Buzzed 17 year-old refusing treatment

[hometownmedic5]

Your whole argument is predicated on this being a patient. He isn't. Once again, he has no medical complaint or desire for services. That makes him not a patient.

Did I work him up? No. Why not? Not a patient. Why did I turn him over to the police? Because a minor under the influence of ETOH with no other issues isn't a medical problem, it's a legal problem. He doesn't need medical care. He didn't request medical care. He doesn't want medical care. My version is as close to abandonment as yours is too kidnapping.

Now, if this kid was stuperous, fall down drunk we might be having a different conversation; but merely ingesting alcohol doesn't require medical attention regardless of age. This would be a cake walk to defend in CQI. Maybe not for you at your service, but I don't live in a world where every person I contact goes to the hospital whether they want to or not.

 

[bakertaylor28]

Except for the fact that your overlooking the fact that in most states minors (i.e. under 18) lack capacity to enter into informed consent in the first place, unless they are emancipated. Rather, a parent or legal guardian is the party that must legally consent to treatment. So unless, the parent /.legal guardian is around, and given the fact that we don't know if it's a potential life threatening situation or not, getting some rudimentary information, such as vital signs, etc. is within reason - as the presumption is that it is a potentially life-threatening situation until concrete information and evidence proves otherwise.
You have to keep in view that:

1. We CANNOT assume that alcohol is the only substance involved. Teenagers LIE all the time, TO EVERYONE.
2. The scenario of an 18+ party suggests the strong possibility of the presence of illegal drugs in context of the situation.
3. We cannot affirmatively rule out the presence of other drugs in the situation without resorting to techniques we don't have at our disposal in the field.
4. What do the vital signs suggest? This will give more information as to the situation. (i.e. if I see something like a brady or tachy pulse rate its a red flag - Alcohol on its own doesn't do that sort of thing unless BAC is relatively high.) A Drug overdose victim can look relatively fine on arrival
but within a mater of moments deteriorate rapidly to a life-threatening level. Early intervention is often key to successful treatment of the overdose
situation. (example: I once saw a amitriptyline overdose that hit the proverbial fan before I had the time to persuade the victim to get in my rig and
at least let me get a set of vitals - think less then five minutes! )

These facts demonstrate the potential for a life threatening situation UNTIL and only UNTIL you affirmatively prove them INCORRECT To the situation at hand. IF you presume and your WRONG, you stand a chance of a DOA happening. No lawyer is going to sue you over a case like this, because of the fact that a court of law would most likely view this type of situation as frivolous on its face. (not that malpractice law, etc. involves what a REASONABLE person would believe about the situation, and my outline above is perfectly reasonable. ).

 

[hometownmedic5]

I saw nothing in the op regarding wonky vitals, or any other measure of instability. What I did see was a situation where the police wanted EMS to take a pile of paperwork off their hands, a daily occurrence where I work. This isn't a medical emergency. This is a dump job, plain and simple. If you work in a system where you have no options in this type of situation except to say thank you as you wipe your chin and walk away, then so be it. That isn't the case for me.

If you think this kid is in a "life threatening situation" I can only assume you've never consumed alcohol. A person who has consumed a life threatening amount of alcohol doesn't present stable one minute and then box out of nowhere unless they just funneled a bottle of everclear or similar.

Either way, this kid needs to go to the hospital about as much as I need two left shoes..

 

[bakertaylor28]

Here's the thing the OP only gives the scenario background and gives no further information, from my reading of it. Hence, getting a set of vitals is in order, minimally (IF you had carefully read my post, you'd have realized what I was getting across.) The thing is that some of us are making the assumption that it is what it appears to be, which is not always the case. When we combine that with the fact that the law in most states does not allow a minor to authorize a legal document (meaning that a 17 year old effectively CANNOT refuse treatment in the majority of states ) we may only defer to the parent on that issue (whom isn't present based on the OP) Consent to treatment is really immaterial at the scene. (Until at such point the parent arrives on scene - and I'm going to assume that law enforcement has already made the necessary notification- as such would be their SOP .) Further, regardless of medical, law enforcement COULD potentially treat and process this as a mental health commitment case (under laws such as Florida's Marchman act.) Where the real liability is involved here is if EMS does nothing and then later something happens.

