going, if still no then have her sign AMA.

Contact Medical, get them to speak with her on a recorded line, if possible, if she still is refusing transport, she gets signed out AMA, witnessed if possible. Of course, there's a whole lot more... since she's allowed you to get vitals, is she coherent/alert & oriented? Repetitive questioning? Can she count backwards from 100 by 7's? Does she have a plan for self-care? Failure of some of these things make me think "concussion" and some make me think that she's flat-out altered mental status, in which she would be unable to refuse...

Know what criteria patients in your system must meet in order to be able to AMA.

 

[exodus]

I cant even count backwards from 100 by 7 lol.

 

[Aidey]

^^^ Same here. I must be permanently concussed. 100...93...86...ummm yeah.

 

[CANDawg]

I cant even count backwards from 100 by 7 lol.

1) Subtract 10.
2) Add 3.
3) Repeat.
4) Look like a genius as you rattle it off while the pt is counting on their fingers.

 

[Aidey]

1) Subtract 10.
2) Add 3.
3) Repeat.
4) Look like a genius as you rattle it off while the pt is counting on their fingers.

Showoff :glare:

 

[Tigger]

1) Subtract 10.
2) Add 3.
3) Repeat.
4) Look like a genius as you rattle it off while the pt is counting on their fingers.

I will remember this for the next time I get drilled in the back of the head with a hockey puck at work. I couldn't get past 93 and the "real" post-injury concussion tests went just as poorly.

Contact Medical, get them to speak with her on a recorded line, if possible, if she still is refusing transport, she gets signed out AMA, witnessed if possible. Of course, there's a whole lot more... since she's allowed you to get vitals, is she coherent/alert & oriented? Repetitive questioning? Can she count backwards from 100 by 7's? Does she have a plan for self-care? Failure of some of these things make me think "concussion" and some make me think that she's flat-out altered mental status, in which she would be unable to refuse...

Know what criteria patients in your system must meet in order to be able to AMA.

So let's say that you do suspect that the patient has a concussion. It's likely though that she will still think that she is perfectly rational and just has a headache or something. How are you going to get this patient, who really, really does not want to go to the hospital, to go? Yes she's altered, but in such a way that she can argue back.

 

[DesertMedic66]

I will remember this for the next time I get drilled in the back of the head with a hockey puck at work. I couldn't get past 93 and the "real" post-injury concussion tests went just as poorly.



So let's say that you do suspect that the patient has a concussion. It's likely though that she will still think that she is perfectly rational and just has a headache or something. How are you going to get this patient, who really, really does not want to go to the hospital, to go? Yes she's altered, but in such a way that she can argue back.

How is she altered? If she answers all my questions with no issue and I find her to be AOx4 then there is not much you can do. Have her talk to med control, try to talk her into going. If still no then have her sign AMA. Make sure you document the heck out of the call and make sure you advice the patient to go to the hospital by some other means since she doesn't want to go by ambulance.

If your patient is AOx4, not on a psych hold, not under police protective care, and is charge of their own care then it is kidnapping if you transport them against their will.

 

[Aidey]

Also, what 19 year old has a plan for the next day let alone self care? lol