So, I'm learning about how doctors make competence determinations in school, and it struck me that I couldn't think of particular criteria that EMS uses for competence. I looked it up in my protocol book and couldn't find anything, and my service doesn't have a particular protocol about it. Logically, AMS seems like an excellent criterion, but while I have a good "feel" for AMS, I don't know that I could define it in front of a jury. I also feel like this is a big area for potential litigation in EMS... but for doctors, it's less of a big deal. Their determination relies on much more general ideas, like ability to understand the situation, ability to voice an opinion, ability to support that opinion logically, etc., which are not backed up by any particular scale or test. This is a common difference between doctors and EMTs, though, so I expected some sort of checklist-like form of anti-litigation. Do any of you have specific local or state protocols specifying and limiting your ability to determine the medical competence and reliability of your patients?
Is Competence Determined by Protocol?
- Thread starter AMF
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I think that in practical terms it comes down to a judgment as to whether to call law enforcement to have someone arrested, and much of the responsibility actually rests with the LEO. You make your case as a paramedic or EMT as to why the person needs to be formed, and they generally place a lot of weight on that opinion, but ultimately they have to decide whether it's lawful.
I find that where protocols exist, they tend to be extremely restrictive, i.e. anyone who has consumed alcohol is supposedly no longer competent. The wording often suggests the paramedic / EMT must transport these patients, but fails to face the reality that many of the patients that fall within these guidelines remain competent, and don't meet criteria to be arrested.
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It absolutely IS a big potential source of litigation.
Altered mental status isn't that hard to determine. Does the patient know where they are, what time it is, who they are, what is going on? Are they trying to harm themselves or others?
If you can document a good reason to believe that the patient is not oriented, and can show that you were acting in good faith to do what you thought was in the best interest of the patient, you probably have little to fear, legally. And of course the best legal protection is to get a direct order from MCO.
I would not personally physically restrain a patient unless it was clearly imminent that they were going to harm themselves or someone else. That's the cop's job.
Although it is far form a perfect system, we use (and document) the following criteria as part of our "Aid to Capacity" test - required any time that a patient refuses treatment/transportation to the hospital.
1. Pt. verbalizes/communicates understanding of clinical situation (e.g. what is wrong with you?)
2. Pt. verbalizes/communicates appreciation of applicable risks (e.g. what could happen if I don't help you?)
3. Pt. verbalizes/communicates ability to make alternative plan for care (e.g. what will you do once I leave?)
4. Responsible adult on scene.