What do you do in this situation...?

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Tk11

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Just out of curiosity as I don't remember learning it...

You have a teenage patient that overdosed, you can tell they need medical help. Patient says they're ok and don't want to be transported, Dad says she or he needs to be transported to the hospital, mom says she or he is ok and doesn't need to go the hospital. So do you still have the right to transport or what happens here? May be a dumb question I don't know, sorry if it is.
 
How old is the teenager?

Does the teenager have a child of his/her own?
 
Call a supervisor to assist, but with this situation I would go with transport based on father's request. If the two parents disagree that is on them. Once someone says they want their child to go to the hospital you won't have a leg to stand on if this goes to court.
 
How can you tell the "overdosed teenager needs help"? Especially if they are coherent enough to say they do not need help and one parent agrees?

I do not mind assisting with hypotheticals, but add some detail.

Otherwise, the answer will be "Call the supervisor or call the police".
 
I agree with AK. It all depends on what is meant by overdose. If they took 2 800mg Motrin, no worries. If they took a bottle of tylenol, different story. Either way, I think getting the police and medical control involved are a good idea.
 
akflightmedic said:
How can you tell the "overdosed teenager needs help"? Especially if they are coherent enough to say they do not need help and one parent agrees?

I do not mind assisting with hypotheticals, but add some detail. And assuming they told you they overdosed.

Otherwise, the answer will be "Call the supervisor or call the police".
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I didn't want to go into a bunch of detail, was just curious about the situation.
 
Well....without detail, an accurate comment on the situation cannot be made.

And you implied this as a hypothetical situation...you did not say it outright but it is implied. You should have left it that way and worked the story to get the info you want.
 
Tk11 said:
Just out of curiosity as I don't remember learning it...

You have a teenage patient that overdosed, you can tell they need medical help. Patient says they're ok and don't want to be transported, Dad says she or he needs to be transported to the hospital, mom says she or he is ok and doesn't need to go the hospital. So do you still have the right to transport or what happens here? May be a dumb question I don't know, sorry if it is.
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This is lacking details, I'm not sure how to respond.

I'm not one to kidnap a pediatric patient without parental consent.

I'm inclined to assess vitals, contact sup/online medical control, and go from there.

In this case I also think the locality/state matters.
 
MMiz said:
This is lacking details, I'm not sure how to respond.

I'm not one to kidnap a pediatric patient without parental consent.

I'm inclined to assess vitals, contact sup/online medical control, and go from there.

In this case I also think the locality/state matters.
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Ok thanks.
 
akflightmedic said:
Well....without detail, an accurate comment on the situation cannot be made.

And you implied this as a hypothetical situation...you did not say it outright but it is implied. You should have left it that way and worked the story to get the info you want.
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So what do you do if an adolescent patient says they're ok one parent agrees, the other one doesn't. On any situation that you believe they need more medical care than what can be provided on scene? Basically what I wanted to know.
 
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The answer here depends very much on your local legislative arrangements regarding competency and informed consent.

If what they took did not need immediate assessment or treatment in ED (for example, they have not overdoses on benzodiazepines) then I would refer this patient to the community mental health assessment people. These are usually Registered Nurses who have specialist qualifications and experience in psychiatric nursing and act as Duly Authorised Officers under the Mental Health Act to determine if somebody needs to be treated against their will or without consent. This is a detailed assessment that ambulance personnel cannot perform. At least locally, it does not need to be performed in-hospital as the CMHT is set up to perform this act in the community. In-fact, in practical reality, if the parents had called the 24 hour 0800 mental health emergency number the CMHT would go to them, perform whatever assessment is required and go from there without even needing to get ambulance involved!

I would be quite happy for the patient to be looked after by the parents provided CMHT were going to come to them. If transport is required then unless there is a clinically necessary reason to do so, ambulance transport is not required. He can be taken in the parents car on in the CMHT's Kia Serato.
 
Sorry, not trying to be difficult. You have yet to state what was ingested, how much was ingested, how much time had passed since ingestion...and you have failed to state what convinces YOU that the person is an OD in need of higher level of care.

It is not a black or white answer....a lot of what we do is shades of grey.

Every detail is relevant and my response will never be the same (most likely).

Where are they?
Are the parents married and live under same roof?
Does one have full custody?
Is their a dispute at a public or location away from the home?

I have many more questions all which have bearing on what I would do in this particular situation.

If you want a default, safest solution...you have been given that, which is call a supervisor, Medical Control or a police office. Dump the responsibility on them, save your conscience and then complain about them later in regards to how they made the wrong decision like most people do.
 
like AK said this is not a black and white answer for it. as soon as you have two parents disagreeing on treatment I would recommend PD assist (Personal Experience those scenes can become very tricky to handle), also with this being an overdose PD isnt a bad option to have with you anyways because of the possibility of attempted suicide and they are able to put a 'hold' on the patient. Also like AK said contact Med Control and get advice from them, who will most likely say get PD involved and transport.
 
Thanks for the replies everyone, very informative. I didn't mean just that particular situation where a patient ODs but any situation when parents aren't argeeing.
 
any situation like that, Med control, PD, Supervisor. its the safest answer, make someone else make the decision
 
Contact your operations manager or supervisor and explain the situation. Personally, I would explain to the parents that I would rather take him to the hospital, and have everything check out, than not take him, and his condition deteriorate. If they can't understand your point of view, let them fight about it. The patient is a minor, and one guardian has already expressed his desire for his son to be taken to a hospital.

Here's another situation to think about: A patient is in cardiac arrest, one of their children states that they do not want any attempt of CPR or other life saving measures, and the other states they want all live saving measures to be taken. What do you do?
 
Is there something makes ambulance personnel inherently incapable of making a logical clinical decision? No? Then why "pass the buck" and "let somebody else make it" - isn't that just poor form, pointless and lazy?

If I called the Duty Shift Supervisor or my Territory Manager and asked them, they'd tell me "you are on scene, you are treating the pt, you make the decision!"
 
Clare said:
Is there something makes ambulance personnel inherently incapable of making a logical clinical decision? No? Then why "pass the buck" and "let somebody else make it" - isn't that just poor form, pointless and lazy?

If I called the Duty Shift Supervisor or my Territory Manager and asked them, they'd tell me "you are on scene, you are treating the pt, you make the decision!"
Click to expand...

Clare, first there was no logical, clinical decision to make as the poster did not give any requested detail regarding the "overdose and what signs indicated she/he obviously needed help".

Therefore, with lack of information, most of us just said if you want to be safe, call Med Control, the police for convincing or your Supervisor for more convincing. Sometimes bringing in fresh faces to a scene accomplishes original intent. A new person brings "more perceived authority, experience, knowledge, whatever" and sometimes they are able to build the rapport you as initial provider did not or could not.

I have had many patients change their mind about transport by the mere act of allowing my partner to switch up and take lead. Even when they were lesser position than me...in this game you do what works when needed.

So no it is not really pointless, lazy or poor form. It is simply using another resource when presented with a challenging situation to obtain end result which is best for patient. Would a more experienced provider have to default to this...probably not. But that is not what the poster is presenting.

And then finally, Ewok is spot on. Our short courses get them in, get them out and we truly do not prepare our EMTs or even our medics for clinical decisive decision making. Logic is often absent. For years, we have had checklist mentality in most everything we do, if A then B, sometimes C.

We are evolving into a more learned approach to EMS, but it is going to take many more years before we see some real progress.

In the meantime, insurance is steering the way for this approach and many communities, companies and services are being proactive and getting on board with the changes (Community Paramedic programs, NPs on ambos) etc....

Exciting times as long as you are not scared of education.
 
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