Etoh?

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dillan

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I'm an EMT-B volunteer, with a non paying/non charging service. Had a call to the local tavern with an elderly (85'ish) M who had fallen off his bar stool. Upon arrival pt was supine. Placed C-colllar and log rolled on to LBB. Loaded and transported. He is also one of the town drunks and a pervert. My question is "Was is necessary to complete a full trauma assessment?" Also, the guy is trying to grope 2 females in the back.
 
It probably was not necessary, but i cannot tell for sure due to me not knowing every thing that happened. In my point of view its a gray area It is justifiable that he was put on a LSB, for various reasons including but not limited to covering your own and other reasons due to he actions described in the back of the rig.

And, *cough* ADMIN, shouldn't this be in the EMS Talk section, as it isn't a question about the Forum.
 
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as much as it is annoying and even with the hx this guy has (according to you) every pt in my opinion deserves the same treatment. the only hx we shud be interested is medical hx and the event that caused the injury. i can see your frustration though being a vollie, i respect that so much....but just remember you cud run on this guy and not give him e the full work up only to discover in the ED that he had a Fx or H/I and then ur up the creek without a paddle cos you didnt treat appropriately man..my advice give everyone the full up that they need
 
Drunk or not or even the town perv, standard of care should always apply. And remember, in a crowded bar there are witnesses to your care.
 
Indeed, i have had patients swing on me and after the PD restrained tehm i still provided care for (her) the way i would anyone else.
 
Difficult patients.....

This is were you have to put what you know about someone aside and treat him like any other trauma patient. You should not compromise your patient care standards for any reason, even if the patient is a "real piece of work".
 
dillan said:
I'm an EMT-B volunteer, with a non paying/non charging service. Had a call to the local tavern with an elderly (85'ish) M who had fallen off his bar stool. Upon arrival pt was supine. Placed C-colllar and log rolled on to LBB. Loaded and transported. He is also one of the town drunks and a pervert. My question is "Was is necessary to complete a full trauma assessment?" Also, the guy is trying to grope 2 females in the back.
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Good job with the c-collar & LB! Yes, complete a full trauma assessment. You never know what else you might find...you never know the whole story & it's better to be safe than sorry!
 
Why does being "town drunk and a pervert" matter?

Alcohol can mask many symptoms... including those of a head injury and diabetics. If someone has ETOH onboard... you need to work them up completely.

If your patient is assaulting you or your crewmates... get PD assistance. The patient may need to be restrained.


Why did you board and collar the patient? What signs and symptoms were present to indicate that was needed? Did the patient loose consciousness?

Are they on blood thinners?

Oh... I moved it to the EMS Talk session.
 
Furthermore, it will be that ONE TIME that you don't follow standards of care because it was thought that it is the same ol' routine, that will get you in the hot seat. Same assessment every time.
 
I can understand Spinal precautions. Uncontrolled fall from greater than 4 feet. Chances are good the Pt struck his head. It doesn't take much to cause even a minor C-spine fx. Up here, our protocol states any contact the head makes with an immovable and solid object requires Spinal precautions.
 
Come work at the jail with me for a week.

If you got into EMS for helping people while they are acting nice, you sure made a misstep. Treating all people well can't hurt, you are going to see good people at their worst, and strong people at their weakest; sometimes their strength will amaze you, especially kids; but you always have to do the job the right way. If the scene and setting call for stringing the patient up between golden weather balloons flown by virgins, do it. And remember scene safety includes not letting yourself or your partners get cornered or clouted by anyone. If you cannot safely examine or treat a patient, then it has to wait until it is safe. ;)
 
Perv's need love too!

Pt care is pt care and the same standard applies to all. As a female who has treated many a "handsy" pt in varied stages of inebriation, the best defense is not being embarrassed by the pt or showing that it's getting to you. People like this generally thrive on your discomfort.

Watch the hands, and remember, inappropriate touching is an assault and can justify restraints. I have used them or just the threat of them to keep pts in line in the back of the rig. There is no reason to endure being groped by a pt.

But, you can minimize it by being in control of your patient and the scene. Direct eye contact, firm voice, (one deputy here calls it my 'mom voice') "Do not do that again. Do you understand? If you do that again I will either place you in restraints or pull this rig over and wait for law enforcement to ride with us? Do you understand me?"
 
