No Choice But To Go To The Hospital!!

CFRBryan347768

CFRBryan347768

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Now i'm not second guessing my crew, because in the end he did need medical attention, according to hospital standards. But any way the question is would you have transported, heres the scene...

you pull up on scene for an unknown medical you find an 87 y/o m 1 recently amputated leg(according to him, but he can not recall when it was done) he does not want to go to the hospital, he did not call 911 his neice did but she is no where to be found, after arguing back and fourth, the medics feel he can not take care of him self and is making the wrong choice by trying to refuse treatment and we cant wait for his son who is stuck in traffic 45 minutes away, upon lifting him onto the strecher(easily accessable, no tight spaces) you realize he has no pants on and the chair he was sitting in is also a "dumper" so after almost puking over that smell and the smell of cat urine you get him to the ambulance.....would you guys have agreed to transport?
 
Without further information, I can't really say. Information about the housing situation, his attitude, state of mind, etc. When you say "dumper," do you mean a specialty designed seat to allow for defication?

It does not seem that he has the ability to support himself, but it does seem that his son is, at the very least, making an attempt to care for him. How successful that care is, though, I can't say. My main problem is that it seems that the crew is overmanding him because they think he is making the wrong choice, not because he can't make a choice. The simple fact is if the patient understands the ramifications of their wishes, then we are supposed to respect those wishes, be them right, wrong, or indifferent.
 
Well... was he CAOx4? Does he understand the risks associated with refusal, and still wishes to refuse care? If yes and yes... Press Hard, making three copies. If you don't want to let him refuse... call command and/or speak with PD.

If you take someone without their consent, without a legal reason to do so... that would be kidnapping.

From your post, it seems you have BLS transport units with ALS chase cars... the medic can't just say "he's going"... the medic needs to call command and be able to articulate WHY The patient isn't able to remain at the residence. Is he being abused/neglected? is he suffering from an altered mental state (sounds like he might have been).

At the least... a call like this needs to be delegated to a person who makes more money to make these decisions - like a command doc and the service supervisor.

Jon
 
part

of the problem was, which i for got to add, was that he wasnt making sense, and was not completely honest...."sir are you on any medications?" no, in plain view notice i said plain view were 4 diffrent valid perscriptions for him....wether we made the right choice or not, he would have needed a hospital in the near future.
 
Not knowing medication/medical history doesn't necessarily mean anything. If I had a dollar for everypatient who denied having a medical history ("Do you have any medical problems such as..." "Nope"), but later ended up stating that they do ("Well, I do take these pills), then I'd be rich.

Of course it doesn't necessarily not mean anything either.
 
I

guess our protocols could be very diffrent or, the medic in charge honestly felt that there was no chance of leaving the pt. but as stated it worked out in the end because of some things that needed medical tretment.
 
aox4 and able to understand risks of refusal= clear and available. i dont kidnap people
 
It's never that simple. How many suicide patients are A/Ox4 and understand that the sucessful result of their actions is death? In California, temporary holds can be placed due to danger to self, danger to others, or grave disability. The question is, does the patient fit into the last category.
 
i agree the issue of behavioral emergencies is not always clear cut...

there was a call where a male in his late 60's was having chest pain... family called 911... medics hooked him up to the 12 lead, and he was having an MI...

however, he refused treatment against all advice and medical control's strongest attempts... he simply said he understood the risks, and would refuse treatment and seek his own doctor...

he died later that day.

did he know he was in the process of dying? apparently he did, and did not want to stop it's course. was he in right mind to make that decision, even though it was against all logical reason? he was, and although difficult, he was allowed to make it.

when it comes to behavioral emergencies, the guidelines for us seem to be that it is within someone's right to let a current illness take it's course without intervention. however, to act against oneself, and cause an illness or injury that previously did not exist, is the case where they would not be able to refuse...

hard decisions some times, and not always black and white.
 
I have had to deal with this with a master manipulator pt. We had some long discussions with the MPD and law enforcement and this is what we came up with:

  • You cannot force anyone, no matter what the health condition to accept your treatment against their will, if they are alert to person, place and time.
  • The only exception is if they are threatening harm to self or others.
  • If they are threatening harm to self or others, we use LEO's for an ITA (Involuntary Treatment Authority)

Two cases immediately leap to mind, one we were able to document an adult at risk only after she got so drunk that she didn't know who or where she was. The other was a demential pt. She was declared legally incompetent, but the one son who had the POA over her healthcare was out of town and the other son couldn't authorize treatment. We called the MPD and he said leave her home.
 
