# ED or jail A&Ox3 but slurred speech



## Guy Zandler (Nov 23, 2018)

I was on my first call on my own at the local volunteer squad. We got a call for a woman who broke into a train from the train station and was drunk.

We made our way and I asked the police what happened. When I met the individual I asked her how she was feeling and with alcohol on her breath she said, "fine," and she didn't understand what she did wrong. I told her what the police said and then told her I needed to ask her a few questions. I asked her for her name, what city she was in, and what day it was. She was able to give me all that information and told me she lived in NY but was here for work. I asked her if she wanted to refuse medical attention and before she signed my partner said, "Hang on! You're drunk. You're coming with me to the hospital." She refused. My partner said, "You're coming to the hospital or you're getting locked up." So she went. My partner said I was irresponsible and that she was drunk so she's altered.

My question is this: She was A&Ox3 and she knew where she lived. She did have alcohol on her breath but if she was able to answer my questions correctly then she's not altered. She may have committed a crime but she could have signed an RMA. Am I correct?

Thank you in advance for your responses. I'm just trying to learn from these situations.


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## DrParasite (Nov 23, 2018)

several things:

1) being drunk does not mean you need an ambulance.  in fact, I was drunk last night: I didn't need a hospital, nor an ambulance ride for observation
2) simply consuming alcohol does not mean they are altered.  did she understand what was going on?  what were you called for?  was she going to jail?
3) was she under arrest?  if she was, than it's not her choice: the cops are legally responsible for her.  

ask your administration what their policy is on drunk people.  based on your description, she was drunk with no complaints.  does your squad have a written policy that all people who consume alcohol need to go to the hospital, even if it's against their will?  sounds like a question for an officer or a supervisor.


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## PotatoMedic (Nov 23, 2018)

Drunk does not mean you cannot refuse care.  There is some case law about that, that I'm not going to look up at this moment.  Sounds like you nearly kidnapped someone!  Least she consented after being coerced.


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## VFlutter (Nov 24, 2018)

Sooo what is the ER supposed to do with her?


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## StCEMT (Nov 24, 2018)

Yeah, you're partner is wrong....


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## Akulahawk (Nov 24, 2018)

VFlutter said:


> Sooo what is the ER supposed to do with her?


Though we don't like getting 'em, once they're in the ED, they get two options: metabolize to freedom or leave with a responsible (and not drunk/high) adult. Fortunately enough for my ED, we don't normally get the slightly drunk folks... the ones we get are usually so drunk that they can't hardly verbalize much more than a couple very slurred words and/or grunts. Able to stand? Yeah... about 4 or 8 drinks ago.

We just don't normally get the alert/oriented/able-to-formulate-self-care plan drunks. The problem is that nobody wants to take the liability (real or perceived) of watching these folks until they're sober and if the local "drunk tank" has had a bit of bad press because someone was actually not drunk and died because of a medical problem (like a stroke...) then the PD/Sheriff isn't going to risk more bad press for the very drunk.


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## Tigger (Nov 24, 2018)

https://depts.washington.edu/psyclerk/secure/mentalstatusexam.pdf

Being alert and oriented does not necessarily mean you are capable of making an informed decision...


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## ZombieEMT (Dec 7, 2018)

I think there is no definitive answer to this without truly seeing the patient for myself. I will say this. Evaluating a persons mental state, is more then person, place and time. Simply consuming alcohol doesn’t mean you are incompetent. It also does mean you have anything wrong. Generally based on your scenario, I say, yes they can refuse. 

However, I ask, what is their true mental state? Is she acting appropriately? Is she able to safely be respiratory for herself? If she is refusing can she physically sign and walk away?


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## Never2Old (Dec 10, 2018)

Tigger said:


> https://depts.washington.edu/psyclerk/secure/mentalstatusexam.pdf
> 
> Being alert and oriented does not necessarily mean you are capable of making an informed decision...



And that is how I found myself in an EMS career


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