Dealing with patients who were involved in a crime.

[Aidey]

This isn't about treatment, but about what you do and don't let the patient do. I'm basically just curious how other people handle these types of calls.

Hypothetical scenario. 2 people are in a car, they run a red light and get into an accident with another vehicle. The 2 people both admit to drinking alcohol. The person in the other car dies on scene.

Your patient the passenger in the at-fault car. You are transporting them before the police have been able to take a statement. Do you take that into consideration when dealing with the patient? For example, not letting them use their cell phone, or talk to other people on scene. Do you document any differently?

 

[EMSLaw]

If your patient is the passenger, they haven't done anything illegal (maybe stupid, in that they got in the car with a drunk behind the wheel and let said drunk drive), so why would they be treated any differently?

We're health care providers, not cops. If the cops want a patient to be prohibited from doing things we normally let patients do (i.e. call the family to let them know what happened), then they need to arrest the person and come in the back of the ambulance with us. Otherwise, it isn't my problem.

Even if your patient were the drunk driver, you still have an obligation to treat them like a patient - general lack of sympathy in health care professions for people who hurt themselves while drunk aside.

If you come into a crime scene, on the other hand, you should do your best to do as the police ask/command. That usually means going in and coming out the same way, and disturbing things as little as possible. Though if the patient is still alive (or in cardiac arrest but workable), that might have to fall by the wayside so you can actually treat the patient. In that case, keep the clothes you cut off, and document everything you do - which you should be doing anyway.

 

[emt_irl]

the way i see it is. we are neutal to everything even at a crime scene. a patient is still a patient to us no matter whats going on.

so id treat them the same as everyone else unless im told different

 

[reaper]

Document every thing that happens or is said. Other then that, they are your Pt first.

If they want to call someone and it does not interfere with care, I have no right to stop them.

As far as crime scenes. Treat your Pt and document everything. Try not to disturb the scene, unless needed. I don't take "commands" from officers, so that is not a problem.

 

[FLEMTP]

Anything the person says can be used against them. We are authoring a legal document. If I have a driver who is DUI and crashed with or without injuries, I will document any and all statements they make about the crash, their level of intoxication, and anything pertinent to the crime.

In the state of Florida a police officer has the right to request that a paramedic draw blood for an alcohol level in any crash, especially one with great bodily harm or death. If we refuse, we can be arrested. With that said, if I have a critical patient, I explain that to the officer, and they are usually very understanding and will request it at the ER. As part of that, we are also required to obtain a consent form from the person if they are conscious and competent. If they are not, implied consent allows us to draw it. If they refuse, the officer can still request it and order us to draw it, because of the implied consent. ( your acceptance of a license is consent for breath or blood alcohol testing, it states it on the front bottom of the FL DL)

All of those events are documented in the PCR, including whether consent was voluntary or involuntary, and any statements the patient made regarding the circumstances of the crash.

If they are not transported (we are called many times to do an on scene blood draw only on a non injured suspected DUI) I will document everything in the same manner in a PCR, and have the patient sign a refusal of care, or, if they are under arrest, I have the officer sign it, since technically the arresting officer is now the "legal guardian" of the patient.

If my patient is the passenger, I will again document anything they say about the circumstances of the crash, and suggest to the officer that the report should be subpoenaed. In the county I work in, the state attorney will issue a subpoena 100% of the time for the EMS and hospital PCR's in a DUI manslaughter/DUI homicide case.

 

[feldy]

for anything related to crime, if you are transporting request a cop to ride with you but make sure they dont interfere with your care and document anything.

 

[reaper]

Anything the person says can be used against them. We are authoring a legal document. If I have a driver who is DUI and crashed with or without injuries, I will document any and all statements they make about the crash, their level of intoxication, and anything pertinent to the crime.

In the state of Florida a police officer has the right to request that a paramedic draw blood for an alcohol level in any crash, especially one with great bodily harm or death. If we refuse, we can be arrested. With that said, if I have a critical patient, I explain that to the officer, and they are usually very understanding and will request it at the ER. As part of that, we are also required to obtain a consent form from the person if they are conscious and competent. If they are not, implied consent allows us to draw it. If they refuse, the officer can still request it and order us to draw it, because of the implied consent. ( your acceptance of a license is consent for breath or blood alcohol testing, it states it on the front bottom of the FL DL)

All of those events are documented in the PCR, including whether consent was voluntary or involuntary, and any statements the patient made regarding the circumstances of the crash.

If they are not transported (we are called many times to do an on scene blood draw only on a non injured suspected DUI) I will document everything in the same manner in a PCR, and have the patient sign a refusal of care, or, if they are under arrest, I have the officer sign it, since technically the arresting officer is now the "legal guardian" of the patient.

