# Patient In Distress



## traumateam1 (Jul 22, 2008)

Ok so I got this call sometime last summer so not all the details are clear. The reason for this scenario is I am just wondering what other medics would do. Ok so here we go.

It's about 1100 hrs and you are dispatched to a busy event going on in your down town with about 30,000 people attending. The call comes in as a young female in serious distress. You drive down to the location and find a young woman about 16 years of age in some emotional distress with two volly medics trying to attend to her.
What you are able to gather from the medics is that she is deathly afraid of ambulance from some past experiences. A friend needed a band aid (or something like that) for a blister on her foot so as they walked over to the on site ambulance she just freaked right out.
You find the patient sitting down crying heavily with some small "puddles" of vomit around the area, you're told they are from her.
You try to reach anyone that can take her home but everyone you try is unavailable.
So MY question is what would you do for this patient?
Just a little side note: she absoluetly refuses to go towards your ambulance.


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## MagicTyler (Jul 22, 2008)

Oh... That gets sketchy... She can't legaly refuse transport, parents can't be contacted... :unsure:


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## Ridryder911 (Jul 22, 2008)

Leave her alone.... obviously, she has some phobia issues. She stated she does not want help. so be it. Even touching her constitutes battery. As well she is a minor. 

R/r911


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## traumateam1 (Jul 22, 2008)

> She stated she does not want help.


She never said she didn't want help. I just said that she did not want to go to the ambulance. She does accept and allow you helping her. Just no going to the ambulance. So there is no battery. You have consent to help her.
But thank you for your input.


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## Ridryder911 (Jul 22, 2008)

She does not want to be in my ambulance then so be it. That is where I take care of them. I am not going to administer any med.'s or therapy without transporting. She is awake and alert? Apparently she is breathing, no bleeding and so far .. the only symptom is a phobia of ambulances with vomiting, which is not considered life threatening. Unless she has an outstanding medical history.. I am not going to do much, because she is a minor. Neither is an ER Doc until the parents arrive.

R/r 911


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## mikeylikesit (Jul 22, 2008)

Situational Phobias can exhibit the following symptoms.

Shortness of breath or smothering sensation 
Palpitations, pounding heart, or accelerated heart rate 
Chest pain or discomfort 
Trembling or shaking 
Feeling of choking 
Sweating 
Nausea or stomach distress 

Feeling unsteady, dizzy, lightheaded, or faint 
Feelings of unreality or of being detached from yourself 
Fear of losing control or going crazy 
Fear of dying 
Numbness or tingling sensations 
Hot or cold flashes 
Fear of fainting
So i would leave her away form the Ambo and only treat what i could until i had her sign a refusal of transport.


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## BossyCow (Jul 23, 2008)

First, either move her away from the ambulance or move the ambulance to where she can't see it. That will establish some trust with the pt that you are not going to try to trick her into getting into the ambulance. Then, deal with the anxiety which should decrease as soon as the source of the phobia is removed.

Since she is a minor, I think a call to the parents is in order. If possible, get her to call her folks on her own phone if she has one so the parents are spared the OMG its a call from the medics about my daughter anxiety. She probably shouldn't be left alone but you just can't hogtie pts and drag them unwillingly into your rig for state imposed treatment.


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## mycrofft (Jul 23, 2008)

*Cut to the chase...she has a blister.*

If she refuses treatment by ambulance for her blister (and what are you doing using an ambulance for a blister?), so be it. Slip her friend a bandaid and she can treat it later at home. Be gone.

If the sixten year old is a threat to self or others (not revealed in this scenario), you really need law enforcement (at least you do around here, if there is no imminent threat such as approaching fire etc) to make the "5150" determination. Ambulance phobia is not such an emergency. You may find in your area that being a minor constitutes implied consent, but being legal is different from being prudent, save the "falling on your professional sword" act for one life-threatening situation.


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## traumateam1 (Jul 23, 2008)

Thanks to everyone for posting.
Just to get to mycrofft's comment about the blister and bandaid. It was her friend that came to the ambulance doing stand by medical coverage for the event that set it off. They didn't call us for that.

I was just curious as to see what other people would of done. Personally we just made sure ambo was out of site, kept the O2 that was on her, on. And got a hold of her brother that was 20 and had him come pick her up and he signed a refusal of treatment/transport form.

Again.. I know I'm not good at these sims but I was just curious as to what people would do.
Thanks everyone!


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## Ridryder911 (Jul 23, 2008)

Although, phobias are real they also can be a sign of mental illness. This case I would tend to suggest something is wrong and she needs more professional help than prehospital. If she "freaks" out seeing an ambulance just by walking by it or near medics, she is need for in-depth counseling and therapy. What would happen if a EMS unit was to be at a stop light or request to yield right of way? I would tend to also wonder the usage of substance abuse that would produce such "odd" behavior. 

