What's your "line" on refusals?

NPO

Forum Deputy Chief
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Law enforcement is refusing to place him in protective custody? easy answer. request an EMS supervisor to respond to the scene, as well as a law enforcement supervisor to the scene.

PD supervisor still refuses? ok, can i have your name and badge number please? and of the officer who initially refused? I will need it so when the lawsuit gets filed, they can be personally named in the wrongful death suit.

EMS supervisor, how do you want me to handle this? are you comfortable with obtaining a refusal? if not tell me exactly what you want me to do, because this is a bad situation and I don't want it falling back on me. And if he saying nothing else to do, than mr overdose person, "can you sign here please? this is a bad idea, and it's likely you need help, but I can't force you to go. hey family members? can you sign here that he is making this really bad decision on his own free will, and that I think it's a bad decision?"

If law enforcement is failing to do their job, and the EMS supervisor says there is nothing else to do, than you've exhausted your options, and people have the right to make stupid decisions regarding their healthcare.
Yep. That's essentially what happened.

This was in a rural area, where the PD is unstaffed after 11pm (and it was 11:01pm, literally) so you can imagine how well this went over. The officer tried to call his chief, but he wasn't answering.

I called medical control to get everything on a recorded line. Doctor agreed, he needed protective custody.

I called my supervisor and his exact words were "are you sh***ing me? This is why we need that law passed."

We obtained a refusal, I documented the heck out of it, had the refusing officer sign as a witness to the patient's refusal, got his name and badge number, and I wrote an incident report.
 

StCEMT

Forum Deputy Chief
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I'll do you one better.

Patient states he took an intentional overdose of 50x500mg of Tylenol. He states he is refusing care and will fight if he is forced to go to the hospital. He has a history of mental illness and a previous Tylenol overdose attempt resulting in prolonged ICU admission. Law enforcement refuses to place him in protective custody.

Now what? This is an actual call that I actually ran.

(Keep in mind, in my state paramedics cannot force people against their will for SI. It is in the works so long as the paramedic has completed a 40 hour CIT course.)
I'll tell them to get a Lt on scene as well as my Lt or Capt. Next is a phone call to an MD. There will probably be some not so kind words from me as well. I'll let the people higher up the food chain fight it out.

Not gonna lie, stories like that make me glad we have a really good relationship with both fire and PD. We're usually all on the same page with how we manage things.
 

Peak

ED/Prehospital Registered Nurse
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I'll do you one better.

Patient states he took an intentional overdose of 50x500mg of Tylenol. He states he is refusing care and will fight if he is forced to go to the hospital. He has a history of mental illness and a previous Tylenol overdose attempt resulting in prolonged ICU admission. Law enforcement refuses to place him in protective custody.

Now what? This is an actual call that I actually ran.

(Keep in mind, in my state paramedics cannot force people against their will for SI. It is in the works so long as the paramedic has completed a 40 hour CIT course.)
I don't understand why there are states where the ED attending can't place a medical or mental health hold. If a patient walks up to PD and tells them they want to kills themselves then I think they should be able to drive them in to the ED, but why would a non-medical/pysch trained person get the final word on competency and placing a hold?
 

NPO

Forum Deputy Chief
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I don't understand why there are states where the ED attending can't place a medical or mental health hold. If a patient walks up to PD and tells them they want to kills themselves then I think they should be able to drive them in to the ED, but why would a non-medical/pysch trained person get the final word on competency and placing a hold?
As much as I don't believe it is the responsibility for EMS to be handling the bulk of psychiatric calls (because most of them are non-medical, do not require a MSE, etc...), I do believe EMS should be, with proper training, permitted to place someone on an involuntary hold for situations like these.

The patient said he would fight. Fine. Ketamine. Then I'll transport you.
 

hometownmedic5

Forum Asst. Chief
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I believe in the patients ultimate right to make stupid decisions and that I should have minimal legal ability to restrict that right. I also believe in my right to have a career and make a living, and that I should do what is necessary to protect my ability to do so beyond all else.

Where those two points intersect for me under the protocols I have to work with is OLMC, so my solution here as it is in many gray area cases is to drop back and punt. Call the doc, lay out the facts, they make a decision, I carry out their orders. It’s a little “Nurembergy” for sure, but it’s the best I have to work with. If I don’t call when I’m supposed to, at the very least my local authorization to practice is in jeopardy. One level up is my job, and then my license. So it’s a short road from making a decision outside of the protocols to the unemployment office, at least here.
 

DrParasite

The fire extinguisher is not just for show
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I don't understand why there are states where the ED attending can't place a medical or mental health hold.
to be honest, I thought most ED attendings could place a mental health hold..... however, the person needs to be evaluated by the ED attending, not their extension (paramedic, resident, nurse, etc), or more accurately, they need to sign the paperwork, and idk if an ED attending can or will do that without performing the assessment personally, because if they are wrong, or were given the wrong information, it falls back on them.
If a patient walks up to PD and tells them they want to kills themselves then I think they should be able to drive them in to the ED, but why would a non-medical/pysch trained person get the final word on competency and placing a hold?
While I agree with you to a point, psych emergencies are considered medical emergencies, which is why an ambulance is called. Could the crazy person be given a nice easy ride to the ER in the back of the cop car? sure. but the cop isn't a medical provider. But many in EMS (myself included) would say a psych patient, especially a violent psych) is better transported in the back of a patrol car instead of in the back of an ambulance.

Also, when the cop puts someone on a hold, they aren't acting a medical or psych provider, they are acting as the enforcer of the law. Taking someone's civil liberties away is one of the riskiest things a cop can do from a liability standpoint (or so I am told), especially when they haven't committed a crime. So PD would much rather not get involved and risk that liability, and let someone else assume the risks. At least that is how it was explained to me.
 

FiremanMike

EMS Coordinator
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I'll do you one better.

Patient states he took an intentional overdose of 50x500mg of Tylenol. He states he is refusing care and will fight if he is forced to go to the hospital. He has a history of mental illness and a previous Tylenol overdose attempt resulting in prolonged ICU admission. Law enforcement refuses to place him in protective custody.

Now what? This is an actual call that I actually ran.

(Keep in mind, in my state paramedics cannot force people against their will for SI. It is in the works so long as the paramedic has completed a 40 hour CIT course.)
Nah, that makes it easier. This isn no longer SI, he actually made an attempt.. He's either going to the hospital like a grown up, getting arrested, or getting ketamine.
 

NPO

Forum Deputy Chief
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Nah, that makes it easier. This isn no longer SI, he actually made an attempt.. He's either going to the hospital like a grown up, getting arrested, or getting ketamine.
In my state that's battery and kidnapping. We have no ability to force anyone without LE assistance.
 
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