If my patient is the passenger, I will again document anything they say about the circumstances of the crash, and suggest to the officer that the report should be subpoenaed. In the county I work in, the state attorney will issue a subpoena 100% of the time for the EMS and hospital PCR's in a DUI manslaughter/DUI homicide case.

You may want to reread the laws, before you get charged with Battery.

An officer cannot force you to do a blood draw. It is Paramedics choice, if they want to. An officer cannot force you to do a blood draw against Pt's wishes. Only a court order can do that. The Pt has the right to refuse any sobriety test they choose. They will lose their license if they refuse, but cannot be forced to do them.

In FL, a Paramedic drawing blood on scene for a DUI is a courtesy for the officers, not a mandate. You also must use the kit provided by the officer and it must be witnessed by them at all times.

I have refused many DUI draws, because the pt would not consent.

 

[FLEMTP]

You may want to reread the laws, before you get charged with Battery.

An officer cannot force you to do a blood draw. It is Paramedics choice, if they want to. An officer cannot force you to do a blood draw against Pt's wishes. Only a court order can do that. The Pt has the right to refuse any sobriety test they choose. They will lose their license if they refuse, but cannot be forced to do them.

In FL, a Paramedic drawing blood on scene for a DUI is a courtesy for the officers, not a mandate. You also must use the kit provided by the officer and it must be witnessed by them at all times.

I have refused many DUI draws, because the pt would not consent.

As a matter of fact I DID re-read the laws.

316.1933 Blood test for impairment or intoxication in cases of death or serious bodily injury; right to use reasonable force.--

(1)(a) If a law enforcement officer has probable cause to believe that a motor vehicle driven by or in the actual physical control of a person under the influence of alcoholic beverages, any chemical substances, or any controlled substances has caused the death or serious bodily injury of a human being, a law enforcement officer shall require the person driving or in actual physical control of the motor vehicle to submit to a test of the person's blood for the purpose of determining the alcoholic content thereof or the presence of chemical substances as set forth in s. 877.111 or any substance controlled under chapter 893. The law enforcement officer may use reasonable force if necessary to require such person to submit to the administration of the blood test. The blood test shall be performed in a reasonable manner. Notwithstanding s. 316.1932, the testing required by this paragraph need not be incidental to a lawful arrest of the person.

and the same applies for boating accidents:

327.353 Blood test for impairment or intoxication in cases of death or serious bodily injury; right to use reasonable force.--

(1)(a) If a law enforcement officer has probable cause to believe that a vessel operated by a person under the influence of alcoholic beverages, any chemical substances, or any controlled substances has caused the death or serious bodily injury of a human being, a law enforcement officer shall require the person operating or in actual physical control of the vessel to submit to a test of the person's blood for the purpose of determining the alcoholic content thereof or the presence of chemical substances as set forth in s. 877.111 or any substance controlled under chapter 893. The law enforcement officer may use reasonable force if necessary to require the person to submit to the administration of the blood test. The blood test shall be performed in a reasonable manner. Notwithstanding s. 327.352, the testing required by this paragraph need not be incidental to a lawful arrest of the person.

and just in case you do refuse.. you can be charged with this:

843.06 Neglect or refusal to aid peace officers.--Whoever, being required in the name of the state by any officer of the Florida Highway Patrol, police officer, beverage enforcement agent, or watchman, neglects or refuses to assist him or her in the execution of his or her office in a criminal case, or in the preservation of the peace, or the apprehending or securing of any person for a breach of the peace, or in case of the rescue or escape of a person arrested upon civil process, shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.

so you were saying?B)

 

[terrible one]

Hypothetical scenario. 2 people are in a car, they run a red light and get into an accident with another vehicle. The 2 people both admit to drinking alcohol. The person in the other car dies on scene.

I had a call almost exactly like this 3 years ago.
teenager steals a car, high speed pursuit results. stolen car with two passengers runs a red light and kills a driver of another vehicle. two teenagers exit car and foot pursuit occurs.

Transported both to local ED with officer in the back. Other driver was DOA. As far as documenting went I treated it no different than anyother TC.

 

[reaper]

As a matter of fact I DID re-read the laws.



and the same applies for boating accidents:




and just in case you do refuse.. you can be charged with this:




so you were saying?B)

No where in any of those does it even mention that Paramedics are mandated to preform a blood draw. The second one does not reflect to EMS. It is the Paramedics discretion on whether they want to preform the draw or not.
I was doing these long before the state officially OKed for full state use. We actually spoke with the State Representative involved with pushing it through. One thing that was always emphasized was the right of refusal by any medic, at any time.

