# some people just AMAZE me....



## MikeRi24 (Apr 18, 2008)

just got back from running a call with my fire dept. I roll the truck as being the EMT in charge with 2 CFR's under me. Its for a 15 year old male, supposedly having a seizure in a parking lot of a school. we get there, the kid is clearly still seizing, PD is already on scene and have him laying down. I get him on an NRM O2, get a set of vitals (P 112, BP 176/92, R 24 and shallow), and listen to one of my guys get some information from his brother who happens to be there. I learn that he has seizures quite often and sometimes several times a day. I also learn from PD that his mom has been called and will be there any second. Great, just what I DON'T need. Ambulance shows up and the medics pretty much take over, we get him on the stretcher and load him in the back. PD wants to hold the ambulance til mom gets there. fine, not gonna argue and I have passed on care to the medics so it's really their call. mom gets there and i take over our clipboard and talk to her to get some more info. I have the following conversation:

Me: ......and what hospital will we be going to tonight?
Her: oh he aint going to no hospital. i be taking his *** right on home!
Me: ok...how often do these seizures usually occur?
Her: oh usually once a day at least sometimes more, he just lays there and gets up eventually he's fine
Me: is he being treated by a doctor for epilepsy or any other seizure disorder?
Her: no, there aint a damn thing wrong with him I'm taking him home!
Me: ok ma'am, thats entirely up to you, however you need to realize that your son is very sick. Seizures can be a very serious condition, especially when they occur as frequently as you say and and are untreated. 
Her: I am telling you he's fine he does this all the time
Me: well, I really think it would be in his best interest to go to the hospital and get this checked out. His blood pressure is abnormally high and he's breathing is a little rough. He really needs to go to the hospital
Her: oh He will be fine i gots a blood pressure machine at home if it gets any worse I'll think about calling his doctor
Me: ok ma'am, I'll just need you to sign this stating that you argee to refuse medical treatment on behalf of your son, but again I strongly recommend he go to the hospital and get checked out.

I looked at PD waiting for them to step in, but they didnt want anything to do with it. kids mom signed the release, kid got out of the ambulance damn near fell out if it, actually, and hobbled over to his mom's Escalade and they were on their way. I always hate it for the kid, especially when they know they need to get seen by a doctor, and the parent just isnt having it. I always feel bad for the kids because they're not getting the treatment they need to live a better, healthier life. people just amaze me sometimes.....

/rant


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## CFRBryan347768 (Apr 18, 2008)

In a case like this are their any circumstances where you would "over rule" the mother becuase clearly something is wrong with the kid and she doesnt want help for him?


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## MikeRi24 (Apr 18, 2008)

CFRBryan347768 said:


> In a case like this are their any circumstances where you would "over rule" the mother becuase clearly something is wrong with the kid and she doesnt want help for him?




not sure how this varies from state to state, but in NY the police can basically take the child into custody as a minor and then release them to EMS. I've only seen that happen once, and it was when I was working for a paid EMS service and a kid flipped his ATV over, was in-coherent and had a laceration to his head and the father was being very combative about letting his son get treated. Police on scene arrested the father because he took a swing at my partner, and basically took the child into their protective custody to release him to us to treat/transport. Unfortunately, I don not see this practice being done enough. not sure of its because police are just unaware that they have the power to do that, or what the case may be.


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## EMTMandy (Apr 18, 2008)

MikeRi24 said:


> just got back from running a call with my fire dept. I roll the truck as being the EMT in charge with 2 CFR's under me. Its for a 15 year old male, supposedly having a seizure in a parking lot of a school. we get there, the kid is clearly still seizing, PD is already on scene and have him laying down. I get him on an NRM O2, get a set of vitals (P 112, BP 176/92, R 24 and shallow), and listen to one of my guys get some information from his brother who happens to be there. I learn that he has seizures quite often and sometimes several times a day. I also learn from PD that his mom has been called and will be there any second. Great, just what I DON'T need. Ambulance shows up and the medics pretty much take over, we get him on the stretcher and load him in the back. PD wants to hold the ambulance til mom gets there. fine, not gonna argue and I have passed on care to the medics so it's really their call. mom gets there and i take over our clipboard and talk to her to get some more info. I have the following conversation:
> 
> Me: ......and what hospital will we be going to tonight?
> Her: oh he aint going to no hospital. i be taking his *** right on home!
> ...


