# Off duty at a restaurant, you witness a bari+geriatric fall



## J B (Jun 4, 2013)

You're sitting at a restaurant, eating dinner.  You hear something hit the floor.  Look up to see a ~250 pound, ~80y/o F on the floor.  She has a younger (~40y/o) woman with her, possibly a daughter.

The pt slurs her words slightly, has not had anything to eat in 12 hours.  Possibly some dementia.  Pt has what appear to be large bruises all over her face, but denies having any other falls today.

What do you do?


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## Ecgg (Jun 4, 2013)

Order chips and salsa and enjoy the show  

Later you QA/QI between each other all the mistakes the crew did?


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## MedicBender (Jun 4, 2013)

Use 2 steaks and some napkins to secure c-spine, backboard her with a table, then wait for the praise from the arriving paramedics.


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## DesertMedic66 (Jun 4, 2013)

I can't decide which one of those answers I like better haha


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## rmabrey (Jun 4, 2013)

Ecgg said:


> Order chips and salsa and enjoy the show
> 
> Later you QA/QI between each other all the mistakes the crew did?











MedicBender said:


> Use 2 steaks and some napkins to secure c-spine, backboard her with a table, then wait for the praise from the arriving paramedics.



What are you thinking? You cant mix Mexican and Continental.


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## J B (Jun 5, 2013)

:rofl:

I guess my main concerns are:

1) Per my protocols, I think she should technically be getting collared and backboarded... She probably doesn't need it, but it is what it is I guess.  If I help her to her feet and it turns out she injured her spine in the fall, am I now liable because I didn't provide standard of care?

2) She has bruises all over her face, meaning she probably falls like this pretty regularly.  Is she a danger to herself?

3) Can/should you ask the daughter if pt has a history of dementia?  If pt has altered mental status after the fall, it could be cause for calling 911 I think?


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## Medic Tim (Jun 5, 2013)

J B said:


> :rofl:
> 
> I guess my main concerns are:
> 
> ...



off duty means you are a bystander not an emt so there aren't any protocols to follow. offer to call 911 if needed then go back to your meal. let the responding crew handle it. ...... besides there isn't really anything you can do anyway.


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## STXmedic (Jun 5, 2013)

Medic Tim said:


> off duty means you are a bystander not an emt so there aren't any protocols to follow. offer to call 911 if needed then go back to your meal. let the responding crew handle it. ...... besides there isn't really anything you can do anyway.



What he said.


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## Handsome Robb (Jun 5, 2013)

I'd step over her and order a beer. Then possibly ask if her daughter would like me to help get her off the floor or call 911.

No, probably would stop at the ordering a beer. Well, I'd drink the beer too...


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## Arovetli (Jun 5, 2013)

Am I on a date with an incredibly beautiful woman? if so that totally changes my strategy.

Or, is the daughter hot? Im not really into the cougar thing, but hey, YOLO


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## rmabrey (Jun 5, 2013)

Arovetli said:


> Am I on a date with an incredibly beautiful woman? if so that totally changes my strategy.
> 
> Or, is the daughter hot? Im not really into the cougar thing, but hey, YOLO



-1 internets for using YOLO, even in a joke


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## Handsome Robb (Jun 5, 2013)

Arovetli said:


> Am I on a date with an incredibly beautiful woman? if so that totally changes my strategy.
> 
> Or, is the daughter hot? Im not really into the cougar thing, but hey, YOLO



I like your style.


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## TheLocalMedic (Jun 5, 2013)

rmabrey said:


> -1 internets for using YOLO, even in a joke



^This

But in all seriousness, if this happened to me I'd have someone call for a code 2 ambulance, give her a once over and go from there.  

Check a quick Cincinnati stroke scale, ask about diabetes hx, determine if there is underlying head trauma or figure out why the heck her face is all bruised up.  Could be a prior head injury manifesting, or maybe she is just a little too vigorous in applying her makeup?

Or maybe she's a little blitzed?  Seems like half of the older folks I see are drunk as skunks.  

