# What would you (specifically GradyEMT) do?  Scenario...



## ErinCooley (Mar 29, 2008)

A friend went thru the Grady "interview" process y'day.. test, practical, interview, etc.  During the interview he was given a scenario and asked what he would do...  Grady, I'm picking on you since its your hood.

you are called to the scene (a inner-city Atlanta crime ridden neighborhood)  An 85 yo woman was robbed, door broken down while she was gone.  Upon arrival home, she started to exhibit anxiety signs.  Police are on scene, scene is safe.  Shortly after EMS arrival, police are called to an "officer down" call and leave.  Your patient is upset but refusing to go to the ER.  She has no front door and is not safe... What do you do?  Legally and ethically?


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## yowzer (Mar 29, 2008)

ErinCooley said:


> you are called to the scene (a inner-city Atlanta crime ridden neighborhood)  An 85 yo woman was robbed, door broken down while she was gone.  Upon arrival home, she started to exhibit anxiety signs.  Police are on scene, scene is safe.  Shortly after EMS arrival, police are called to an "officer down" call and leave.  Your patient is upset but refusing to go to the ER.  She has no front door and is not safe... What do you do?  Legally and ethically?



Legally? She's not impaired, right? So she has the right to refuse treatment and transport.

Ethically? I wouldn't want to just leave her alone. Does she have relatives who can come over? Neighbors or another support network? The Red Cross?


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## Ops Paramedic (Mar 29, 2008)

She is not physically injured and needs no emergency care.  That is is anxious and upset is not a true emergency, and can be dealt with later, it is also a normal reaction.  Legally you are not bound as she is not injured and does nor require immediate transport to hospital.  This case is more of Police issue than a medical one, besides, they will stay on scene to take statements, and you can advise them (as they training) that should any thing chance, phone us, we will come back.

Move on to the next call...


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## Grady_emt (Mar 29, 2008)

Erin, Since you are picking on me, here you go. 
       Had an actual call that was quite similar to this, except PD had busted the door down serving a warrant at a 70yof's apt (oops, bad info, wrong apt), then called us out to check her (basis of the interview scenario i've been told).  Upon our arrival, she had no complaint, however her door would close, but not lock.  PD then got a call of shots fired, possible person shot in the same housing complex (Bowen Homes, close to 400 units, 4 fatal shooting so far this year) so they all go flying off to that call and neglected to tell us they were leaving.

      While my partner was assessing the pt v/s for a refusal due to her age, I called a supervisor to be enroute to our location once he cleared the call he was on (he was enrt to the person shot) .  The pt didnt want to go because whe was worried about her apt and belongings.  We also had AFD start a wagon to see if they could help us secure the door in any way.  During assessment, pt is in new onset A-fib and tells us if we can get her front door secured that we can leave through and lock the back door and she will go to the ER for eval.   Our supervisor drags a Sgt from PD with him to the apt once the shots fired was cleared as a false call.

      With FD help, we were able to move a large bookcase/china cabinet to behind the door to temp secure it.  The PD Sgt gave the woman his card, as well as the precinct's captain's card and told her that on Monday morning a crew from the city would be by to re-hang her front door.  All in all, we were happy, the pt was about having her door temp secured, and she got a new front door on Monday morning.


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## VentMedic (Mar 29, 2008)

Grady_emt,

I applaud you and your service for truly extending the effort to make an elderly person secure in mind and body!  

Many of our elderly patients return home to find their life's personal belongings stolen or trashed after even a very brief hospital stay. Situations like this can leave an older person vulnerable and literally take their independence away if the proper steps are not taken to ensure their safety. Everybody wants to pass the responsibility off to someone else. "Not my job" has unfortunately become the most stated phrase in many American professions.   For most, it is just "move on" and "not my problem".   Doesn't say much for us as a society.  It's not just EMS.  Elderly and handicapped people fall through the cracks of our healthcare and social welfare system all the time.   