 

Did you or the medics report this incident? If not I would ASAP. This is a major CPS issue. Failure to provide health care to a child is a form of neglect on the part of the parent(s)/legal guardian(s). We as EMS providers ARE mandated reporters..


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## MikeRi24 (Apr 18, 2008)

EMTMandy said:


> Did you report this incident? If not I would ASAP. This is a major CPS issue. Failure to provide health care to a child is a form of neglect on the part of the parent(s)/legal guardian(s). We as EMS providers ARE mandated reporters..



I believe one of my chiefs did. I will actually call him right now to see if he did....if not then I will. usually the chiefs take care of that in our department, but cant hurt to double check


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## EMTMandy (Apr 18, 2008)

MikeRi24 said:


> I believe one of my chiefs did. I will actually call him right now to see if he did....if not then I will. usually the chiefs take care of that in our department, but cant hurt to double check


 
Cool. Very sad story...


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## Jon (Apr 18, 2008)

Kidnapping a patient isn't a cool thing to do, and there are lots of legal and ethical issues with it.

If a patient / guardian is mentally competent and understands the risks of refusal (including serious injury and/or death) and still wishes to refuse... there isn't a lot we can do.

Given that the kid seems to have some sort of seizure disorder... a parent wishing to refuse treatment and take the kid home, if it seems like a "normal" seizure without other injury, isn't abnormal. What's going to happen? They are going to go to the ED, sit around for hours, do some blood tests, perhaps a CT scan, and tell them to talk to talk to their PCP to try to get him appropriatly medicated.

As for Mom not answering your questions... Mom might have just been being obnoxious and blowing you off, because she is just fed up with the seizures, and probably had to leave work to come pick him up... so to put yourself in her shoes, she's stressed and frazzled, and has some EMT who doesn't know her from adam TELLING her how she should care for her son.

A lot of seizure calls are because the person normally has seizures... but is in a new environment, and the bystanders don't know it is "normal" for the person.


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## Ridryder911 (Apr 18, 2008)

MikeRi24 said:


> not sure how this varies from state to state, but in NY the police can basically take the child into custody as a minor and then release them to EMS. I've only seen that happen once, and it was when I was working for a paid EMS service and a kid flipped his ATV over, was in-coherent and had a laceration to his head and the father was being very combative about letting his son get treated. Police on scene arrested the father because he took a swing at my partner, and basically took the child into their protective custody to release him to us to treat/transport. Unfortunately, I don not see this practice being done enough. not sure of its because police are just unaware that they have the power to do that, or what the case may be.



Better re-check your laws, parents have the right to refuse treatment for any of their children in all fifty states. Police cannot automatically "take over" because the parents are a dumb arse. They can place the child in protective custody if there is imminent harm, which is very thin line on seizures.. if the child is not currently seizing or if the parent is not performing physical harm. As well, no physician is going to treat the patient if the family or parent refuses to allow. Once the parent says no, and they inform them of the risks, that is all one can do. Yes, they can inform the local authorities responsible for child welfare. There is a hot debate among law suits for interfering and not interfering. 

R/r 911


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## CFRBryan347768 (Apr 19, 2008)

Just read an article and I got the impression that the Hospitals Lawyer should be seeked out and a court to over ride the parents decision. But obviously that could take a while so they said to contact a child protective service.


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## el Murpharino (Apr 19, 2008)

MikeRi24 said:


> not sure how this varies from state to state, but in NY the police can basically take the child into custody as a minor and then release them to EMS. I've only seen that happen once, and it was when I was working for a paid EMS service and a kid flipped his ATV over, was in-coherent and had a laceration to his head and the father was being very combative about letting his son get treated. Police on scene arrested the father because he took a swing at my partner, and basically took the child into their protective custody to release him to us to treat/transport. Unfortunately, I don not see this practice being done enough. not sure of its because police are just unaware that they have the power to do that, or what the case may be.