And why would you want to c-spine this woman?  Unless she took table to the neck on the way down and has a neuro complaint I couldn't ever justify putting her in c-spine.  But I'm also one of those rebels who almost never puts someone on a board if I can help it.


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## J B (Jun 5, 2013)

Medic Tim said:


> off duty means you are a bystander not an emt so there aren't any protocols to follow.



I don't think it's quite that black and white in the USA... 

Here is the good Samaritan law in my state:



> Section 13. No person who, in good faith, provides or obtains, or attempts to provide or obtain, assistance for a victim of a crime as defined in section one, shall be liable in a civil suit for damages as a result of any acts or omissions in providing or obtaining, or attempting to provide or obtain, such assistance *unless such acts or omissions constitute willful, wanton or reckless conduct.*



As an off-duty EMT, you can be held to a higher standard because "you should know better".  It would be up to the judge/jury to decide whether or not failing to follow protocols was "willful, wanton or reckless conduct."  I've heard stories about people getting screwed but I can't confirm them or find any case law on this.

Realistically, the odds she needs board/collar are tiny.  If something happened, she would need to know I was an EMT and then know she could even sue me in the first place.  After that it would be up to the lawyers/judge/jury.  So really not worrying about, but good to be aware of what "could" happen I think.


Edit -

Actually, apparently good Sam laws don't apply at all to healthcare workers in MA:



> Section 12V. Any person, *whose usual and regular duties do not include the provision of emergency medical care*, and who, in good faith, attempts to render emergency care including, but not limited to, cardiopulmonary resuscitation or defibrillation, and does so without compensation, shall not be liable for acts or omissions, other than gross negligence or willful or wanton misconduct, resulting from the attempt to render such emergency care.



https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter112/Section12v


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## STXmedic (Jun 5, 2013)

You would need a duty to act to be held liable. You do not have one off duty. Do not lay a finger on the patient and you will not be open to lawsuit. How would they even know you're an emt unless you run in as Ricky Rescue to save the day.

If she doesn't need CPR or abdominal thrusts, she'll be fine until the ambo gets there; and there's nothing you could really do anyway.


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## Arovetli (Jun 5, 2013)

Good Samaritan typically applies only to lay persons.

P.s., YOLO


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## Aidey (Jun 5, 2013)

rmabrey said:


> -1 internets for using YOLO, even in a joke



I'm tempted to give a +1 infraction for it...


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## STXmedic (Jun 5, 2013)

Aidey said:


> I'm tempted to give a +1 infraction for it...



:rofl:


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## usalsfyre (Jun 5, 2013)

Personally I think she's losing her airway (slurred speech) so I'm going to prepare for the steak knife and drinking straw crich I've always wanted to do....

Seriously, help her up, don't tell them who I am, let responding EMS take care of it and return to dinner. No muss, no fuss, no misplaced liability concerns.


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## Melclin (Jun 5, 2013)

J B said:


> :rofl:
> 
> I guess my main concerns are:
> 
> ...



My main concern is how she came to be that old while being that fat and still healthy enough to be dining out. I wanna know. 

1) You're not at work and not subject to your protocols. 

2) Maybe....so what? 

3) That would mean getting involved. Getting involved means you could make a mistake...without the protection of you employers protocols/insurance. Seriously, if your concern is liability then surely you're more likely to get sued for running over, making yourself known, assessing/treating/making recommendations (like whether or not to call EMS), than for sitting quietly in the corner without mentioning to anyone that you're a EMT. 

I'm of the opinion that if I am close enough to it that I can't politely ignore them and should, by the laws of not being an arsehole, help in some way, then I forget I am in healthcare and just go over like anyone else and say nice things, pretend to give a toss and help her up. Hopefully future Mrs Melclin sees this, mistakes me for a nice bloke and decides she might buy me a drink.


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## Wes (Jun 5, 2013)

All kidding aside, with the bruising, I'm wondering if she's on anticoagulant therapy.  Couple that with the slurred speech, and you've got a great chance for a CVA or some sort of head bleed.   Keep her still, get as much history as you can, and wait for the on duty crew to show up.  Unless, of course, you decided not to be Ricky Rescue and finished your meal instead.


