Advice on dealing with this....

[62_derick]

I was doing some Ride along time as part of my EMT Class. Was called out for an elderly fall victim at an assisted living facility. We arrived to find a elderly female in her bathroom, complaining and yelling at the nurses trying to help her. We approach her only to be called names and threatened. We asked her if she was hurt or in any kinda pain, Her response was leave me alone, go away.

We also tried to get another nurse that deals with her everyday but to no use she didnt budge. The medic that I was with pressed on her hip and she didnt scream in any pain or complain about that, just threated him and told him to leave her alone. We asked her numerous times if she was in any pain and/or if she wanted to go the hospital but she didnt say yes or no she just threatened us and told us to go away.

So the medic made the desison and said we are going to take you to the hospital and get you checked out. The medic and the emt I was with picked her up and placed her on the streatcher. As we are bringing her out to the rig she was still threatening and yelling at us. Her daughter showed up and the PT didnt want anything to do with her daughter either. On our way out to the rig she starts yelling at me and calls me a dummy.

On our way she is trying to unfasten the straps on the steatcher to get lose and at one point she hit the medic.

After we transfered her, the medic asked me what could have been done different durning the call. I suggested restraining her and he said he would have done that but with her age there could have been some more issues..

Now with me being a new emt I would think that if she is that threatening and hitting employees she should have been restrained, but then again if she wasnt in any pain maybe she shouldnt have been transported anyways.

I belive the policy for the nursing home was that all pt get transported if ems is called.

What would you guys have done different or would not have done or suggested.

 

[Sasha]

Now with me being a new emt I would think that if she is that threatening and hitting employees she should have been restrained, but then again if she wasnt in any pain maybe she shouldnt have been transported anyways

She sounds altered. Did she have a pmhx of dementia or Alzheimers? What did her 12 lead look like? BGL? Skin condition?? BP? Pulse? Regular or irregular? Is this her normal mentation?

 

[Scout]

Kidnap?


Without sound confirmation that she is non compos mentis it sounds like she was refusing care.

Maybe she wanted a bit of respect. I don't know how you approached it but i get the feeling she was a proud woman who was not happy with being in the home and wanted to do things herself. A bit of talking and assistance in getting her up rather than lifting her might have been an option.

But again without being there its hard to say.

 

[JonTullos]

Given her age and the fact that she was in a nursing home I'd say she was likely experiencing AMS in some form or another but without actually being there it's hard to tell. What information did you get from the nursing home staff? Was this her normal mental status or was this unusual? Did the home or her daughter have power of attorney in order to force her to go to the hospital? Vitals? Meds? Last oral intake? Basically the whole SAMPLE history.

 

[ResTech]

She was at an Assisted Living facility so technically these patients most often can refuse EMS just the same as if they were living in a regular apartment. Essentially that is what Assisted Living is, an apartment, just with in-house medical supervision.

Usually patients who are in Assisted Living do not have alzheimers since they require closer monitoring.... some do have slight cases of dementia though.

Sounds like maybe she was just really aggravated and having a bad day from falling and losing control of your life for the moment and having to depend solely on others. Of course, you don't want to assume that.

As far as restraining, I don't think its a good idea to restrain unless its a last resort and the behavior is really impeding necessary care. Most states have specific protocols and guidelines that must be followed for physical and chemical restraints.

Sounds like your crew did what they should have. They were firm and got the patient up and on the stretcher and to the hospital. Just from what you posted I don't think I would have done ne thing ne different... other than consider refusal if nothing was abnormal on the PE and after a family member was called and consulted with.

Just remember that with geriatric patients, the brain becomes smaller with aging which permits more movement within the skull. On the interior of the skull, there are several bony projections that can lacerate the brain from it sliding over them... also with more movement of the brain, it swishes more and is more likely to be injured....

Its not uncommon for a elderly patient to have a intracranial hemorrhage from a standing height fall... I have seen quite a few... sub-dural hematoma is most common but think epi-dural if patient had a rapid decline in condition.

In a patient like this, always think of ICH... also what was the patients baseline mental status? Is she normally a pleasant resident? Or is she always in a bad mood and not very polite?

 

[62_derick]

She sounds altered. Did she have a pmhx of dementia or Alzheimers? What did her 12 lead look like? BGL? Skin condition?? BP? Pulse? Regular or irregular? Is this her normal mentation?

