AMA w/ETOH On Board

[Aidey]

I just want a little more in my report then some objective and subjective info.

The entirety of any medical report is made up of objective and subjective info.

 

[JPINFV]

Not sure if you read my original post. but you might wanna give it a once over so we can stay on track here.

I never stated my school had taught me that any presence of an intoxicant indicated impairment to make sound medical decisions.

...because this is the first thread ever, in the history of EMS on the intertubes, to discuss patients who have had varying amounts of alcohol?

In-fact I have not mention my schooling once? I mentioned my Local protocols in which i operate under. Am I green Paramedic? sure. I am just trying to figure out how to draw a better line so I can protect myself and my fellow colleagues from lawsuits (not that having a definitive line would do that).

EMS med mal lawsuits don't happen as much as everyone thinks they do. You're much more likely to get into a lawsuit for a traffic accident than a properly documented refusal.

My school did teach us what most people here are saying. I just want a little more in my report then some objective and subjective info.
In the case of the patient i mentioned Earlier, I did not take her against her will to the ER.... to take a hospital bed from some other patient who could have had better use for it. She signed our AMA, I explained to the MICN that the patient had consumed ETOH but was not impaired by it. Patient Passed the Road test and went with security to her room where i assume she slept it off since no-one was called back out. Now can i get sued for my actions that night? i wouldn't doubt it. Can I lose that lawsuit? i wouldn't doubt it. If I had a BAC% or a uniform scale to follow could i still be in hot water? i wouldn't doubt it.

...and this is the problem! BAC% does not necessarily mean a patient is or is not intoxicated. You can get a DUI at 0.01% if you're driving like you're intoxicated.

Besides, what are you going to do if the MICN told you to not allow an AMA? Are you ready to fight patients who are have capacity into your ambulance?

 

[JPINFV]

The entirety of any medical report is made up of objective and subjective info.

Well, technically the A and the P of SOAP isn't objective or subjective...
^_^

 

[Aidey]

I'm going with the technicality that isn't part of the report, it is part of the chart.

Yes, I did give it that much thought before I posted. ^_^

 

[mycrofft]

Five is four

Inability to make informed decisions confers implied consent. Unless they want to fight about it or start screaming "Rape!". Then your safety and the pt's safety comes into play. Call LE.

The trouble comes when LE insists you transport someone, especially when they will not ride along in the vehicle with you. If the officer threatens to arrest you for not complying, give him/her the keys and tell them respectfully to do it themselves. Then file a report, including name and badge number.

Drunks will fight immobilization. What will do the drunk more harm, riding sitting up or unrestrained, or fighting a spineboard?

 

[JPINFV]

I'm going with the technicality that isn't part of the report, it is part of the chart.

Yes, I did give it that much thought before I posted. ^_^

Is there a difference between a patient care report and a medical chart?

/knows that this is getting ridiculous.

 

[Aidey]

Is there a difference between a patient care report and a medical chart?

/knows that this is getting ridiculous.

The patient care report is just the objective and subjective bits, the chart is all the other stuff too.

And it is the middle of the night, we are allowed to be a little ridiculous.

 

[nemedic]

And it is the middle of the night, we are allowed to be a little ridiculous.

Bah Humbug!!!!! If we allow this now, then we will have to allow it in the early morning. then any time before noon or after 5, and all weekend. then the whole world will become one giant ball of ridiculous. :wacko:



this rant sponsored by the Letter I for Insomnia and pur fine Corporate Partners at Monster Energy. :wacko:

 

[usafmedic45]

Yes, experience can't be taught, but experience and the ability to exercise judgement are not the same. The schools that are teaching their students that the presence of any intoxicant means implied consent are doing their students, and their subsequent patients, no good. Your school should have gone over how to determine capacity as the ability to interact with patients is not just based on post education experience.

EMS med mal lawsuits don't happen as much as everyone thinks they do.

If they did, I'd be living in a much nicer apartment, my college would be paid for and I'd probably have a maid on staff.

BAC% does not necessarily mean a patient is or is not intoxicated. You can get a DUI at 0.01% if you're driving like you're intoxicated.

...or the patient I had with a 0.5 BAC that was more or less coherent and conscious. Of course, that was not nearly as interesting a case as:

In South Africa a man driving a Mercedes-Benz Vito and was arrested on December 22, 2010, near Queenstown in Eastern Cape. His blood had an alcohol content of 1,6g/100ml. Five boys as well as a woman who were also in the vehicle with 15 sheep, allegedly stolen from nearby farms, were also arrested

.....especially when you figure that those three people and fifteen sheep were in one of these: http://en.wikipedia.org/wiki/File:Mercedes_V-Klasse_20090815_front.JPG




Source: Wikipedia (http://en.wikipedia.org/wiki/Blood_alcohol_content#Highest_recorded_blood_alcohol_level.2Fcontent ) , but originally derived from: http://www.sowetanlive.co.za/news/2010/12/24/drunkest-driver-in-sa-arrested

 

[Sandog]

.and this is the problem! BAC% does not necessarily mean a patient is or is not intoxicated. You can get a DUI at 0.01% if you're driving like you're intoxicated.

Of course you have supporting links to validate this? Not meaning to be a smart arse, but there must be some quantitative methods for police to determine mental impairment, otherwise it is just subjective which leaves reasonable doubt, and no DA would support this. And let's exclude those professions that any trace ETOH is a violation.

 

[Aidey]

I can't cite case law or a statute but I can attest that in at least one state there is a difference between DUI and DWI. Driving under the influence can be issued to anyone deemed to be impaired by anything - including things other than alcohol. Driving under the influence is specifically applied to cases in which the person is deemed to have a BAC over 0.08%.