Mike, are you referring to the mental hygiene law (section 9.41) in which the cops can "direct the removal of any person to a hospital who is conducting himself in such a manner which is likely to result in serious harm to himself or others".  I have seen it done numerous times on psych patients.  I have never seen it used for children whose parents didn't want transport.  This would probably be a better question left to a lawyer who understands the law more than I.  It's a good question, though.  I wish I could give a better answer.

The NYS DOH statement regarding minors and the mental hygiene law:

http://www.health.state.ny.us/nysdoh/ems/policy/99-09.htm

http://www.treatmentadvocacycenter.org/LegalResources/StateLaws/NewYorkstatute.htm


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## MikeRi24 (Apr 19, 2008)

el Murpharino said:


> Mike, are you referring to the mental hygiene law (section 9.41) in which the cops can "direct the removal of any person to a hospital who is conducting himself in such a manner which is likely to result in serious harm to himself or others".  I have seen it done numerous times on psych patients.  I have never seen it used for children whose parents didn't want transport.  This would probably be a better question left to a lawyer who understands the law more than I.  It's a good question, though.  I wish I could give a better answer.
> 
> The NYS DOH statement regarding minors and the mental hygiene law:
> 
> ...



no im not referring to the 941. i've had that done numerous times (you get that quite often working in a city). the "law" i am referring to is something that specifically deals with minors. I'm actually half tempted to go and dust off my State Protocol book and look it up. 

RidRyder, I'm not trying to kidnap the pt. You are absolutely right about the parent having full authority to say "this is normal for him, hes fine I can just take him home." The mom said that he had seizures all the time, usually once sometimes more a day, whcih again, thats fine potentially perfectly normal for this person. What raised the red flag for me was when she said that he had not been diagnosed and was not being treated for any kind of siezure disorder, nor has he ever seen a medical professional about the siezures. Even if this had only been going on for a couple days and this was maybe his 3rd or 4th one, I would have been ok with letting the parent sign off and just suggesting to her that he see a doctor about this. But the fact that this is going on all the time and has been for a great length of time, and has not seeked any medical care for it, does not sit well with me. The child needs some medical attention, further than what I can provide.


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## VentMedic (Apr 19, 2008)

> fine i gots a blood pressure machine at home if it gets any worse I'll think about calling his doctor



Apparently the child has a doctor and the mother is knows something about monitoring BP.  I would not expect that from someone who speaks as you have written about here.   

There may be a lot more here about history that the mother does not wish to impart to you.  When she mentioned "his doctor", I would have gotten the name for the record.  Then, I would have politely asked if it would be okay to call his doctor now.  Even if she didn't have the number, a name could have been relayed to your dispatch to look up.   

We were always cautioned about caring for kids that we suspected child abuse.  All it took was either patent to suspect we knew something and they could refuse transport.  It would then take a lengthy process to get the oppourtunity to help the child through legal investigations.  If we could just get the child to the hospital, suspicions could be confirmed and a hold could be placed.   

Unless there is blatant abuse or immediate danger, police may be reluctant to step in.  They can however refer it to the appropriate agency to investigate.


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## Jon (Apr 19, 2008)

MikeRi24 said:


> no im not referring to the 941. i've had that done numerous times (you get that quite often working in a city). the "law" i am referring to is something that specifically deals with minors. I'm actually half tempted to go and dust off my State Protocol book and look it up.
> 
> RidRyder, I'm not trying to kidnap the pt. You are absolutely right about the parent having full authority to say "this is normal for him, hes fine I can just take him home." The mom said that he had seizures all the time, usually once sometimes more a day, whcih again, thats fine potentially perfectly normal for this person. What raised the red flag for me was when she said that he had not been diagnosed and was not being treated for any kind of siezure disorder, nor has he ever seen a medical professional about the siezures. Even if this had only been going on for a couple days and this was maybe his 3rd or 4th one, I would have been ok with letting the parent sign off and just suggesting to her that he see a doctor about this. But the fact that this is going on all the time and has been for a great length of time, and has not seeked any medical care for it, does not sit well with me. The child needs some medical attention, further than what I can provide.


Again... did she ACTUALLY say - "He does not see a physician" and "he does not take any medications"... or was she just MORE THAN A LITTLE stressed and really didn't feel like answering your questions, because this is a normal part of life with her son, and a Cell-Phone Samaritan got EMS involved when there is no real reason for you to be there?