 

[FLEMTP]

No where in any of those does it even mention that Paramedics are mandated to preform a blood draw. The second one does not reflect to EMS. It is the Paramedics discretion on whether they want to preform the draw or not.
I was doing these long before the state officially OKed for full state use. We actually spoke with the State Representative involved with pushing it through. One thing that was always emphasized was the right of refusal by any medic, at any time.

And thats all fine and well.. but I have seen with my own eyes a state trooper file charges and arrest a medic at the ER after the call because he flat out refused to do a blood draw on a drunk driver who killed a lady. He refused because he has a grudge against the police for a record in college and that the cops are all bad and out to screw everyone, and decided the trooper was going to "stick it to" the girl, so he refused thinking it would help her get out of the DUI and get him in her pants while he was at it. He ended up arrested and pled out to something else in court.. he was charged with refusal to aid peace officers...if i can find the arrest record online i'll post the link showing that is what his arrest was for.

Something else id like to point out is I also have a law enforcement background, and I know what the legislative intent was on many of these laws... but im here to tell you that sometimes when we enforce them, the "legislative intent" goes right out the window... same thing as the the book way of doing things is out the window in the field for us sometimes.

The "mandated" part is refusal to follow a lawful order from a sworn LEO. They do not have the training and or knowledge to draw and collect a blood sample, so they NEED a medical person to do it, so by not drawing the blood for them, you are "refusing to assist him or her in the execution of his or her office in a criminal case" If there is no good reason why you can't do the blood draw on scene then you should be doing it if they tell you to do it.

A critical patient is a good reason to refuse. I could also see many LEO's letting the fact that you are going to transport them for unknown injuries be the reason you refuse, but if you are called to the scene and refuse to do one on a noninjured person, and dont have any good reason other than you're not doing it, you dont wanna go to court, you dont wanna get involved, etc then I know of a decent number of cops that wouldnt hesitate to charge you, and, in the end.. they'll get their blood draw one way or another. Not saying i agree with it, im just telling you how things are out there.

 

[JPINFV]

So... law enforcement agencies are reimbursing EMS crews who are called out for the sole purpose of a blood draw, correct? Unless it's a muncipal crew, isn't it theft of services?

 

[Aidey]

I'm not sure where I said anything about not treating the person professionally, or humanely. If not letting someone talk on their cell phone is now treating them badly, we have a big problem, I don't let anyone talk on their phone in the back until all assessment and treatment is done. The only exception is if someone is translating via phone.

I'm more thinking about preventing conflicts of interest, or not making the problems worse. For example, in my hypothetical situation would you transport the driver and passenger together? Would you tell either one the other person is dead? Do you let the hospital staff know that the patient is likely a participant in a crime?

 

[FLEMTP]

So... law enforcement agencies are reimbursing EMS crews who are called out for the sole purpose of a blood draw, correct? Unless it's a muncipal crew, isn't it theft of services?

Couldnt tell you how they do it for private services, I work for a municipality.

I dont see how it would be theft of services.. EMS has a duty to respond when called, and do you report theft of services every time a homeless guy or someone without insurance calls 911? I mean come on now, its a stretch... plus how many times have you ever been called to "check a patient" for the police?

 

[FLEMTP]

I'm not sure where I said anything about not treating the person professionally, or humanely. If not letting someone talk on their cell phone is now treating them badly, we have a big problem, I don't let anyone talk on their phone in the back until all assessment and treatment is done. The only exception is if someone is translating via phone.

I'm more thinking about preventing conflicts of interest, or not making the problems worse. For example, in my hypothetical situation would you transport the driver and passenger together? Would you tell either one the other person is dead? Do you let the hospital staff know that the patient is likely a participant in a crime?

People do not talk on cell phones in the ambulance while being transported. Not only is it rude to the EMS crew, but you called 911 for a medical emergency, if you have the desire to talk on the cell phone over talking to the EMS crew, then its obvious you dont need EMS.

No way would I let someone either under arrest, psych, or suspected of a crime talk on a cell phone. Too easy for someone involved in an accident to "get the story straight" prior to talking to the police, plus if there is a death involved, they dont need to know that until the police discuss it with them.

No way would I transport driver and passenger together for the same reason, deciding on a story for example, about who might have been driving, or who had what to drink or smoke, etc.