 

[CAOX3]

The problem its I don't think anyone is quite sure how to handle these folks, the police don't want them because if they die in a cell its going to be a media nightmare, the hospital shouldn't have to babysit someone who doesn't no their limitations, our services don't want them left because if they die their on the hook for it.

Do I believe intoxication is a medical emergency, in instances it can be. I just think its a slippery slope, we let them ama they die everyone gets all pi ssed off, we take them to the hospital their all pisseded off, we can't win.

Use your best judgement and expect to get flack from one direction or another.

 

[DrParasite]

The trouble comes when LE insists you transport someone, especially when they will not ride along in the vehicle with you. If the officer threatens to arrest you for not complying, give him/her the keys and tell them respectfully to do it themselves. Then file a report, including name and badge number.

oh hell no.

first of all, the officer cannot force you transport someone. he or she can suggest it, he can give the option of the ER or jail, but he can't force you to transport anyone. if HE forces you to take a drunk to the hospital, than he MUST place the patient in protective custody, and then HE WILL be accompanying the patient to the hospital.

secondly, he CANNOT threaten to arrest you for not complying. well, he can threaten, but he can't ACTUALLY arrest you. if he does threaten, request his Sergent or Lt respond to the scene. He can't force you to commit a crime by threatening to arrest you (and yes, kidnapping/taking someone against their will is a crime), despite what some officers might think. and before someone brings it up, it's not the same as failing to move the fire truck that is protecting the MVA scene from oncoming traffic, as it is an illegal order.

lastly, I am NOT giving my keys to an officer to transport. if he is going to play that game, tell him to put the drunk in his car. he can drop him off at the hospital just as well as you can.

or call your EMS supervisor, let him make the call, that's what they gets paid the big bucks for.

and then file a formal complain after you have obtained the officer's name and badge number

btw, our medical director will not let drunks refuse AMA. if you call the doc and tell him the patient has been drinking, he will not let the paramedic have the patient RMA. not only that, dispatch is not supposed to even mention anything about alcohol during the dispatch, because it can skew the field provider's perception of the call (at least that was what my supervisor just told me last week).

 

[JPINFV]

Of course you have supporting links to validate this? Not meaning to be a smart arse, but there must be some quantitative methods for police to determine mental impairment, otherwise it is just subjective which leaves reasonable doubt, and no DA would support this. And let's exclude those professions that any trace ETOH is a violation.

Would citing California Vehicle Code work?

"23152. (a) It is unlawful for any person who is under the influence of any alcoholic beverage or drug, or under the combined influence of any alcoholic beverage and drug, to drive a vehicle.
(b) It is unlawful for any person who has 0.08 percent or more, by weight, of alcohol in his or her blood to drive a vehicle. "

http://www.dmv.ca.gov/pubs/vctop/d11/vc23152.htm



Why is subsection A and B written so differently if only people above 0.08 percent are too drunk to drive? Notice that B is written to include alcohol alone, drugs alone, or a combination of alcohol and drugs.

 

[JPINFV]

btw, our medical director will not let drunks refuse AMA. if you call the doc and tell him the patient has been drinking, he will not let the paramedic have the patient RMA. not only that, dispatch is not supposed to even mention anything about alcohol during the dispatch, because it can skew the field provider's perception of the call (at least that was what my supervisor just told me last week).

Ok, your patient has had 2 drinks and wants to sign AMA. Your online medical director says no. How do you compel transport?

 

[HotelCo]

Ok, your patient has had 2 drinks and wants to sign AMA. Your online medical director says no. How do you compel transport?

PD, I suppose.

If they won't die from choking in their own vomit, or falling into traffic, they can go. Hell, I might give them a lift home if they don't live far.

 

[usafmedic45]

I can't cite case law or a statute but I can attest that in at least one state there is a difference between DUI and DWI.

In some states, simply being sleep deprived to the point where it effects your ability to drive is grounds enough for a DWI charge.

How do you compel transport?

"Look, it's either you ride with us or you ride with the cops. Which is easier for you?"

 

[JPINFV]

...and if the police refuse to detain the individual?

 

[ShotMedic]

Ok, your patient has had 2 drinks and wants to sign AMA. Your online medical director says no. How do you compel transport?

A little while ago there was an incident in our local area that i happen to catch on the radio where a bicyclist crash with out a helmet at per witnesses at scene had a LOC of 2-5mins when he awoke became combative but oriented to person place and time and stated for the event "i crashed my bike". Patient had consumed a unknown amount of ETOH with a strong odor on his breath. Patient was missing teeth and had a large laceration to his forehead with approx 500cc of blood loss. the medics on scene were trying to start an assessment but the patient was combative towards them stating he cant afford them and do not touch me. medics quickly radioed for Law enforcement to expedite but due to the rural nature of there area ETA was 1 hour and first responders had launched an Air ambulance with an eta of 15mins. Medical Control was contacted and the ER Dr. stated the patient must be transported, no exceptions. Air ship landed, patient was chemically sedated cant remember if they intubated and transported to trauma center. Wife showed up on scene and became severly aggravated when she saw her husband being loaded into the $$$$ air ambulance. after assaulting one of the on-scene medics law enforcement finally arrived and took wife into custody. I am not sure what became of this incident but one example on how everyone can be on different pages on this issue

 

[usafmedic45]

...and if the police refuse to detain the individual?

99% of the time, just making the hint that the other option is a ride in the cop car will get people to go along.