No minors refuse....

[CAOX3]

So would you transport a 16 y/o driver in a TC even is she was without complaint out of fear of some injury that she has but isn't complaining about?

TC?

In my system I dont have a choice unless a parent or adult is present or I can speak with them.

I dont have a problem transporting a minor without complaint, they lie, they are scared and they just wrecked daddys Benz.

There are a whole list of reasons why they wouldnt be honest with me, their not where their supposed to be, their not with the people their supposed to be with, their hiding their dope in the glove compartment, whatever.

Why not err on the side of caution? Unaccompanied minors make up a very small percentage of our calls.

 

[exodus]

So would you transport a 16 y/o driver in a TC even is she was without complaint out of fear of some injury that she has but isn't complaining about?

I would.

She's not liable for herself, and I would imply that her parents would want her to get a full medical assessment by a doctor before being totally cleared, rather than be sent home. If the collision is strong enough for her to be bruised on her shoulder, it was strong enough for her to hit her head and bruise it.

 

[JPINFV]

TC=Traffic collision. I'd argue that not everyone in a traffic collision is a patient and I don't have to get a refusal from a non-patient.

For starters, money. If I ever have a child transported when they lack a complaint, then I'm not paying for services not requested.

Inconvenience to everyone involved (the hospital now has to baby sit. The parents now have to come to the hospital when the vehicle might be in drivable condition. List goes on).

In the case of a patient without complaint, the fact that there is no complaint.


Exodus, there are a lot of things that can cause bruises. I guess football players should be required to go to the hospital if they're parents weren't at the game since if an impact is hard enough to leave a bruise, then it was hard enough to bruise their head.

 

[EMSLaw]

So would you transport a 16 y/o driver in a TC even is she was without complaint out of fear of some injury that she has but isn't complaining about?

You can transport a minor to the ER under the doctrine of implied consent for a life-threatening medical emergency. The idea being that an reasonable parent would want their child treated in a life-or-death situation.

In the case of minor injuries, though, things get a bit foggier. You really need to contact the parents if possible, and obtain their consent for treatment and/or transport. If you can't contact the parents, then you have to get the police involved so they can assume temporary custody of the child (and probably tell you to take him or her to the hospital).

 

[18G]

JPINFV makes a valid point. Not everyone involved in an MVC is considered a patient. We had this specifically addressed in my region. Unless the occupants requested EMS themselves, have a complaint, or have visible injuries, they are not considered a patient and do not require a refusal. This gets documented as a "no patient found", non-injury, or good intent call regardless if minor or adult.

I think some common sense needs to prevail and you need to show that you acted in the best interest of the individual in question.

 

[JPINFV]

A few quick final comments because I don't want this to go around in circles, which I fear it is heading in.

"Always" and "never" are almost always not the correct answer on multiple choice tests and this is one test strategy that applies to real life.

Absolutes like zero tolerance always comes with unintended consequences.

"Can" and "should" are two different questions.

Just because you can doesn't mean you should.

Sometimes just because you "should" doesn't mean you should (see comment about absolutes).

The road to hell is paved with good intentions.

 

[CAOX3]

I agree we did get a little off track.

As far as the article, in my opinion it seems this was a slam dunk transport the medic failed his patient.

Refusals policies are put in place for these such occasions, we cant control decisions made by all providers, so we institute policies to prevent these situations from occuring.

So yes I agree we may transport some minors that may not even require transportation and yes it may be a pain in the butt for everyone involved. Im fine with that if it prevents some knucklehead provider from leaving a kid on scene to die.

 

[Aidey]

So you're dispatched to a minor motor vehicle collision and one car has a 16 year old occupant with a hematoma on her shoulder where she hit the door. She asks for an ice pack. Do you give her an ice pack, and if so, do you still transport over her objections since she "can't refuse?" Based on your assessment so far, the hematoma is her only complaint and she if fully alert and orientated.

There are situations where reality is more nuanced than the class room. At what point is the patient with a psychiatric disorder unable to consent and is instead treated under informed consent. I'd definitely argue that A/Ox4 isn't the end all, be all of determining competence. What about elderly patients who are slowly losing their mental abilities due to progressive neurological disorders? How about when said patient's wishes clashes with their nurses wishes when in a long term care facility or a family members. These aren't easy questions to answer in reality and not one which can necessarily be run through medical control a lot of little details are going to fall through the cracks in a radio conversation.