Its been a while since that call but from what I can remember he vitals were good and 12 lead was good. And I think she has been like this in the past.

The medic also mention about giving her an iv to relax her but she probably would ripped it out.

Kidnap?


Without sound confirmation that she is non compos mentis it sounds like she was refusing care.

Maybe she wanted a bit of respect. I don't know how you approached it but i get the feeling she was a proud woman who was not happy with being in the home and wanted to do things herself. A bit of talking and assistance in getting her up rather than lifting her might have been an option.

But again without being there its hard to say.

Well the thing is we were there on the called for 30 mins before going to the rig we had asked her if she was in pain or wanted to be transported. She gave us no yes or no answers to anything we would ask her.
We would have been more then happy to get her to a sitting position and not transport her if she would have said she didn't want to go. The nurses have tried to lift her also but with the same affect.

We also told her that if she didn't want to be taken to the hospital then she should show us that she can get up on her own (with our help of course) but she just told us to leave her alone.

Now that I think of it maybe we could have let her cool down and then approached her.

 

[rescue99]

There has been no mention of history, current or past. If this were a dementia sufferer, it may be her normal. If not...doh!

 

[spisco85]

If your assessment revealed AMS then I definatly would have transported. If enroute she was pulling at things and trying to take things off soft restraints would be applied to maintain adequate patient care such as starting an IV, keeping the leads on her, pulse ox, allow the taking of a manual BP and subsequent automatic BPs.

 

[JPINFV]

She was at an Assisted Living facility so technically these patients most often can refuse EMS just the same as if they were living in a regular apartment. Essentially that is what Assisted Living is, an apartment, just with in-house medical supervision.

Usually patients who are in Assisted Living do not have alzheimers since they require closer monitoring.... some do have slight cases of dementia though.

Unless the patient is altered or has a conservatorship (note: a power of attorney: health care CANNOT over rule a patient who is alert and orientated. If the patient has capacity, then the DPAC:HC can't over rule the patient), then the patient can refuse care regardless of if they are in a SNF or assisted living facility. Now in this case, there isn't enough information given to determine if the patient has capacity or not.

There are assisted living facilities set up specifically to work with patients with alzheimers.

 

[Ridryder911]

She knew appropriate person, place and event, cogintive and awareness of the injury or event? If not, then and only possibly then you have the right of describing altered mental status. If not, congrat's you maybe charged with kidnapping.

Patients have a right to refuse care and service, as well to be offerred alternatives and informed of risks if not chosen.

I can see being persistant, if the patient appeared to be non-lucid of understanding the risks, but if the patient is alert and understands.. You have NO grounds of touching or treating the patient.

Restraining? Was she really in-danger to herself or others or did you place her in dangerment? Restraining is a Felony if not warranted, one has to be cautious in usage.

R/r 911

 

[rescue99]

Sad and stupid!

Read this last week and wondered what the heck these people were thinking when they ruined their careers?

http://www.emsresponder.com/web/online/Top-EMS-News/Criminal-Charges-Filed-in-Fake-EMT-Training-in-Massachusetts/1$10164

 

[rescue99]

Read this last week and wondered what the heck these people were thinking when they ruined their careers?

http://www.emsresponder.com/web/online/Top-EMS-News/Criminal-Charges-Filed-in-Fake-EMT-Training-in-Massachusetts/1$10164

ooops, wrong button..well, read on if yer interested.

 

[kittaypie]

i agree with RidRyder, if she was AOx3 and mentally competent she has the right to refuse care. if that were the case, i would've had her sign AMA.

otherwise you would be charged with assault, battery and kidnapping. let's hope she (or family) doesn't sue.

i had a similar experience with a drug addicted patient in rehab. she was acting out and her roommates were tired of her so they called 911 to get her out of there. the fire department (medical authority out here) arrived and demanded she be transported because they didn't want to have to respond again in the middle of the night for the same reason. the patient was AOx3 and refused transport. the captain began yelling at her and demanded us to restrain her and transport. being a relatively new EMT, i didn't speak up and complied.

this pisses me off to no end. just because a patient is a drug addict, cranky old lady, homeless, etc. doesn't necessarily mean they are not still competent mentally. they have the same rights as everyone else. just because the patient pisses off the medic in charge does NOT give him the right to kidnap the patient, even if he thinks it's "for the patient's own good".