I've got a feeling that you might have been talking AT the parent... but you weren't communicating, and therefore you were asking questions and she didn't feel that you needed an answer. Part of that is perhaps your approach... by starting off saying "what hospital are we going to", you don't give her an easy option to refuse care. You then try to get HPI and PMH AFTER she's heard that you want to do something that is unnecessary in her mind... I'd be pretty frustrated with the EMS/FD staff at that point if I were in her shoes.

A child abuse investigation is a PITA, and reporting abuse is a big deal, and not to be taken lightly.

In many places, the big questions that need to be answered before a refusal are:
Is the patient menatally and legally competent to refuse care?
Do they understand the risks inherent in refusal?

If they are mentally and legally competent (CAOx4, Legally able to make decisions) ande they understand the risks involved, than they can usually refuse, or refuse care for someone in their custody.


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## Flight-LP (Apr 19, 2008)

MikeRi24 said:


> I would have been ok with letting the parent sign off and just suggesting to her that he see a doctor about this. But the fact that this is going on all the time and has been for a great length of time, and has not seeked any medical care for it, does not sit well with me.



Not your decision.................If you have a concern, then notify the appropriate agency, otherwise, your taking a child out of the custody of a parent without legal grounds to do so. It would be in essence kidnapping. Not to mention whatever form of arse whooping that mom would impose on you. By your eloquent desccription of the conversation that took place, I would go out on a ledge by saying that the child and mom were black. Now how would it look professionally upon your organization and our industry if you just up and took a child away from mom because something "didn't sit well with you". As sad as it truly is, the race card is strong and you will more than likely be on the losing end. Observe and report, those are your limitations...................

Jon - "Cell phone samaritan", I like it!!!!!!


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## Jon (Apr 19, 2008)

Flight-LP said:


> ..Jon - "Cell phone samaritan", I like it!!!!!!


I heard it from a partner... who I'm sure heard it from someone else.

Too true, especially for our "MVA's with Unknown Injuries"_

I was driving and saw an accident. I didn't feel like stopping for injuries... I just called 911 because maybe someone might be hurt... but I've got no idea!"_


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## MikeRi24 (Apr 19, 2008)

Jon said:


> Again... did she ACTUALLY say - "He does not see a physician" and "he does not take any medications"... or was she just MORE THAN A LITTLE stressed and really didn't feel like answering your questions, because this is a normal part of life with her son, and a Cell-Phone Samaritan got EMS involved when there is no real reason for you to be there?
> 
> I've got a feeling that you might have been talking AT the parent... but you weren't communicating, and therefore you were asking questions and she didn't feel that you needed an answer. Part of that is perhaps your approach... by starting off saying "what hospital are we going to", you don't give her an easy option to refuse care. You then try to get HPI and PMH AFTER she's heard that you want to do something that is unnecessary in her mind... I'd be pretty frustrated with the EMS/FD staff at that point if I were in her shoes.
> 
> ...



as I was asking question, I pretty much just go through the PCR (helps me make sure I get everything). I did get the name of his primary, the staff on the ambulance went so far as to call med control at the children's hospital (we are required to do so with anyone under 18 who's parent signs off), and went to hand the phone to the mother saying "the doctor on the line would like to speak to you" and she closed the cell phone as soon as it was handed to her. anyway, as I was asking my questions, I say "does your son take any medications for anything at all?" to which she said no. I asked "does he have any history of seizures?" to which she said yes, and I then asked if he took any medications for them, she said no, and then I asked if he was under a Doctor's care for them and she also said no. I then has the conversation that I put in my original post (I've learned that being repetitive when asking questions can sometimes get the answers that you need a little bit better). 

the pt himself was not COAx4,  he was barely conscious. unfortunately, he can;t legally accept or refuse care his parent has to for him. I also know its not my decision and its not up to me if they go or not. I can make a recommendation that they go and give some supporting reasons if they'd like to hear them, but I guess what I was trying to get at when I used the "I would have been ok with..." statement is that i wouldnt have raised an eyebrow towards the situation and it wouldnt have gotten my feathers ruffled (thus i prob wouldnt be having this conversation with all of you).


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## BossyCow (Apr 19, 2008)

I am not sure you are reacting to the pt condition as much as you are with the mothers perceived attitude. 