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## Akulahawk (Jun 5, 2013)

J B said:


> You're sitting at a restaurant, eating dinner.  You hear something hit the floor.  Look up to see a ~250 pound, ~80y/o F on the floor.  She has a younger (~40y/o) woman with her, possibly a daughter.
> 
> The pt slurs her words slightly, has not had anything to eat in 12 hours.  Possibly some dementia.  Pt has what appear to be large bruises all over her face, but denies having any other falls today.
> 
> What do you do?


Observe if she's still breathing, call for on-duty medical aid. I'm not going to "out" myself as a paramedic unless I have to. For all anyone knows, I'm a guy with a first aid card who cares enough to pull out his phone and call 911. I'm not too concerned about a spinal injury... however, I'm concerned about the possibility of a CVA causing, or a CHI as a result of the fall. Neither of those require spinal precautions.

After help arrives, I'm fading back into the woodwork and enjoying my own dinner.


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## fortsmithman (Jun 6, 2013)

If I was out of town I would just see if EMS was called and just sit back and eat my meal.  If this happened in my town then there would e an expectation of me doing something (I'm in a small town where just about everyone knows I am EMS).


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## firecoins (Jun 6, 2013)

If 911 was called, my concern would be EMS units knowing me.  I might involve myself but not out myself as a medic. Try and quietly gather info and pass it on to the EMS crew. I should be minimally involved.


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## epipusher (Jun 6, 2013)

Absolutely nothing.


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## wanderingmedic (Jun 6, 2013)

I don't do anything off duty unless someone is in imminent danger/is dying right in front of me (eg an arrest, or bad car accident way out in the boonies). When I do help off duty I haven't really worried about getting sued for two reasons: 1) I'm an EMT, I don't have much to sue for and 2) If I do my job and provide good patient care there is not really a reason to be overly concerned.


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## Glucatron (Dec 15, 2013)

rmabrey said:


> What are you thinking? You cant mix Mexican and Continental.



Oh, I love you! You just pulled a Waiting!


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## Ewok Jerky (Dec 15, 2013)

I'm going out to  my truck to get my AED I bought on EBay.


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## Rialaigh (Dec 15, 2013)

beano said:


> I'm going out to  my truck to get my AED I bought on EBay.



:wub:


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## Bryek (Dec 22, 2013)

Not to Necro an old thread but I agree with everyone here. She's not about to die so don't worry about it. 

If you were the responding ambulance, sure. But there are three differential diagnoses for this:

1) Hypoglycemia.
2) Stroke.
3) Alcoholism.

1) Do a BGL.
2) Cincinnati stroke questions and grab 12-lead.  
3) Seriously, alcoholics fall over all the time, have slurred speech and don't eat properly. Old people can be drunks too!


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## lilith88 (Jan 8, 2014)

MedicBender said:


> Use 2 steaks and some napkins to secure c-spine, backboard her with a table, then wait for the praise from the arriving paramedics.



sounds good to me


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## dixie_flatline (Jan 9, 2014)

My only question is - are we really considering 250 lbs to be a bariatric patient these days?  That's smack in the middle of the bell curve, at least here in good old 'MURICA.


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## unleashedfury (Jan 14, 2014)

Arovetli said:


> Am I on a date with an incredibly beautiful woman? if so that totally changes my strategy.
> 
> Or, is the daughter hot? Im not really into the cougar thing, but hey, YOLO



QFT, If I am looking to "impress" my date this could be my chance its Ricky Rescue Time!!!  h34r: 
-1 on the cool points for me being all but married. 



dixie_flatline said:


> My only question is - are we really considering 250 lbs to be a bariatric patient these days?  That's smack in the middle of the bell curve, at least here in good old 'MURICA.



I think if 250 is bariatric then most of my patients are fat bodies... 

for the most part, I would offer limited assistance if need be. if the daughter appears to have things under control, or 911 has already been summoned I need to do nothing. If there is a need for minimal assistance I am sure I can offer a lending hand or a cell phone for 911. I don't need to run to my car grab a Ricky Rescue bag get vitals instruct daughter to hold C-spine get history meds, vitals etc. etc. I am off duty my personal life and professional life are 2 different things some people seem to forget that.


