"She's not acting right."

[abckidsmom]

I am sorry but the fetus plays no role here. The mother has the choice of being treated or not being treated unless she is altered. The fetus is not my concern.

I totally agree. The fetus is not in play.

 

[Veneficus]

She refuses every slick attempt at the step approach, including the slick "I'm on your team" kneeling by the side of the bed trick. "Get back from me, don't touch me! You know you can't touch me if I tell you not to.!"

She refuses to eat or drink.

She's just a shining ray of sunshine in the night!

Private conversation with the boyfriend reveals that she is in charge of the house, and he's thinking he's in major trouble for calling at all. He says he will not be calling again unless she's unconscious. You take a minute to educate him on what to do if he thinks her sugar is low.

Private conversation with her reveals nothing. She's not talking.

Boyfriend says there are no drugs or alcohol in the house (even before Roscoe arrived.)

Then there is no patient and no reason to stay.

 

[abckidsmom]

Then there is no patient and no reason to stay.

While I know this, and am comfortable with that decision, I still feel a little doubt when I'm in a situation like this. My point with this scenario was to see if other experienced medics have any of that.

Would you (the collective you) give this chick a second thought after you left?

 

[NomadicMedic]

Would you (the collective you) give this chick a second thought after you left?

Nope. At least, not until we were dispatched again for "unconscious diabetic".

 

[mycrofft]

Sure I'd think about it.

There are calls I think about thirty years later.

There is the possibility that the boyfriend DID pull the red lever too fast, also.

 

[Veneficus]

While I know this, and am comfortable with that decision, I still feel a little doubt when I'm in a situation like this. My point with this scenario was to see if other experienced medics have any of that.

Would you (the collective you) give this chick a second thought after you left?

probably more than I should

 

[EMSrush]

While I know this, and am comfortable with that decision, I still feel a little doubt when I'm in a situation like this.

Did you consider calling MedCon, to see if the Pt might be willing to speak to him/her? Even if the Pt refused to speak on the phone, it's another good way to document your attempt, and CYA.

 

[abckidsmom]

Did you consider calling MedCon, to see if the Pt might be willing to speak to him/her? Even if the Pt refused to speak on the phone, it's another good way to document your attempt, and CYA.

I have called medical control on refusals where I truly believed the patient would die if they stayed home, but this was not one of those times.

I feel comfortable with documenting the attempt to convince her with just the deputy there as a witness. Calling medical control is nothing more than having one more knee-jerk reaction in the thing, IMO. They never say anything more than "you are going to die if you don't go to the hospital!"

The last time I called, for the guy in anaphylaxis who was refusing, the resident was more uncomfortable with his refusal than I was. We had arrived on scene and given him epi immediately, then after he could breathe he was refusing transport. We ended up giving him 50 mg Benadryl, a liter of saline and solumedrol before we left him on the scene. It was not one of my happiest moments, but given his absolute refusal to be transported, I figured we did alright by him. The resident dictated the paragraph he wanted included in my report. It had a lot of direct quotations in it.

 

[Seaglass]

I'm not as experienced as most people here, and I'm not a medic, but I would've thought about it after the fact. I usually forget about calls pretty quickly, but sometimes they'll stick with me. I'll try to figure out why.

In this case, I'd try talking to the patient alone first. I can usually talk them into letting me evaluate. The pregnancy isn't a factor for me, though I'd try using it to persuade the patient to let me evaluate her.

If that doesn't work, I'd take the boyfriend aside, tell him what he can do and when he really needs to call, and probably take my time getting back to the station. Then I'd document the hell out of it.

 

[Veneficus]

Did you consider calling MedCon, to see if the Pt might be willing to speak to him/her? Even if the Pt refused to speak on the phone, it's another good way to document your attempt, and CYA.

There was actually an EM study about 7 years ago (I read a lot of studies, some 4-6 a day so I don't always have the link handy) that showed patients were less likely to refuse when speaking to a doctor, even on the phone, than with EMS persons.

BUt if the person is (like in this case) doesn't want anything to do with help, then I wouldn't be too inclined to pull a doc away from whatever she was doing to listen to an argument between me and the patient over the phone.

In this case, the patient seems really anxious about accepting help. Perhaps from a fear or negative experience in the past. (like a self righteous provider that threatened her or made her afraid of calling for hellp.)

 

[usafmedic45]

She refuses every slick attempt at the step approach, including the slick "I'm on your team" kneeling by the side of the bed trick. "Get back from me, don't touch me! You know you can't touch me if I tell you not to.!"

She refuses to eat or drink.

She's just a shining ray of sunshine in the night!

Then her shuffling off her mortal coil and taking her spawn with her would be no great loss to the world now would it?

Would you (the collective you) give this chick a second thought after you left?

You mean beyond hoping that somehow her uterus becomes so polluted from whatever drugs she uses and VD she's picked up that she can't breed anymore? No, not really.

I have called medical control on refusals where I truly believed the patient would die if they stayed home, but this was not one of those times.

I feel comfortable with documenting the attempt to convince her with just the deputy there as a witness. Calling medical control is nothing more than having one more knee-jerk reaction in the thing, IMO. They never say anything more than "you are going to die if you don't go to the hospital!"

CYA. The doc is a much more lucrative and attractive target for the malpractice lawyers than an EMS provider.

Nope. At least, not until we were dispatched again for "unconscious diabetic".

Hopefully, the "father" would get distracted enough by his XBox or the NASCAR race that he wouldn't notice until it was well beyond that point.

In this case, the patient seems really anxious about accepting help. Perhaps from a fear or negative experience in the past. (like a self righteous provider that threatened her or made her afraid of calling for hellp.)

More than likely just good ol' fashioned stupidity.

 

[Veneficus]

More than likely just good ol' fashioned stupidity.

I disagree, more than likely is afraid of the bill that is going to come with going to the hospital.