This isn't about classroom medicine vs real world medicine. It is about what is legal or not to do. Whether we agree with the laws or not, we still have to follow them. I also work in a system where someone under the age of 18 who is not emancipated legally can not refuse transport. Period. End of discussion. We (EMS) have no control over this. State law states anyone under the age of 18 is not capable of refusing care.

If we arrive on scene and assess a minor to be uninjured and we can't contact their parents we can call med control and request permission to not transport. Unless it is an emergency, I attempt to contact all parents prior to transporting to let them know, get any history the kid may be forgetting, and to find out what hospital the patient should be taken to.

Like was mentioned above, most MDs won't go for under 18 refusals. Maybe, maybe they would with someone who is 17, nearly 18 and they were not the one who requested EMS; but when I call I expect the MD to always tell me to transport.

In the other examples you used it's hard to say what I would do without a scenario since there is a large spectrum of patients that fall under those categories. If we have a patient that is technically AOx4 and turns to me and says "you really need to shut the ambulance door before the carnivorous pink polka-dot bunnies get in" chances are they are going to the hospital even if they don't want to.

 

[Outbac1]

Here a pt can refuse at age 16. If we have any doubt as to the pts condition we very strongly encourage them to go. If they still refuse I then call online for a second opinion. If the DR. thinks they should go they usually say something along the lines of " I think they should go if they continue to refuse be sure they know they could DIE from this and have them sign a refusal." Sometimes if the pt hears the Dr. say they could "Die" they change their mind.

In this case its hard to say what really happened and was said. But it raises concerns about an inadequate assessment and a one person responding truck. A second medic may have had a different opinion as to the pts condition. Also we don't know the level of the attending persons medical training. Were they really qualified to do a thourough assessment?

 

[Outbac1]

We can only recommend treatment and/or transport, Ambulance Officers can also decline transport and are not legally obligated to transport a patient.

There are times this would be nice to have. (Bold highlights mine)

 

[MrBrown]

This isn't about classroom medicine vs real world medicine. It is about what is legal or not to do. Whether we agree with the laws or not, we still have to follow them.

Good point

If we have a patient that is technically AOx4 and turns to me and says "you really need to shut the ambulance door before the carnivorous pink polka-dot bunnies get in" chances are they are going to the hospital even if they don't want to.

Here, that would fall under the bit that says ambos can transport and/or treat an incompetent patient if it is in thier best interest.

There are times this would be nice to have. (Bold highlights mine)

I am suprised Canada doesn't have something like we do here, you Canuckistanaians seem darn clever

 

[Outbac1]

Now thats a mouthfull! Glad I was sober when I read that.

When someone calls, we HAVE to transport. No matter how ridiculas the pt complaint. Now that doesn't mean they get baby sat at the hosp. I've marched a good many in the front door to wait their turn in the waiting room with all the walk ins. If a person becomes a frequent flyer for non life threatening calls then we can have them investigated and their future 911 calls will go to a triage Dr. who decides if they get picked up. Documatation is imp., if they are calling to say they are SOB and we continually document that they are not. It definantly goes against them.

 

[firecoins]

I really have not read the thread but several things about the article stick out.

Medic2 was given the duty to assist the emergency call. Medic2 only had one responder, James Griffin. Griffin arrived at 1:54 p.m. and left 16 minutes later at 2:10 p.m. on August 12, 2008. One responder at just 16 minutes, a questionable evaluation

The ;ength of time it takes to do an assessment seems odd. I can do a full assessment in less than 16 including an ECG and orthostatics. We do not take exact temperatures since nobody carries thermometers. Most ALS providers I know can do this and be quite thorough.

Atlas Fraley rated his cramp pains at 7 on a scale from 1 to 10 with 10 being aggressively severe. Atlas explained muscle pains in arms, legs, and abdomen. Fraley's pains were so bad he could not sit still nor stand still. Fraley was noted as asking for an IV and when the pain would subside. Fraley's blood pressure was 134/102 with 92 beats per minute while standing as noted by Griffin.

Based on this the pt should be going to the ER.

Griffin's report reflects Orthostatics were not performed along with no ECG, and no temperature taken.

ECG shpuld have been done. We don't take temperatures. We feel the patient's skin. They are hot, cold or inbetween but a hx of events should have set something off here. Does anyone else take temperature?

 

[Aidey]

I thought it was strange too that they were going on about "just 16 minutes". I sure as heck hope I can take full vitals, orthos, and an EKG in 16 minutes...

 

[NC_EMT]

This was not too far from where I live. I was under the impression that minors could not sign a refusal and must be transported as implied consent. At least thats what I was taught in school.

 

[firecoins]

In 16 minutes you should be on the way to the ER.