So does that Pt. require neck/back per your protocol? In mine they get neck and back. They have a mechanism that could cause a C-spine injury and they have ETOH onboard. The combination of a possible mechanism with any number of other factors buys you a collar and lsb in my system.
So that out of the way a full trauma assessment; absolutely. Do I think I will find any injuries, maybe. Am I allowed to pat my Pt down, no. But I can do a trauma assessment. If I pull a belligerent drunk out of a bar I will have LE check for weapons but I will also do a trauma assessment making sure their waistline, pockets, and socks are not hurt.
Finally they like to grope people in the ambo; no problem. That is a firm indication for hands getting packaged up inside the spider straps. That is how I conduct business!
J
 
OK... now for the "what I do if I have a patient who is making my partner uncomfortable".

I'm a big guy. 6'3" and wide. I've got a VERY loud voice when I need to... and I've got no problem calling for the PD if I need them. Usually drunk patients don't try to grope me. If they are female... I try to have a female crewmember ride with them and I'll drive... if not that, then make sure there is someone else in the back with me... PD, another volunteer, etc.

Just because the patient is an a**hole doesn't mean you don't need to treat them, though.
 
Jon said:
Just because the patient is an a**hole doesn't mean you don't need to treat them, though.
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This I have to disagree with. Back of my unit is no different from the real world. You want my respect, then you show me respect. I do not put up with anyone disrespecting me or my partner. They will get the same treatment as anyone else, but they may not get the respect.
 
Even if he is a frequent flyer, maybe he'll get the picture after getting drunk enough winding up in an ambulance on an uncomfortable backboard and stacked up ER bills...however i'd still treat him as any other patient
 
reaper said:
This I have to disagree with. Back of my unit is no different from the real world. You want my respect, then you show me respect. I do not put up with anyone disrespecting me or my partner. They will get the same treatment as anyone else, but they may not get the respect.
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Now you're just lowering yourself to their level. Maybe it gives one some satisfaction to treat a patient like a di*k just because that is the way he or she is treating you. But what it illustrates to me an inability to adapt patient communication skills in consistent professional manner, irregardless how the patient is treating you.
 
Sorry, I am known for having the best pt empathy and communication. There is nothing unprofessional about not letting yourself be disrespected or treated like crap.

You will be amazed at how fast the drunk little punk, will start to be nice. Then I am just as nice back.

This does not mean that I physically or verbally abuse my Pt's. I treat them well, just not as friendly as I normally am.
 
karaya said:
Now you're just lowering yourself to their level. Maybe it gives one some satisfaction to treat a patient like a di*k just because that is the way he or she is treating you. But what it illustrates to me an inability to adapt patient communication skills in consistent professional manner, irregardless how the patient is treating you.
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Karaya you are poingnant as ever! A pt's attitude should never sway your bedside manner. Morals and ethics kids ...

As to the original thread ... Why the HeKK are we even discussing this? Common sense cmon! Are you sure he was drunk? Did you draw blood and do labwork? Are you sure he wasn't just a victim of surroundings? DKA, and just happened to be in a bar??? You don't know. C-Spine, Back Board, head to toe assessment, transport to the closest appropriate facility. D-Stick, Temp, ECG monitoring appropriate to pt. condition, BP, SPO2, Discretionary IV access, Fluid Challenge ( provided they are confirmed normotensive) , Thiamin.

If he starts to get squirly in the back of the truck, I would try verbal correction, if that doesnt work, I would use soft restraints to restrain him to the stretcher so he is not a danger to himself or those around him.

If he has a head injury he may be altered. Being the town drunk, and a perv does not disclude him from the best possible care available to him.
 
I've always found that intoxicated patients react to the way you present yourself in a situation. I'm small (5'3" and 125#), so I know that while I'm a scrappy fighter, I do not want to have to tussle with any patients. I always present myself in a professional manner, act sweet as pie, and ALWAYS end up with the patient wrapped around my finger. That being said, I don't give my patients an inch. If they are being disrespectful, I let them know, but in my most respectful way possible.

As for the focused/trauma assesment, unless you have an x-ray machine, a CT scanner, and an MRI, the assume the worst. Who knows, maybe your patient fell off of his stool because he's nursing a stab wound between the ribs up at his arm pit. Or maybe he was just a sloppy drunk. But either way, and ESPECIALLY because you're dealing with a geriatric pt, you should always cover your butt and the bases. It really is better to do too much than not enough in our line of work.
 
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