hometownmedic5, you also didn't carefully read the part of my post about the distinct and overwhelming possibility that drugs OTHER than alcohol may be present. C;mon what do kids these days do at an 18+ party? smoke pot which could be laced with God knows what, and/or engage in drug use. Its not the environment you expect within the typical adult (21+) bar scene anymore. We're seeing increased use of hard drugs and we're seeing things like synthetic pot these days.- and the effects of some of these substances can be unpredictable in their own right. Alcohol when combined with certain other drugs (particularly with the case of stimulants) will have an erratic and unstable onset of symptoms. Chances are that a 17 year old ISN"T going to tell the truth with that regard, likely because they want to avoid getting arrested for constructive possession OR because they want to avoid the distinct possibility of someone else ending up being arrested for a drug offense as a result of the situation. Therefore, it would be wise to assume, if anything, that about everything that comes out of this kid's mouth is probably a LIE.

Therefore, as an insurance policy, personally, I'm going to assume a drug / alcohol interaction or drug overdose has taken place UNTIL I have at least two sets of relatively stable vital signs OR enough verifiable information to lead me to safely believe that it's nothing more than an alcohol case.

 

[Carlos Danger]

Following the reasoning presented in the last few posts, we are pretty much responsible for anyone under the age of 18 who we come into contact with.

17 year old at the fast food place: "Here's your order, sir".

EMT to 17 year old: "Thank you. Hey, you look a little fatigued. Are you feeling OK?"

17 year old: "Yea, I'm fine. Just a little wiped out from a long busy day. School, practice, and now work."

EMT: "Are you sure you are just tired? How do we know you don't have a medical problem going on?"

17 year old: "I don't know....I'm perfectly healthy........and I feel fine, other than just being tired".

EMT: "Well, you could have something going on not know it. Maybe you are on drugs and just aren't admitting it to me - lots of kids your age use drugs. You could possibly even wake up dead tomorrow, and I'd be responsible. I know you say you are fine, but I can't legally take your word for that since you are under 18. I'll need to take you to the hospital if I can't get ahold of your parents".

17 year old: Wut is happening?

 

[NomadicMedic]

Following the reasoning presented in the last few posts, we are pretty much responsible for anyone under the age of 18 who we come into contact with.

17 year old at the fast food place: "Here's your order, sir".

EMT to 17 year old: "Thank you. Hey, you look a little fatigued. Are you feeling OK?"

17 year old: "Yea, I'm fine. Just a little wiped out from a long busy day. School, practice, and now work."

EMT: "Are you sure you are just tired? How do we know you don't have a medical problem going on?"

17 year old: "I don't know....I'm perfectly healthy........and I feel fine, other than just being tired".

EMT: "Well, you could have something going on not know it. Maybe you are on drugs and just aren't admitting it to me - lots of kids your age use drugs. You could possibly even wake up dead tomorrow, and I'd be responsible. I know you say you are fine, but I can't legally take your word for that since you are under 18. I'll need to take you to the hospital if I can't get ahold of your parents".

17 year old: Wut is happening?

 

[CALEMT]

People on this thread be turning a whole lot of nothing into a full blown "give me every fire rider and go code 3 to the hospital now" type of call. This is a classic security "I don't want to deal with this so I'll pawn it off to someone else" kinda call. There's no medical aid needed, therefor there is no patient. How this call should go:
EMS: "kid, you okay?"
Kid: "yeah, just drunk"
EMS: "cool beans, sercurity, you can handle this"
Security: "crap"

 

[NomadicMedic]

People on this thread be turning a whole lot of nothing into a full blown "give me every fire rider and go code 3 to the hospital now" type of call. This is a classic security "I don't want to deal with this so I'll pawn it off to someone else" kinda call. There's no medical aid needed, therefor there is no patient. How this call should go:
EMS: "kid, you okay?"
Kid: "yeah, just drunk"
EMS: "cool beans, sercurity, you can handle this"
Security: "crap"

Right, but it's not really a no patient. Its a request for service that turned out to be a no patient. You need to document that you saw the kid, there was no medical need and the subject remained with the security officer. I'd say a set of vitals wouldn't be to far out of line. At least you can say that there was no immediate medical need if you wind up sitting at a conference room table giving a deposition.