I absolutely let the ER staff know that the patient was involved in a crime scene of some sort... that way they are aware the police will be coming to the ER shortly to interview the person, and so they can call the police should the person decide they want to leave AMA to avoid arrest. Plus, its a safety issue for the ER staff...if the person is suspected of a DUI homicide.. or even a non-alcohol related crime, say a strong arm or armed robbery, the ER staff should know, because you never know WHAT a person will do to avoid arrest...especially when they are under the influence of a mind altering substance.

I also make sure the ER staff know that my patient was involved in the same incident as Medic XX's patient so they can be sure to keep them separate, and it can alert the ER staff to a BS flag should both of the patient's claim to have been the driver, for example. It professional courtesy to let the ER staff know anything you can tell them about the patient and the situation, not to mention it paints a clearer picture for them about the patient's symptoms and/or condition.

 

[JPINFV]

Couldnt tell you how they do it for private services, I work for a municipality.

I dont see how it would be theft of services.. EMS has a duty to respond when called, and do you report theft of services every time a homeless guy or someone without insurance calls 911? I mean come on now, its a stretch... plus how many times have you ever been called to "check a patient" for the police?

I'm sure that, at the very least, the homeless person gets a bill even if there's a realization that he won't be paying. Of course a big difference between the police and a homeless guy is that the police have money. Similarly, EMS has a duty to respond to emergencies. Hopefully a "help, we need a blood draw" call is put on the lowest possible priority level since it isn't, by it's very nature, not an emergency. After all, if they really need a blood draw, why not transport to a medical facility or have their medical team at intake draw the blood?

 

[FLEMTP]

I'm sure that, at the very least, the homeless person gets a bill even if there's a realization that he won't be paying. Of course a big difference between the police and a homeless guy is that the police have money. Similarly, EMS has a duty to respond to emergencies. Hopefully a "help, we need a blood draw" call is put on the lowest possible priority level since it isn't, by it's very nature, not an emergency. After all, if they really need a blood draw, why not transport to a medical facility or have their medical team at intake draw the blood?

Well... sometimes there are situations where you need a blood draw on someone, but you dont have enough probable cause to effect an arrest for DUI of either alcohol or other drugs, so you do the blood draw, release the person on scene, and once the blood test comes back, obtain the arrest warrant and go pick the suspect up.

Taking a person to a hospital like that or to the jail for a blood draw sometimes isnt practical, and it creates an interesting custody issue... if they dont want to go, and you dont have enough PC to make an arrest at the time, how can you justify detaining someone and taking them to the ER or jail? You cant. Its easier to call someone to the scene and do the draw.

Our agency only sends a bill if we transport or administer ALS treatment on scene (ie: diabetic hypoglycemia) so there is no charge for us to do a blood draw for PD.

The most common scenario is that we get called for a car accident, arrive on scene, find that there are 2 vehicles, one is the victim who is deceased on scene, and the suspect that is either being placed under arrest for DUI, or some other charge, and the officer needs a blood draw, the sooner the better to preserve evidence, seeing as how some intoxicants can be out of the system by the time you do the draw at the jail or ER. The suspect is not injured and does not need EMS transport, and either the patient refuses or the officer refuses for the patient. We dont transport, but we are on scene doing paperwork on the deceased, and do the draw in the ambulance for the officer.

The other scerario is that the suspect is not injured, and at the time of the accident the officer doesnt have enough of a PC to make the arrest, and they do the blood draw as more of a procedural event, to aid in the investigation and either clear the suspect or implicate them. We do the paper work on the deceased, do the blood draw on the suspect, and obtain a refusal from them.

Either way, we would have already been there so its not really taking a unit out of service just to do the blood draw.. its just another thing to do while we are on scene before we clear. Plus, if there is a deceased, we're just sitting there waiting for the ME to come take custody of the body anyway.

 

[JPINFV]

So, basically, it's an end run around the law more than anything else. If they lack probable cause to detain and transport, then there's an interesting 4th amendment issue. I find it surprising that the legalities of forcing an invasive procedure (ok... it's a blood draw... but blood is not in plain sight. This is a search and seizure) have less restrictions than conducting a vehicle search.

 

[medicdan]

Anything the person says can be used against them. We are authoring a legal document.

I'm sorry, that doesn't work for me. LEOs, please correct me if I am wrong, but while that statement is true, is only applies only after the subject has been advised of their rights, or the cliche "Miranda Rights", and even then, only when the subject is detained, or is not free to leave on their own. Assuming they are A&O, they can leave our care... by signing a refusal... so the Miranda laws don't apply...

 

[JPINFV]

Technically, Miranda is only an advisory. Those rights were always present, even before Miranda v Arizona. Of course to quote Ron White, "... I had the right to remain silent, but lacked the ability."