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## rugrat (Feb 13, 2014)

I would fall over too and see if other people play along... :rofl: 


or loudly announce "stay away from the caeser salad here... it's a real killer... exhibit A and I rest my case"... then go back to enjoying my dinner


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## mycrofft (Feb 13, 2014)

Arovetli said:


> Good Samaritan typically applies only to lay persons.
> 
> P.s., YOLO



Good Samaritan can apply any time a duty to act does not exist. I.E., after duty hours.


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## mycrofft (Feb 13, 2014)

dixie_flatline said:


> My only question is - are we really considering 250 lbs to be a bariatric patient these days?  That's smack in the middle of the bell curve, at least here in good old 'MURICA.



Bariatric is basically the same as morbidly obese. When the weight is causing illness, isolation, death, then it is bariatric. 

If I'm six foot four and 250 and my shortness of breath, inability to wash and dry myself, fallen arches, knee and hip pain/degeneration, inability to shop for groceries  or attend church, and hypertension are attributable to my weight, then I'm a bariatric patient.

If I'm four foot six and weigh two hundred and it is not affecting me clinically or socially, then I am not.


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## dixie_flatline (Feb 14, 2014)

mycrofft said:


> Bariatric is basically the same as morbidly obese. When the weight is causing illness, isolation, death, then it is bariatric.
> 
> If I'm six foot four and 250 and my shortness of breath, inability to wash and dry myself, fallen arches, knee and hip pain/degeneration, inability to shop for groceries  or attend church, and hypertension are attributable to my weight, then I'm a bariatric patient.
> 
> If I'm four foot six and weigh two hundred and it is not affecting me clinically or socially, then I am not.



I guess my definition of the term is colored by our use of it in the FD here; we call out the "bariatric unit" when our normal unit is incapable of safely accommodating a patient - our normal Ferno stretchers can only hold 400lbs, so anything above 400 I consider bari.


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## DesertMedic66 (Feb 14, 2014)

dixie_flatline said:


> I guess my definition of the term is colored by our use of it in the FD here; we call out the "bariatric unit" when our normal unit is incapable of safely accommodating a patient - our normal Ferno stretchers can only hold 400lbs, so anything above 400 I consider bari.



400lbs? Our gurneys hold 700lbs. Around 500+ lbs the patient becomes too wide to fit in our type II units.


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## Handsome Robb (Feb 14, 2014)

Our normal gurneys can hold 700 lbs however for patient comfort anything over 350-400 generally gets our bariatric unit and bariatric gurney, which is twice as wide and can hold 1500 lbs. but it's the only manual gurney we own...


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## mycrofft (Feb 14, 2014)

I just shake my head thinking about how well something loaded with over 300 pounds maneuvers through doorways and hallways in homes, not to mention steps and rotting porches.
And then I read that a mfg says their litter will take on 700 lbs.:unsure:


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## Handsome Robb (Feb 14, 2014)

Our Bari stretcher has 6 points of contact when it's raised and also has handles that you can attach to it so it's like a flat cart with handles on both ends at costco and you can just push them around without having to change the height of the gurney. 

Unfortunately these manufacturers have to make these things burly because America is full of massively oversized people...I understand genetics but I also understand poor life choices.

Obesity must only affect those that live in the central areas of North America...ie the USA lol.


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## Kevinf (Feb 14, 2014)

It still boggles my mind how people that were trim early in life can allow themselves to get morbidly obese. I'm 6' 175lbs, but if I wake up one day and notice I'm 200lbs, you better believe I'd be doing something about it. But there are people that go from under 200lbs to 400+ and I just can't wrap my mind around it. One of our paramedics is an example. Trim in his 30's, huge now (with medical problems related).


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## dixie_flatline (Feb 14, 2014)

Robb said:


> Obesity must only affect those that live in the central areas of North America...ie the USA lol.



Believe it or not, I think Mexico has passed the US in obesity rates.


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