How do you guys handle these calls? such as Intoxicated individual, able to walk but with an unsteady gait, slurred speech. Definitely drunk unknown number of drinks, bystanders report that he was in a fight where he was kicked in the head repeatedly noted to have a 2cm laceration to the front of his head above his R eye very adamant that he is not going to the hospital despite encouragement from his friends, PD and EMS. AAO x 4, although not able to recall what bar he is at consistently (so, is he really AAO x 4?), but otherwise knows the city and state.
Our protocol states that if they are intoxicated with associated trauma they "must" be transported to the ED, although we have the option to contact medical control for a refusal. The above scenario is very specific because it relates to a call I went on, this person was transported as he eventually consented, but in general how do other providers handle this? how hard do you push these people to go to the ED if they are refusing? what criteria are you using to determine if they have "decision making capacity," particularly when they are intoxicated, as the protocol states that they must have to refuse care? It seems that when I have taken these people to the ED they commonly sign out AMA, as the ED seems to take the approach that if they can hold the pen and sign the AMA form they can sign out. But frankly I can't seem to get a good answer from any of my superiors as to the best way to handle these calls.
One of the problems that I think that I encounter with these is determining their decision making capacity, it's defined in the protocol as an ability to; know the risks of refusing, understand those risks, and still refuse given that. I've gone the route of telling them the risks that i believe are associated with the condition with the obligatory "you might die" speech, having them explain that back to me, and question them again about their desire to refuse care, but things get gray when they are intoxicated in terms of their understanding. What is more of a liability? Taking them to the hospital against their will if they are intoxicated, or signing them out even with doubts about their decision making capacity?
I feel like a big answer here is going to be "call medical control" while I have done that in the past, i work in a small system and frankly the ED physicians on duty are not at all familiar with our protocol, and as you all know I'm sure it can be challenging to paint an accurate picture on the phone with the ED physician as to their level of intoxication and demeanor.
I know that was a long post, but thanks for any input!
Our protocol states that if they are intoxicated with associated trauma they "must" be transported to the ED, although we have the option to contact medical control for a refusal. The above scenario is very specific because it relates to a call I went on, this person was transported as he eventually consented, but in general how do other providers handle this? how hard do you push these people to go to the ED if they are refusing? what criteria are you using to determine if they have "decision making capacity," particularly when they are intoxicated, as the protocol states that they must have to refuse care? It seems that when I have taken these people to the ED they commonly sign out AMA, as the ED seems to take the approach that if they can hold the pen and sign the AMA form they can sign out. But frankly I can't seem to get a good answer from any of my superiors as to the best way to handle these calls.
One of the problems that I think that I encounter with these is determining their decision making capacity, it's defined in the protocol as an ability to; know the risks of refusing, understand those risks, and still refuse given that. I've gone the route of telling them the risks that i believe are associated with the condition with the obligatory "you might die" speech, having them explain that back to me, and question them again about their desire to refuse care, but things get gray when they are intoxicated in terms of their understanding. What is more of a liability? Taking them to the hospital against their will if they are intoxicated, or signing them out even with doubts about their decision making capacity?
I feel like a big answer here is going to be "call medical control" while I have done that in the past, i work in a small system and frankly the ED physicians on duty are not at all familiar with our protocol, and as you all know I'm sure it can be challenging to paint an accurate picture on the phone with the ED physician as to their level of intoxication and demeanor.
I know that was a long post, but thanks for any input!