 

[hometownmedic5]

I read, and understood, every word. We just have contrary opinions on how best to handle this call.

This thread keeps circling back to refusing medical treatment and the authority to contract, neither of which are necessary if the PERSON is not a PATIENT. You don't become my patient till you state a specific complaint or request services without the presence of a complaint; or a third party request services on your behalf and upon presentation to me you are unable to be medically cleared in the prehospital context. If they aren't a patient, I don't need a refusal and if I don't need a refusal, i couldn't care less how old the person not refusing my care is.

I get asked at least once a shift to evaluate a person for the police. The majority don't get in my ambulance. Whether they end up sent not heir way or hooked and booked I don't know, but I don't live in a world where every person I contact gets a ride in my truck and a two thousand dollar bill.

 

[bakertaylor28]

Following the reasoning presented in the last few posts, we are pretty much responsible for anyone under the age of 18 who we come into contact with.

17 year old at the fast food place: "Here's your order, sir".

EMT to 17 year old: "Thank you. Hey, you look a little fatigued. Are you feeling OK?"

17 year old: "Yea, I'm fine. Just a little wiped out from a long busy day. School, practice, and now work."

EMT: "Are you sure you are just tired? How do we know you don't have a medical problem going on?"

17 year old: "I don't know....I'm perfectly healthy........and I feel fine, other than just being tired".

EMT: "Well, you could have something going on not know it. Maybe you are on drugs and just aren't admitting it to me - lots of kids your age use drugs. You could possibly even wake up dead tomorrow, and I'd be responsible. I know you say you are fine, but I can't legally take your word for that since you are under 18. I'll need to take you to the hospital if I can't get ahold of your parents".

17 year old: Wut is happening?

As for this- NO, it doesn't quite work this way. There's a distinct difference between sitting in line at mcdonalds (where dispatch doesn't have you marked a being an in-service unit) and being called out on an emergency run where at least one objective adult feels that there is at least potential. Plus the SOPs have that little thing in there about someone signing the treatment refusal form, but Oh snap, the law doesn't allow a 17 year old to sign legal documents. (So go complain to your congressman if you have a problem with that!) So at minimum, this means your unit is tied up until you can get someone with capacity to sign the damn form. Unless you want to take the chance of something happening and take the Chance at being sued without having much of a valid legal defense. (Because, after all, we're supposed to be considering the remote but theoretically possible contingencies of outcome) Now, had the OP listed a little more objective information to suggest that our scenario isn't something that's more than what meets the eye. I might take a different position on the matter. The argument here tends to forget that a lot of things can present in very atypical manners.

So the critical question is:

What objective and reliable facts do we have that prove that we don't have something suitcased along with ETOH, that perhaps might still be on the up-side in terms of bioavailability?

The answer, is that other than LOC, absolutely NONE, given only the information presented in the OP.

If we read carefully , the OP doesn't give us any information other than LOC. While LOC is a good measure of indicator, its NOT EVERYTHING, and taken on its own can sometimes be deceiving. (one only need to see the effects of psychedelic mushrooms to know what I mean.) Therefore, given what we've been told in the OP, a set or two of vital is the next appropriate step, playing by the book. Bottom line, this is not the sort of thing we can afford to be playing law of averages with - because it only takes that ONE TIME to turn out to be DEAD WRONG - and end up being in the pickle of having some 'splaining to do.

 

[hometownmedic5]

And we again return to the unnecessary signing of the unnecessary form....

I quit. Go ahead and transport him.....

 

[VFlutter]

Bottom line, this is not the sort of thing we can afford to be playing law of averages with - because it only takes that ONE TIME to turn out to be DEAD WRONG - and end up being in the pickle of having some 'splaining to do.

You are more than welcome to practice ultra-conservative, always cover your ***, everything black and white however not everyone sees things that way. Feel free to take every intoxicated underage kid at a concert to the ER if that is what you think is best. I just do not think you are going to convince many people.

If you have a medical director that thinks that way and never allows any deviation from protocol or will never give you orders out of fear of litigation does that make them "safer"? Maybe. Does it make them a better provider? Not in my opinion. I like that quote that every doctor, or medical provider for that matter, owns a piece of the graveyard but that doesn't mean you should practice out of fear for that one time.

