# Crash



## LifeSaver98 (Sep 5, 2016)

18 y/o female who crashed her bike. She doesn't remember the event. She complains of neck pain and headaches. 3/10. Her helmet appears to be undamaged. She doesn't know exact date but knows the month. Does not know the time of day either. Her heart rate is elevated along with respiratory rate. He bp is low. She has a few minor scrapes and is a little sore. She claims she is ok and wants to refuse treatment. How would you proceed?


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## SpecialK (Sep 5, 2016)

For her to be considered competent she must consistently:

a) tell me she wants to refuse, and
b) tell me reasons why, and
c) repeat the information I give her as to the risks involved, and
d) demonstrate an understanding of (c).

If she can do all of the above then she is competent.  This is regardless of any degree of brain injury we suspect.  There was a case about 8 to 10 years ago where a guy got belted in the head with a bit of wood and consistently refused treatment, left the hospital and died of a dirty big cerebral haemorrhage.  He however, did demonstrate he was competent to make such a decision and I agree.


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## Arovetli (Sep 5, 2016)

I rarely know the date and time.....

First I'd figure out why she crashed the bike in the first place...and as mentioned, attempt or complete a full H&P, offer tests like EKG, make sure she meets your protocol's requirements for refusal, document properly, refer to an urgent care or PCP and send her on her way


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## LifeSaver98 (Sep 6, 2016)

Got a scenario a friend sent me. Tell me what you think. 
18 y/o female who crashed her bike. She doesn't remember the event. She complains of neck pain and headaches.  3/10. Her helmet appears to be undamaged. She doesn't know exact date but knows the month. Does not know the time of day either. Her heart rate is elevated along with respiratory rate. He bp is low. She has a few minor scrapes and is a little sore. She also complains of SOB and ringing of the ears. She claims she is ok and wants to refuse treatment. How would you proceed?


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## NomadicMedic (Sep 6, 2016)

We've already answered this in another thread.


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## epipusher (Sep 6, 2016)

Test question?


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## LifeSaver98 (Sep 6, 2016)

epipusher said:


> Test question?


No. Just something a friend sent me.


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## LifeSaver98 (Sep 6, 2016)

DEmedic said:


> We've already answered this in another thread.


I know. I meant to delete it. I missed a lot of info that I forgot to add.


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## zzyzx (Sep 7, 2016)

If you are asking if she has the right to refuse, the answer is yes, because she is alert and oriented. Not knowing the exact date is ok. The fact that she does not remember the event is significant, but it does not mean that she isn't now alert and oriented. You also need to ask yourself if she is competent to refuse. If she is drunk as a skunk, for example, then she would not be competent to refused.

I think you are also ask if we would feel comfortable having her sign a refusal knowing that she would not be seeking any further medical care. That question is hard to answer with just the information you have provided.


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## Akulahawk (Sep 7, 2016)

Folks, I merged the threads so that all responses for this particular scenario are/will be visible in one single thread. Carry on!


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## OnceAnEMT (Sep 7, 2016)

Describe the "crash". Witnesses? The question of why she crashed is pretty key here. LOC/down time? Competence aside, barring something crazy to the answers of those questions I don't want to backboard this patient. A C-collar may be warranted depending on what palpation of the neck turns up. That said, if there is anything suspicious about the "why" answer I am leaning towards medical. Hx? Recent surgery or invasive procedure? 

If she's a competent adult than she can refuse and that's alright. But we can continue to ask questions, discuss, and educate until she walks away, asks us to walk away, or is convinced that she should go to the hospital.


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