After a seizure, the child is going to present as you describe. The mother may have seen this many times and perhaps because of that comes across as a bit non-caring or cavalier in her reaction to her son's condition.

The parent of a child with an active seizure disorder can become accustomed to the incidents and impatient with EMS personnel seeing the child for the first time. Add to this, a parent who may be a bit short on the social graces and a bit long on attitude, and you have a recipe for mis-communication.

According to our protocols, a patient, with a history of seizure disorders(mom stated yes to history) does not need to be transported by EMS. They are not to be left alone, but they do not need to be transported. 

A parent has the right to determine what if any meds their child is going to take. Your opinions about the mother's fitness to make that decision are irrelevant. I have a friend with a son diagnosed with Cystic Fibrosis, the child also has a seizure disorder. There have been several times when the seizure meds are discontinued for an interval. Sometimes to reassess the condition or dosages. 

I've found that when I find myself reacting emotionally to a call, as you obviously are, I have to sit back and review the facts of the call, removing all emotional, and colorful additions. Looking at the facts as you stated them, Pt has a known seizure disorder, parent arrived and refused consent. Pt was postictal and by the end of the call, was able to respond, follow instructions and move to Mom's car. Sounds to me like he was coming out of it. 

So, is your issue the fact that the kid wasn't taking meds for the seizure disorder? Did you feel the child was in danger? What danger, what negative outcome did you forsee from this incident? 

You said right off that when you heard mom was coming onscene that you were already annoyed ("Just what I don't need" I think is how you put it) so I'm not surprised that after her arrival, you continued to allow your annoyance rule the scenario.


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## VentMedic (Apr 19, 2008)

MikeRi24 said:


> I looked at PD waiting for them to step in, but they didnt want anything to do with it. kids mom signed the release, kid got out of the ambulance damn near fell out if it, actually, and* hobbled over *to his mom's Escalade and they were on their way. I always hate it for the kid, especially when they know they need to get seen by a doctor, and the parent just isnt having it. I always feel bad for the kids because they're not getting the treatment they need to live a better, healthier life. people just amaze me sometimes.....
> 
> /rant



Did the child appear to have a hx of CP, TBI, SCI or anoxic brain injury?  

Quote by BossyCow


> The parent of a child with an active seizure disorder can become accustomed to the incidents and impatient with EMS personnel seeing the child for the first time. Add to this, a parent who may be a bit short on the social graces and a bit long on attitude, and you have a recipe for mis-communication.



Excellent point.

Many times parents do get annoyed when they have a handicapped child or one that has a chronic medical condition that people, including HCWs, don't understand.  And, yes they can get very defensive.  There are also conditions that are very difficult to control medically even with all the advances the U.S. has in pharmacology.  Many may require orphan drugs that are difficult to get even with all the promised Federal/State help.

I remember an incident a few years ago when I was moonlighting at a Pediatric facility which housed about 50 children, most with trachs and about 15 on ventilators.  The children had varied histories with many being spastic quads from CP, SCI, TBI and anoxic incidents such as "drowning".  

We called an ambulance to transport one of the children and a nurse to the hospital.  The ambulance crew consisted of two EMT-Ps.  When they arrived they proceeded to check out all the other children  which were in ward style rooms with 12 - 15 per room.  Each room had an RN or LVN, RRT and CNA attending the children.   The two Paramedics mistook our laxed attitude about the childrens' spasms and seizures for neglect and abuse.  We found out they wrote a complaint to their supervisor and the State about the facility.  Fortunately, the children were in the custody of the State which required frequent inspections.  The two Paramedics were then scrutinized and had to spend 40 hours with us changing diapers, suctioning trachs and filling feeding bags.  It was probably the most educational and enlightening experience they had ever encountered.   

That little facility has since expanded because, unfortunately, there is a growing need for their services. The EMS crews are encouraged to tour the facility so they are not surprised if they get a call there.  We have had many FFs and Paramedics not make it much past the entrance because it is a difficult sight.

Even Dr. Micheal and Camille Geraldi have been scrutinized by EMS and well meaning bystanders at times as they manage some very difficult Down Syndrome children.   Sometimes they had the time to educate and sometimes they just wanted to get the child home to care for them in a familiar environment.


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