Buzzed 17 year-old refusing treatment

[kaboomgy]

Scenario: You are working a large 18+ music festival and security brings you an alert and oriented 17 year old male, who has a strong smell of alcohol. He admits to drinking tonight, but states he's fine and doesn't want or need medical attention. He admits to you that his parents think he's at his friend's house and begs of you to not call his mom. How would you handle this situation?

I am wondering about the by-the-book or legal procedure here, particularly in the state of California. My first impression is that the 17 year-old is still considered a minor and cannot legally refuse treatment.

 

[Akulahawk]

By the book, a non-emancipated minor is still a minor and cannot refuse treatment, even if said minor's 18th birthday is tomorrow.

 

[TransportJockey]

Call his parents, he's a minor and cannot consent or refuse

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[EpiEMS]

Scenario: You are working a large 18+ music festival and security brings you an alert and oriented 17 year old male, who has a strong smell of alcohol. He admits to drinking tonight, but states he's fine and doesn't want or need medical attention. He admits to you that his parents think he's at his friend's house and begs of you to not call his mom. How would you handle this situation?

I am wondering about the by-the-book or legal procedure here, particularly in the state of California. My first impression is that the 17 year-old is still considered a minor and cannot legally refuse treatment.

Looking at LA County protocols (for example), absent any parental intervention, if he's deemed to be injured or in need of medical attention, you are required to transport. While this individual is not urgently in need of medical attention, I would not release him to his own custody - I would consider (1) calling medical control for their disposition, (2) call his parents, (3) involving LEOs to call the parent so we can release him to the parents, or (4) releasing to LEOs to handle. #2 is preferable, assuming he has no medical complaint or no apparent illness/injury.

Notes:
- Odor of alcohol on breath/drinking do not alone make somebody "incompetent."
- California does not have a law prohibiting internal possession.

 

[Carlos Danger]

So what is the medical emergency that's he's not allowed to refuse care for?

 

[MonkeyArrow]

If there is no medical issue, then there is no refusal. What treatment needs to be provided that someone must refuse/accept? If this person were to "consent", what interventions would you provide to him? Consuming alcohol is not a medical issue. This would be different to showing up to a dispatch and not finding anyone.

Turn security to do whatever they please with him. It is not our place to call someone's parents because they snuck out.

 

[CALEMT]

Go available with no medical aid needed.

But in the sense of your question. Minors can't refuse treatment/ transport. Unless emancipated.

 

[DesertMedic66]

AOx4, GCS 15 with no complaint = no patient

 

[StCEMT]

There is one little subsection in my protocols that miiiight make me give a call to a supervisor for clarifications, but as far as I see it, there's nothing I need to worry about. Later tater.

 

[akflightmedic]

Fire Security.

It is 18+ event, they did not do their job.

 

[DrParasite]

Does he have any complaints? does he want your help? What care, exactly, are you going to force upon this 17 year old, who admits to indulging in a couple of drinks?

Looks like it's a security problem, because they let the under 18 year old in. Let them deal with their issue.

Or even better, they can call his parents to pick him up.

 

[Old Tracker]

Let security call police and have them do a drunk in public, then THEY can call mommy and daddy.

 

[Operations Guy]

This is insane no complaint no patient. Tell security he's not in need of medical care cause drinking is not a medical emergency. Go available let security deal with it.

 

[NomadicMedic]

Did the security staff leave him with you then go back to their post?

Here's a better question, do you document that you made contact with a minor who appeared to have alcohol on board and that you turned him over to security or do you just "go available"?

How do you document it?

Does it go on an official run report?

How much information do you need to gather if you do document the contact?

 

[Operations Guy]

Did the security staff leave him with you then go back to their post?

Here's a better question, do you document that you made contact with a minor who appeared to have alcohol on board and that you turned him over to security or do you just "go available"?

How do you document it?

Does it go on an official run report?

How much information do you need to gather if you do document the contact?

I wouldn't let security just dump him on me. I would document no patient and concerned bystander reported. Document that individual was not in medical need at time and had no complaint. I would document cause say something medical with individual happens later I have documented proof earlier there was no medical emergency. Also if PD was available I would rather hand a drinking minor over to them instead of a minimum wage rent a goon.

 

[Operations Guy]

Also if your agency uses both ePCR and some type of run reporting system I would just put it into the run reporting system for your documentation with a simple paragraph saying no medical needs handed over to security. No need for a PCR if there is no medical.

