Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 I don't know if there's an actual solution to this problem, but I wanted to vent anyways. What requires EMS to transport a drunk to the hospital just because law enforcement says the jail won't accept them because they're " too drunk for jail? " As far as I can tell, merely being detained/arrested for public intoxication does not make one incapable of an informed refusal. And in the vast majority of cases, intoxication is not a condition requiring medical intervention. Just as a hypothetical, what if the drunk patient got in the ambulance and two blocks later, decided they wanted to refuse further care and transportation? While I'm all for playing nice with everyone, I'm getting a bit peeved at being a resource for cops who can't find an alternative arrangement for a drunk. -Wes Ogilvie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 Good question. Let me add to your hypothetical situation with one of my own. Police requesting a transport to a longer facility with an extended out of town transport because it is a county hospital, when you have one in town that is ¼ of a mile away. This is an EMS minefield. The patient is in PD custody, but can still consent or refuse patient care. If they are drunk or on drugs, how much do they have to be before they can no longer consent or refuse? Law enforcement wrongly believes they can refuse treatment or transport " for them " . They can however refuse to allow you access to the patient-at their own risk of course. If they are handcuffed, PD must ride with them in the patient compartment (no handcuff keys if the unit rolls and they become trapped). Add to that that they must " CYA " for every busted lip or scrape, and psychiatric patients or suicide attempt patients. Should they be cleared medically before being sent to the psych facility if there is an extended transport time? This area could be a whole course in itself, in fact I think from Arlington PD hold courses in this area every year at the Texas EMS Conference. Gene has done some great coursework on EMS law as well. Sorry about the large logo. I have a new computer and I am trying to reduce it down! Lt. Steve Lemming, A.A.S., L.P. C-Shift EMS Administration Officer Azle, Texas Fire Department This e-mail is confidential and intended solely for the use of the individual (s) to whom it is addressed. Any views or opinions presented are solely those of the author and do not necessarily represent those of The City of Azle or its policies. If you have received this e-mail message in error, please phone Steve Lemming (817)444-7108. Please also destroy and delete the message from your computer. For more information on The City of Azle, visit our web site at: http://www.cityofazle.org <http://www.cityofazle.org> From: texasems-l [mailto:texasems-l ] On Behalf Of Wes Ogilvie Sent: Monday, June 30, 2008 11:44 AM To: texasems-l Subject: Longstanding EMS issue I don't know if there's an actual solution to this problem, but I wanted to vent anyways. What requires EMS to transport a drunk to the hospital just because law enforcement says the jail won't accept them because they're " too drunk for jail? " As far as I can tell, merely being detained/arrested for public intoxication does not make one incapable of an informed refusal. And in the vast majority of cases, intoxication is not a condition requiring medical intervention. Just as a hypothetical, what if the drunk patient got in the ambulance and two blocks later, decided they wanted to refuse further care and transportation? While I'm all for playing nice with everyone, I'm getting a bit peeved at being a resource for cops who can't find an alternative arrangement for a drunk. -Wes Ogilvie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 > > I don't know if there's an actual solution to this problem, but I > wanted to vent anyways. > > What requires EMS to transport a drunk to the hospital just because law > enforcement says the jail won't accept them because they're " too drunk > for jail? " As far as I can tell, merely being detained/arrested for > public intoxication does not make one incapable of an informed refusal. > > And in the vast majority of cases, intoxication is not a condition > requiring medical intervention. > > Just as a hypothetical, what if the drunk patient got in the ambulance > and two blocks later, decided they wanted to refuse further care and > transportation? > > While I'm all for playing nice with everyone, I'm getting a bit peeved > at being a resource for cops who can't find an alternative arrangement > for a drunk. > > -Wes Ogilvie Many years ago in my Medstar days, I frequently got dumped on by PD with a drunk. Hospital or jail they were told and of course they'd choose the hospital. Many time we'd go a little ways and the drunk would then sign a refusal and we'd let them out on the side of the road. They were not under arrest, nor were they incapacitated. Granted, some did need to be monitored and were transported. I do not know the right answer but if PD is going to hand out that ultimatum, they should accompany there detainee and have to sit with them for hours in the ER. It's passing the buck plain and simple. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 After a law enforcement officer told my patient that. I asked him if the subject was in custody. Once the officer said no. I turned to the patient and advised the person of his choices. When the officer advised my patient with us or him. I asked again if he was in custody. When told no. I told the " patient " the officer was bluffing, and asked the officer to back off. It pissed off my officer, but it got the point across. Tom PS. The officer was a good friend of mine, and we still visit and enjoy company. Tom & Marsha LeNeveu Paramedic, Future RN; & RN Fort Worth Texas Email: TomMarshaLeNeveu@... http://www.emstock.com/ Re: Longstanding EMS issue > > I don't know if there's an actual solution to this problem, but I > wanted to vent anyways. > > What requires EMS to transport a drunk to the hospital just because law > enforcement says the jail won't accept them because they're " too drunk > for jail? " As far as I can tell, merely being detained/arrested for > public intoxication does not make one incapable of an informed refusal. > > And in the vast majority of cases, intoxication is not a condition > requiring medical intervention. > > Just as a hypothetical, what if the drunk patient got in the ambulance > and two blocks later, decided they wanted to refuse further care and > transportation? > > While I'm all for playing nice with everyone, I'm getting a bit peeved > at being a resource for cops who can't find an alternative arrangement > for a drunk. > > -Wes Ogilvie Many years ago in my Medstar days, I frequently got dumped on by PD with a drunk. Hospital or jail they were told and of course they'd choose the hospital. Many time we'd go a little ways and the drunk would then sign a refusal and we'd let them out on the side of the road. They were not under arrest, nor were they incapacitated. Granted, some did need to be monitored and were transported. I do not know the right answer but if PD is going to hand out that ultimatum, they should accompany there detainee and have to sit with them for hours in the ER. It's passing the buck plain and simple. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 Some 10 years ago, in Grandbury, TX, police arrested some teens who had been out drinking to celebrate the beginning of school--the last night before school started. One became so drunk that he was vomiting, and his buddy was driving his mother's new car, so said friend stopped and let the vomiting kid out, along with a friend. His plan was to go home, get his pickup and return. In the meantime, a lil ole lady who lived in the house in front of which this was happening called the cops. Cops arrive and determine that the vomiting kid is too drunk to go to jail and needed to go to the hospital, probably a valid determination. A secondary reason was that the cop car was brand new, had not yet been anointed with vomit, and the cop wasn't eager to spend the rest of his shift breathing fumes from gastric debris. While waiting on EMS, the vomiting kid became emotionally upset and was crying and quite concerned about what his parents were going to say. He made the comment that he just wanted to die. This comment was not communicated by cops to EMS. EMS loads the kid up and starts for the hospital. Enroute, while the attending medic was giving a radio report to the hospital, the patient got up and exited the rear doors of the ambulance. He hit his head on the pavement and died instantly. The medic was looking through the passageway out the front windshield, trying to determine where they were, so he could give an ETA to the hospital. All he heard was the back door opening. He shouted for the driver to stop, but it was too late. There was a grand jury investigation and a TDH investigation. I was hired by the plaintiff's attorney to evaluate the case for liability, and it was my opinion that the patient's act was not reasonably foreseeable to the crew member and that the medic was not guilty of gross negligence, which is necessary to get beyond the limitations on actual damages. Therefore, there was no lawsuit. There were no charges filed either. I am not aware that TDH did anything to the medic. Might have, might not have. It was a bad situation. Mistakes were made. We all learned a bunch from it. Since then, I have urged my students to restrain patients who lack legal capacity to refuse treatment prior to transport and to require that cops accompany any patient who is under arrest. The cops don't like this, because it forces them to go out of service, leave their car at the scene, et cetera. As to Wes's query, it is my opinion that an intoxicated patient does not need to be in jail. Where he needs to be is in a detox facility where he can be observed. I think the aforementioned case illustrates the instability of ETOH intox patients. Steve asks the question, " when does one lose the capacity to consent? " This is a question of fact, and it must be addressed through medical assessment and documentation. I do a presentation on this and have done it several times at the Texas EMS Conference. It involves using objective criteria to determine the patient's present mental capacity and documenting it using facts rather than conclusions. Unfortunately, many do not understand how to do this, nor do they understand the legal significance of it. Few medics can do a competent mental status exam unless, of course, they have attended my presentation. LOL. Just kidding. But you get my point, I hope. If you don't know how to determine objectively whether or not somebody has the capacity to refuse, check out Folstein's Mini-Mental Status Exam, and adapt it to street use, which can easily be done .. Today, if I were evaluating the same case, my conclusions might well be different, since in the last 10 years medics have become more aware of the pitfalls of transporting patients with altered LOC. Whether or not a person needs to be transported to jail or to a hospital is a medical decision, and it should be the medics who make that determination, not the cops. But presently, it's often the opposite. Jails vary infinitely in their abilities to deal with patients with medical conditions. Intoxication is a medical condition. Some large facilities have dedicated areas for intox patients, with appropriate monitoring. Most small jails do not. Having a friend who is a jailor who has had to deal with the consequences