 

[bakertaylor28]

And we again return to the unnecessary signing of the unnecessary form....

I quit. Go ahead and transport him.....

I don't know how your procedures read, but around here, you pretty much have a "patient" from Time of Arrival on scene, regardless of the scenario that presents itself, unless the call is determined to be dispatched based on false information.

 

[TransportJockey]

I don't know how your procedures read, but around here, you pretty much have a "patient" from Time of Arrival on scene, regardless of the scenario that presents itself, unless the call is determined to be dispatched based on false information.

Or if the person on scene does not desire you there, did not call you, and does not want assessment or treatment.

Sent from my SM-N920P using Tapatalk

 

[VFlutter]

So this 17 year old is adamant he does not want medical treatment or transport are you going to forcibly provide treatment? Get law enforcement involved to detain him and transport? Chemically restrain him because you never know what he may have took, he may be a threat to himself or others in a few minutes.

 

[TransportJockey]

So this 17 year old is adamant he does not want medical treatment or transport are you going to forcibly provide treatment? Get law enforcement involved to detain him and transport? Chemically restrain him because you never know what he may have took, he may be a threat to himself or others in a few minutes.

If you're gonna go overboard, you might as well go full retard

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[VentMonkey]

 

[bakertaylor28]

You are more than welcome to practice ultra-conservative, always cover your ***, everything black and white however not everyone sees things that way. Feel free to take every intoxicated underage kid at a concert to the ER if that is what you think is best. I just do not think you are going to convince many people.

If you have a medical director that thinks that way and never allows any deviation from protocol or will never give you orders out of fear of litigation does that make them "safer"? Maybe. Does it make them a better provider? Not in my opinion. I like that quote that every doctor, or medical provider for that matter, owns a piece of the graveyard but that doesn't mean you should practice out of fear for that one time.

Its called being in business to make money, and try to avoid loosing it at reasonable costs. Not something I agree with in this profession, but I will be sure to put in a ***** about it to medical direction on your behalf, Chase - and I'll let you know what they have to say about it. Plus, in that rare event that it goes south, what really are you going to say when confronted by the family? Its a smaller world than you think, and frankly I don't want to be in the position to try to justify something like that. I try to live with the ethical standpoint of keeping as much blood off my hands as humanly possible.

 

[NomadicMedic]

I think you guys may have fallen into the spiral death trap.

Should he be transported? No.

Is he truly a patient? No. He's is only a patient in the sense that a third party (security guard) brought you into his encounter. If you're not needed, politely extricate yourself.

Should you document that security brought him by and he had no medical complaints and he left with security? You betcha.

Do you need to do any more than that? Probably not. Every event I've ever worked only requires a PCR for a patient I've actually treated. Otherwise, a running timeline would suffice.

2010. Handed bandaid to woman with blister on foot. No medical attention requested.

2030. Security stopped at first aid station with a minor (Smith, John 01/01/2000) who admitted to alcohol ingestion. He was in no apparent distress and when asked if he needed or wanted any medical attention, replied "no". He left with security at 2031.

That's probably all you need. No signature.

 

[hometownmedic5]

I don't know how your procedures read, but around here, you pretty much have a "patient" from Time of Arrival on scene, regardless of the scenario that presents itself, unless the call is determined to be dispatched based on false information.

As I said, if that's the world you live in then do what you have to do. I don't live in that world, nor do most of the providers on this thread.

If I treated every person I contact in a month as a patient, I'd spend most of my time writing refusals. I probably do ten third party activations a month where I arrive and find a person who was napping on a bench, or in their car, or who was confused because the store they were looking for closed last month and they were wandering up and down the street looking lost and confused and because they happen to be 80, some cell phone wielding hero called 911.

Not everybody I talk to after being dispatched to their location is a patient and non patients don't require refusals. As presented, this is a police matter, not an EMS call. I would write it up exactly as I posted here and not give it a second thought. If you live in a different world then so be it, but no matter how many times it's repeated that a 17 year old lack legal capacity to refuse care, you're not going to change my mind that this person is not a patient and has business only with the police and his parents.