 

[CWATT]

Alberta, Canada:

3. Mature Minors
1.1 Considerations for assessing minors as mature minors

a) Practitioners must consider the following points when deciding if a minor may be deemed a mature minor:

1. Demonstrates the maturity to make independent decisions (e.g. calling EMS), acts in their own best interests and can clearly make an independent judgment to consent (or not consent) to recommended care and treatment
   
   
2. Demonstrates the intellectual ability to understand both the benefits and risks of proposed care, particularly if their presenting health situation is serious or invasive
   
   
3. Age 14 to 18 years (in rare situations, age may be under 14)
   
   
4. Living apart from parents or representatives (may be married or common law)
   
   
5. Economically independent and successfully managing personal affairs

Re: Refusal of Care:

1.5 Refusal of Care
a) Practitioners must arrange for mature minors to sign a Refusal of Care and/or Transport record in situations where they refuse care and/or transport.



However, there's a trump card:

2. Determination of Capacity

2.1. An adult patient is presumed to have capacity and is able to make decisions until the contrary is determined. However, the practitioner is required in every case, to satisfy themselves that the patient has the requisite capacity to make treatment decisions and is not unduly influenced by third parties.

2.2. Patients are considered to lack capacity if their actions indicate that they present a danger to themselves, practitioners or bystanders.

2.3. The patient’s lack of capacity may be transient or chronic: the lack of capacity may be related to, but not limited to:

1. A mental disorder
2. Intoxication due to alcohol ingestion or drug use
3. Disability due to acute illness or injury
4. They present a danger to themselves
5. They present a danger to others
6. Inability to answer/complete any of the following suggested questions:
   1. What is your name?
   2. Where are you right now?
   3. What day is it?
   4. What’s your birthday?
   5. Where were you born?
      

Since the protocols state "intoxication" rather than "alcohol ingestion", it's inevitable left up to practitioner judgment.

A friend of mine told me of a situation where he was standing outside of a club when an intoxicated girl stumbled out and nose-dived into the sidewalk. Paramedics were dispatched and on arrival she perked up (lights, sirens, adrenaline, etc.). He told them what happened and despite the alcohol and a head-injury (abrasion) they allowed her to refuse transport. I don't agree or disagree with these protocols, and I'm too new to offer any real insight.

 

[SpecialK]

If he has no medical complaint he is not technically a patient. Regardless, the law in New Zealand allows him to refuse assessment and treatment. There is no age limit. As long as he can prove he is competent he can do whatever he likes.

I would still get his name etc. so I could complete a patient report form.

Honestly? What useless bloody event staff. They should have told him to PO and called him a cab or uber to take him home, or at worst, the police.

 

[hometownmedic5]

I'm unable to locate anywhere in the OP a medical complaint. A person without a medical complaint or need for medical aid regardless of their ability or desire to complain is not a patient.

This is a legal matter between the venue, the police, the subject and if available their parents. I would document it as such. This isn't a tough one with a lot of sub textual wrinkles.

17M presented to EMS by venue security with no complaint and no apparent need for medical aid. Security states subject brought to EMS because he is a minor and is admittedly under the influence of ETOH. Subject presents CAOx4 in no acute distress. Subject states no desire for transport nor desire for further evaluation. PD summoned. Care of child turned over to PD to handle.

Now, clearly there are details lacking. What caused this youth to come to the attention of security? What is their reasoning for believing this person needs medical aid? Is there a higher than average index of suspicion regarding possible unvoiced complaints or is this a straight up dump job as has become all too common with ETOH calls.

With no reason to suspect occult problems, you have a minor child under the influence of ETOH with no complaints. NO medical problems, not a patient. Make the cops do their job and go tot he next call.

 

[DrParasite]

Just to play devil's advocate, I'm assuming this is how you are going to document the event exactly as stated, correct?

17M presented to EMS by venue security with no complaint and no apparent need for medical aid. Security states subject brought to EMS because he is a minor and is admittedly under the influence of ETOH. Subject presents CAOx4 in no acute distress. Subject states no desire for transport nor desire for further evaluation. PD summoned. Care of child turned over to PD to handle.

Let's pretend I'm your supervisor and reviewing this chart as part of a random QA. Please answer these questions:
1) you were brought a patient who was a potentially intentional overdose victim. and you didn't transport why?
2) did you assess the patient? if not, how do you know he wasn't in any distress? after all, drugs can do weird things on a patient's body
3) of course you assessed the patient, you documented that he is CAOx4 in no acute distress. if you did assess the patient, did you offer transport? oh, he's a minor... so he can't legally refuse to be transported. so you abandoned him? after all, there is no documentation for what happened, and you did initiate care by the assessment
4) Why did you turn over a patient who consumed a drug, and was very likely under the influence of said drug, to a non-medical person? I believe that is the definition of abandonment.
5) This patient was found by the police the next day at home, with the suspected cause of death being an overdose. your documentation says he was given to you and you didn't transport him. there is no documentation that he refused transport, nor that you explained the risks. now the family is suing us and you personally for being the cause of death of their son. We have notified to department of health, who are conducting their own investigation, we are conducting an internal investigation regarding this incident, and you are on unpaid leave pending the outcome of this lawsuit.

Doesn't sound good does it?