Also wondering why the oxygen therapy was administered? When does the medication oxygen is prescribed for nausea and hysteria? Again, something most EMT's assume is a "cure all".. was she demonstrating poor oxygenation or respiratory distress or was it something that you could do? 

Personally, I would have chalked it up to possible borderline psychosis or again possible underlying substance abuse. No apparent life threatening presentation, she is on her way.. 

R/r 911


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## traumateam1 (Jul 23, 2008)

Ridryder911 it's funny you mention that because I talked to her again a few days later. I ran into her at Canadian Tire where she works. 
She told me she didn't remember anything during her "little" episode, she had also mentioned to  me that when she saw an ambulance going code 3 down her street and she was walking home she almost started freaking out. I did tell her it would be a good idea to see someone about that.. but she didn't really want to go see anyone.
Anyways.. it was my first time seeing such a major episode of anxiety caused by a phobia. So I was just curious as to what other people would do. As mentioned before.
And about that O2 therapy.. the stand by medics had it on her on arrival.. so we just left it on. I was thinking many people think that O2 helps for pain and such that if we tell her it's gonna help her calm down, that she would of believed it.


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## traumateam1 (Jul 23, 2008)

> was she demonstrating poor oxygenation or respiratory distress or was it something that you could do?


Sorry, I missed that the first time I read it. She was demonstrating MINOR resp. distress. Nothing to major though.


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## mycrofft (Jul 23, 2008)

*No, good deal, done good. I didn't see O2 in the scenario, sorry.*

I'm "confident" (as they say) that EMS folk made sure the girl was not tripping out etc...aka "5150".
Oxygen, oxygen...I know, help her hyperventilate, pass out, then have implied consent (just kidding). If she WAS hyperventilating, mask O2 at say 3 liters or less would help, seen it happen unintentionally.

We would occasionally get one of these "odd ones", especially at events or during holidays and sometimes the situation would resolve itself (either cease, get worse, or the story would unfold) if we could just spend a few minutes talking to the patient in a calm and friendly manner.


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## firetender (Jul 23, 2008)

Distress may include hyperventilation which says O2 ain't exactly the route to go. If she's a freak around ambulances, don't bring her to the ambulance. DO a thorough eval, determine the severity and, if you have the time, help her find an alternative. If you don't, find someone who will. Obviously, she didn't need an ambulance.


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## aussieemt1980 (Jul 25, 2008)

MagicTyler said:


> Oh... That gets sketchy... She can't legaly refuse transport, parents can't be contacted... :unsure:



Patients *CAN* legally revoke their consent to treatment / transport. If the patient refuses transport, and you load them up (except under some circumstances under psych guidelines - aka involuntary admission - only authorised by a doctor) you can be found as having unlawfully restrained the patient. This can be taken as assault and battery under common law here in Australia. Especially in this case, as the patient having the ambulance phobia.

Good thing to do would be to treat as required and determine if transport is actually necessary. In this case, it wasnt, and the first priority is to reassure the patient. Obviously, the pt has had a bad experience with an ambulance (could be anything relating from an exceptionally bad attendent to the ambulance not making it to hospital due to MVA issues) so perhaps finding out why may go towards reassuring the patient that they are in the best of hands. The vollies did the right thing in calling for assistance given that the pt was sufferering an anxiety attack and the treatment provided seems ok, but the pt has issues that needs to be dealt with. It is quite rare that I will contact a pt's parents in relation to an incident that has occurred, as you have to consider the issues of pt confidentiality and release of the info. Leave it to the pt or the pts friends to notify the family, you are absolved of all responsibility for releasing potentially confidential information.

I have had this happen with a psych pt who hated flashing lights and the police, and he got in the truck once he was assured that I am taking him to hospital, not the police station. BUT you have to consider the legal ramifications of what you are doing. Pts will refuse transport and treatment if they feel that is not in their best interests, even if you know that they have life threatening injuries. Especially if they have had a few to drink, seem to think that there is some form of police involvement at the hospital,


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## BossyCow (Jul 25, 2008)

aussieemt1980 said:


> Patients *CAN* legally revoke their consent to treatment / transport. If the patient refuses transport, and you load them up (except under some circumstances under psych guidelines - aka involuntary admission - only authorised by a doctor) you can be found as having unlawfully restrained the patient. This can be taken as assault and battery under common law here in Australia. Especially in this case, as the patient having the ambulance phobia.
> 
> ,



With a minor, under the age of 18, in the US, they cannot legally consent to treatment or revoke that consent. We need parental permission or the patient needs to fall under the criteria for implied consent.


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## aussieemt1980 (Jul 26, 2008)

BossyCow said:


> With a minor, under the age of 18, in the US, they cannot legally consent to treatment or revoke that consent. We need parental permission or the patient needs to fall under the criteria for implied consent.



In Australia the age for medical consent is 14, if the pt is over 14 years, we do not need the consent of the parents, only the patient.


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