Consesnt vs. Responsibility follow-up;

[Shane Moore]

Maybe I'm not reading the post correctly but, since when does a 3rd party
(employer or not) get to make ANY decisions re: emergency healthcare?  The
EMTs onscene regardless of their certification level should have been
dealing directly w/ the patient.  In the event that the patient refused, try
all the other tricks up the sleeve (contact online med control, enlist
family/friends, etc).  If the patient still refuses and the concerns and
risks have been explained AND understood, then reassure the patient that EMS
will gladly return if/when needed.  Then document the everliving crap out of
it; you WILL see this chart again.  You may even consider whether the
patient falls under the implied consent parameters for your area, in which
case you're home free (you state that the patient didn't drink alcohol to
excess; did he drink any at all? That could affect the patient's legal
decision making abilities).  
As far as the boss portion; send him to get clean towels and boil some
water... whatever it takes to distract the guy.  His desire to stay out of
trouble w/ the local law and/or alcohol board notwithstanding, he has no
legal say (my opinion) as pertains to care of the patient.
As for the environment:  Having been a manager of a very large nightclub in
a previous life and an EMT for 19 years, I can tell you that I have seen an
increasing number of 'spiked' liquids being unknowingly ingested by
clubgoers.  S/S can be similar to excessive ETOH intoxication (decreased
LOC, decreased resp drive, inability to maintain/protect airway, vomiting,
etc) and can be misread by rescuers called to the scene.  GHB and Rohypnol
are very popular in this area (Pacific Northwest, USA) and are often placed
into unsuspecting persons drinks; odorless, mostly tasteless w/ effects that
are often synergistic. 
As an EMS educator I tell scary bedtime stories of EMTs that fail to
properly document refusals and INFORMED refusals from patients.  Just my two
cents.

Cheers,  

Shane

"They say people fear public speaking more than they fear death. So
technically, if you kill a guy who's scheduled to speak, you're doing him a
favor."

-Scott Adams

-----Original Message-----
From: Forrest Robleto [mailto:farcpr at gmail.com] 
Sent: Saturday, November 04, 2006 3:07 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Consesnt vs. Responsibility;

Yes the EMT-B's should make every attempt to get the victim to go.  EMT-B's
particularly in my state (NJ) have very little liability exposure and
statutory immunnity for most.  But the one area which is more likely than
any other to get them into court and for which they have no immunity is "the
refusal." We teach EMT's to make every attempt to get patients to go.   They
are much safer that way.


Forrest Robleto
EMT-Instructor


On 11/4/06, oded private <tangentcarrot at hotmail.com> wrote:
>
> Young Man (mid 20's),thin and healthy appearing, working in night club,
> crashes at the club. He is unressponsive to voice or pain (GCS score=3),
> but
> has a patent airway, is breathing Spontaneuosly and has a strong pulse at
> around 70 bpm. According to friends, he didn't take drugs or drink
> excessive
> alcohol, but might have been hurt by another clubber. I order the
> activation
> of the EMS. within ~1 min. he starts waking up and vomits. We take him
> outside, where I learn his boss canceled the bus since "his Ok now". He
> keeps on vomiting, has a thready pulse, is shivering, and has retrograde
> and
> antegrade amnesia. Claims are he had been stuck in the head. Finaly,I
> manage
> to convience him to take the bus to hospital. When the bus comes, the
> boss,
> once again, insissts that the owner will take him to the hospital.
> Ambulance
> personnel don't even argue and get away, inspite of my attempts. Finaly,
> we
> get to the hospital by car, at least 40 min post injury (?).
>
> The first dillema is- should EMS personnel (EMT-B'S, in this case) insist
> with such pateints? I tried conviencing them to "talk some sense" into
> him,
> but they refused,despite my description of coma and amnesia, saying they
> couldn't force him and that "he looks fine now", and left the scene.
>
> What are your thoughts?
>
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-- 
V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047