First, sorry, but with the limited info you posted it is impossible to say what, if anything, should have been done differently, or the same.

Second, kind of odd to say that you aren't trying to second guess the paramedics and then do exactly that. Don't you think?

Third, instead of asking the question here, maybe you should be talking to the people that actually were there and made the decision. Start by asking them what they thought was wrong with the patient, why they felt he needed transort, what they saw that made them think that, and why they could not let him refuse.

If you actually want to learn something, that is the way to go about doing it. Playing monday morning QB without any info to go on is a pretty big waste of time.
 
triemal04 said:
First, sorry, but with the limited info you posted it is impossible to say what, if anything, should have been done differently, or the same.

Second, kind of odd to say that you aren't trying to second guess the paramedics and then do exactly that. Don't you think?

Third, instead of asking the question here, maybe you should be talking to the people that actually were there and made the decision. Start by asking them what they thought was wrong with the patient, why they felt he needed transort, what they saw that made them think that, and why they could not let him refuse.

If you actually want to learn something, that is the way to go about doing it. Playing monday morning QB without any info to go on is a pretty big waste of time.
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im not second guessing them i just wanted to know what you guys and gals would have done, i felt he should have gone to the hospital. and the minimal information was everything that was made available for us...the guy could barely communicate(due to the fact we couldnt understand him) besides the f bombs and im not going to the hospital....but than again in this case i was the 3rd person so i had no say. and the more i keep thinking into this the more i believe your right...i am second guessing them haah!
 
Emt

Have you ever heard of breathing through the mouth and not your nose so not to notice the smell? I have been in that type of a situation but look at it this way, what if there was a very nasty accident that you couldn't take to look at, would you turn away? Or say it was you and you were a very site anyone would want not want to help due to the way you looked or smelled, wouldn't you want someone to help you? Being in EMS I think it is part of your duty to serve. I'm sorry but I think you have to over come a lot when you are in EMS.
 
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Bridgegirl said:
Have you ever heard of breathing through the mouth and not your nose so not to notice the smell? I have been in that type of a situation but look at it this way, what if there was a very nasty accident that you couldn't take to look at, would you turn away? Or say it was you and you were a very site anyone would want not want to help due to the way you looked or smelled, wouldn't you want someone to help you? Being in EMS I think it is part of your duty to serve. I'm sorry but I think you have to over come a lot when you are in EMS.
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did i say i didnt want to treat the guy?? NO! it was the simple fact that it smelled that way because he could not care for him self, he was stuck in 1 postition for more than 9 hours. so dont tell me about my duty to serve or overcoming, i have smelled alot worse, and once again NOT ONCE DI I SAY I WOULDNT TREAT THE &$%#*&@ Guy!
 
If I'm not mistaken, Ockham's Razor states:

"All things being equal, the simplest answer is usually the correct one."

So yes, he should have been transported. That was clearly a DHS issue. You could have called med control and put that monkey on his/her back.

However, legally the pt must be C-A-O X 4 and verbally appropriate, fully aware of their consequences and able to quote them back to you. If these are in effect along with noone other than the pt is durable power of attorney, then you do not have informed consent.

Get the refusal and inform the family to call you back when he is no longer that aware which will give you implied consent. Then you can take him. Until then, you cannot even touch him.

At least I believe that's how it works in my state.
 
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I'd definately transport the patient to the hospital for further evaluation, and if need-be have social services come talk to the pt and family. If at that point, the patient/family refuses care, it'll be well-documented and under the authority of the ER doc or social services worker to do so.
 
So your going with the 'pass the buck' method?
 
I wouldn't call it 'passing the buck' I'd call it covering your butt, and allowing someone who's better trained to deal with people who are living in poor conditions. The patient might not have necessarily needed physical treatment, but some sort of psych-consult or intervention with family members present. Its a sticky topic either way you go and I can see either side to the situation. It's just something that my supervisors and the Medical Director has always told us to allow them to deal with instead of at the pre-hospital setting.
 
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