Learn what resources are available and keep a few contact numbers. NiftyMedic911 from Lee County, Florida explained on a recent thread what they do to assist that county's large elderly and impoverished population.


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## ErinCooley (Mar 29, 2008)

Thanks for the input... 

For every possible fix, there was a reason why it wouldnt work... the only thing we didnt discuss was calling FD.  I'm sure it was just a critical thinking, how do you do under pressure exercise so I was just curious how others would answer.

He said that basically after it was all said and done he responded that he would take her in the front of the ambulance, him riding in the back 3 blocks to her sisters because while he realizes that is a breech of policy, leaving her is a breech of the EMT oath.  He would contact supervisor following the incident (supervisor was unavailable at the time, they were dealing with the cop down)


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## Flight-LP (Mar 30, 2008)

I'd politely explain that we are now leaving as our scene is no longer safe and that she is free to come with  .  Otherwise she is on her own, hope she is well!


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## bikenmedic (Mar 30, 2008)

Flight-LP said:


> I'd politely explain that we are now leaving as our scene is no longer safe and that she is free to come with  .  Otherwise she is on her own, hope she is well!



Wow. That's an impressive display of patient advocacy.


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## KEVD18 (Mar 30, 2008)

focused physical exam, mental status eval, explanation of risks of refusal, have her sign said refusal, grab our gear, mark back in and carry on with my shift. 

my job is emergency medicine. not furniture moving, interior design, construction or home security. while her initial complaint wasnt truly an emergency, if the patient feels it it then they deserve treatment whichi will happily provide. if they are competent to refuse treatment and transport and do so, my involvement in the situation is over.


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## Flight-LP (Mar 30, 2008)

KEVD18 said:


> focused physical exam, mental status eval, explanation of risks of refusal, have her sign said refusal, grab our gear, mark back in and carry on with my shift.
> 
> my job is emergency medicine. not furniture moving, interior design, construction or home security. while her initial complaint wasnt truly an emergency, if the patient feels it it then they deserve treatment whichi will happily provide. if they are competent to refuse treatment and transport and do so, my involvement in the situation is over.



+5...............

1. My safety
2. My partner's safety
3. The patient's care and safety

In that order, everytime with no exceptions.................I'm not going to hang out in the hood so Grandma can feel safe. If she refuses treatment and transport, she's on her own, it is not my place to sit there and convince her otherwise, especially for anxiety..............


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## KEVD18 (Mar 31, 2008)

bikenmedic said:


> Wow. That's an impressive display of patient advocacy.



only goes so far. as soon as she decided to refuse treatment(after having the full and complete list of risks of such a decision have been explained to her) she stopped being my patient. nobody is saying they wouldnt treat and transport her. i surely would. but if the crew were to stay and babysit granny until somebody could fix the door, how many calls would have to be held, or turfed to another service(more than likely with a longer eta)? and what if you, wanting to help in EVERY way possible, got gravely injured in the process. moving a bookcase? they can be quite heavy. probably hurt quite a bit if it fell on you. me personally, if i was your employer i would fight your comp claim every step of the way. your not being paid to babysit, move furniture, construct a new door or any other such activity.

theres patient advocacy and trying to be a hero.


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## Jon (Mar 31, 2008)

If the patient has no complaints and no medical signs/symptoms, is CAOx4, and wants me gone, and is safe where she is, I'm gone. _Press hard, making three copies///_

If the patient is having a medical problem, even an anxiety attack, they need an assessment. If they are elderly, and hyperventilationg with an increased heart rate... is that an anxiety attack, or something more sinister... they need an ALS assessment, and perhaps a trip to the ED.

I'd be uncomfortable with the scene with no PD... and the first thing I'd do is request PD assistance... non-emergently... that way, once they cleared their priority call, they would hopefully not forget me.


In this case, I'd work with her to get in touch with the building superintendent, and also call for my supervisor. This is an issue that goes beyond my pay grade. Hopefully, the building super can come up with a way to temporarily secure the door.


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