of a drunk inmate who hanged himself, including a lawsuit and major guilt trip, I can sympathize with those cops who do not want to go there. Either way, we're damned if we do and damned if we don't if " negative patient outcome " occurs. GG > > Good question. Let me add to your hypothetical situation with one of my own. > Police requesting a transport to a longer facility with an extended out of > town transport because it is a county hospital, when you have one in town that > is ¢® of a mile away. > > This is an EMS minefield. The patient is in PD custody, but can still > consent or refuse patient care. If they are drunk or on drugs, how much do they > have to be before they can no longer consent or refuse? Law enforcement wrongly > believes they can refuse treatment or transport " for them " . They can however > refuse to allow you access to the patient-at their own risk of course. If > they are handcuffed, PD must ride with them in the patient compartment (no > handcuff keys if the unit rolls and they become trapped). Add to that that they > must " CYA " for every busted lip or scrape, and psychiatric patients or suicide > attempt patients. Should they be cleared medically before being sent to the > psych facility if there is an extended transport time? > > This area could be a whole course in itself, in fact I think > from Arlington PD hold courses in this area every year at the Texas EMS > Conference. Gene has done some great coursework on EMS law as well. > > Sorry about the large logo. I have a new computer and I am trying to reduce > it down! > > Lt. Steve Lemming, A.A.S., L.P. > > C-Shift > > EMS Administration Officer > > Azle, Texas Fire Department > > This e-mail is confidential and intended solely for the use of the > individual (s) to whom it is addressed. Any views or opinions presented are solely > those of the author and do not necessarily represent those of The City of Azle > or its policies. If you have received this e-mail message in error, please > phone Steve Lemming (817)444-7108. Please also destroy and delete the message > from your computer. > > For more information on The City of Azle, visit our web site at: > http://www.cityofazhttp:/ <http://www.cityofazhttp:/> > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of Wes Ogilvie > Sent: Monday, June 30, 2008 11:44 AM > To: texasems-l@yahoogrotexasem > Subject: Longstanding EMS issue > > I don't know if there's an actual solution to this problem, but I > wanted to vent anyways. > > What requires EMS to transport a drunk to the hospital just because law > enforcement says the jail won't accept them because they're " too drunk > for jail? " As far as I can tell, merely being detained/arrested for > public intoxication does not make one incapable of an informed refusal. > > And in the vast majority of cases, intoxication is not a condition > requiring medical intervention. > > Just as a hypothetical, what if the drunk patient got in the ambulance > and two blocks later, decided they wanted to refuse further care and > transportation? > > While I'm all for playing nice with everyone, I'm getting a bit peeved > at being a resource for cops who can't find an alternative arrangement > for a drunk. > > -Wes Ogilvie > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 What about insisting that PD accompany the " Patient " to the hospital (like we do with those under a PCO) After all if the " jail won;'t take him because he's too drunk " then is he still under arrest and subject to incarceration after being medically cleared? Then the police officer would have to stay with the " patient, " his prisoner and the officers really don't like sitting around hospitals. Just a thought adn my $0.02 for what it's worth. Take care and stay safe one and all, Anita BSHS, NREMTP/LP Take care and stay safe always. " Commit to the Lord whatever you do, and your plans will succeed. " (Proverbs: 16:3) May God Smile on you today. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 It all comes down to the patient's decisional capacity. If the pt's decisional capacity is intact, then I feel it's fine. For example, if your so called " drunk " pt is A & O x 4 / GCS 15, and can explain the situation, explain their reasoning for refusing care and can verbalize the risks of such a refusal after being explained to them, then they have an intact decisional capacity. VERY thorough documentation is necessary though. Ben Wes Ogilvie wrote: > > I don't know if there's an actual solution to this problem, but I > wanted to vent anyways. > > What requires EMS to transport a drunk to the hospital just because law > enforcement says the jail won't accept them because they're " too drunk > for jail? " As far as I can tell, merely being detained/arrested for > public intoxication does not make one incapable of an informed refusal. > > And in the vast majority of cases, intoxication is not a condition > requiring medical intervention. > > Just as a hypothetical, what if the drunk patient got in the ambulance > and two blocks later, decided they wanted to refuse further care and > transportation? > > While I'm all for playing nice with everyone, I'm getting a bit peeved > at being a resource for cops who can't find an alternative arrangement > for a drunk. > > -Wes Ogilvie > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2008 Report Share Posted June 30, 2008 Anita, You're 100% on target. Read my post about the patient who jumped out of the ambulance and killed himself. LE cannot have us be their surrogate. If a patient's under arrest, then the cop is welded to them. We do not do custodial transports. GG > > What about insisting that PD accompany the " Patient " to the hospital (like > we do with those under a PCO) After all if the " jail won;'t take him because > he's too drunk " then is he still under arrest and subject to incarceration > after being medically cleared? Then the police officer would have to stay with > the " patient, " his prisoner and the officers really don't like sitting around > hospitals. Just a thought adn my $0.02 for what it's worth. > Take care and stay safe one and all, > Anita > BSHS, NREMTP/LP > > Take care and stay safe always. > " Commit to the Lord whatever you do, and your plans will succeed. " > (Proverbs: 16:3) > May God Smile on you today. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 We had this exact issue while I was Chief at McGuire Air Force Base. We had two LE agencies one CIV and one Military to deal with both had radically differing views on the topic. We sat down and TALKED to both agencies separately and then together and guess what. We agreed to come to an agreed upon policy and solution that all could live with. It is truly amazing what can be accomplished when you're sitting in a conference room as opposed to the side of the road at 0-Dark thirty! -- Lou Molino, Sr. FF/NREMT-B/FSI/EMSI From the road some where (Cell Phone) Re: Re:Longstanding EMS issue Anita, You're 100% on target. Read my post about the patient who jumped out of the ambulance and killed himself. LE cannot have us be their surrogate. If a patient's under arrest, then the cop is welded to them. We do not do custodial transports. GG > > What about insisting that PD accompany the " Patient " to the hospital (like > we do with those under a PCO) After all if the " jail won;'t take him because > he's too drunk " then is he still under arrest and subject to incarceration > after being medically cleared? Then the police officer would have to stay with > the " patient, " his prisoner and the officers really don't like sitting around > hospitals. Just a thought adn my $0.02 for what it's worth. > Take care and stay safe one and all, > Anita > BSHS, NREMTP/LP > > Take care and stay safe always. > " Commit to the Lord whatever you do, and your plans will succeed. " > (Proverbs: 16:3) > May God Smile on you today. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 No problem! Another thing I will pass along that I stress in my classes. Teach the students the difference between a fact and a conclusion and have them document facts, not conclusions. Example: A & A & O x 4 is a pure conclusion. A lawyer will ask, " How did you know the patient was alert? " " How did you know he was oriented? " And the medic answers something like, " Well, he had his eyes open and was talking to me. " Lawyer: But you did not document that, did you? What did he tell you that led you to the conclusion that he was oriented. And so forth. So it is documented as " Patient's eyes were open and he correctly stated his name, address, the day of the week, date, month, year, and that he had fallen while getting out of the tub. " If there are questions about his mental status, document " He was able to remember three objects, a ball, a pair of glasses, and a glass of water, and repeat them after 5 minutes. " And so forth. Those are objective facts from which a jury can see for themselves what the medic's determinations were based on. Words like " stable, confused, obtunded, abnormal " and so forth, are conclusions. Always describe the patient's actions and when pertinent, quote them. GG GG > > GG, > What a shame about the teen! But a very interesting post. I also think the > cops were very mistaken by not advising EMS that the patient had been upset > and " just wanted to die. " That might have made a different impact on outcome of > this very unfortunate incident. > > Also thanks for the mental assessment tool. I am going to check it out, may > be able to use it myself and in future classes I teach. We all very > definately have to pay attention to the ptietn;s mental status and ability to make > informed decisions especially inder the influence of alcohol and ither > substances. > > Anita > BSHS, NREMTP/LP > > Take care and stay safe always. > " Commit to the Lord whatever you do, and your plans will succeed. " > (Proverbs: 16:3) > May God Smile on you today. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 GG, Thanks for agreeing with me. I actually had a patient jump out of the back of an ambulance once too but we had stopped so he did not get hurt; unless he hurt his bare feet running off into the desert. Any way no one got hurt and on a later run that night we saw him at the hospital, LE had found him and transported him themselves. It is hard sometimes to get our points across and unfortunalty people even us may suffer because of it. But I agree 100% we cannot be LE's surrogate, if they want the patient transported then they need to accompany him or her in the ambulance not following behind to the hospital. Anita BSHS, NREMTP/LP Take care and stay safe always. " Commit to the Lord whatever you do, and your plans will succeed. " (Proverbs: 16:3) May God Smile on you today. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2008 Report Share Posted July 1, 2008 GG, What a shame about the teen! But a very interesting post. I also think the cops were very mistaken by not advising EMS that the patient had been upset and " just wanted to die. " That might have made a different impact on outcome of this very unfortunate incident. Also thanks for the mental assessment tool. I am going to check it out, may be able to use it myself and in future classes I teach. We all very definately have to pay attention to the ptietn;s mental status and ability to make informed decisions especially inder the influence of alcohol and ither substances. Anita BSHS, NREMTP/LP Take care and stay safe always. " Commit to the Lord whatever you do, and your plans will succeed. " (Proverbs: 16:3) May God Smile on you today. Quote Link to comment Share on other sites More sharing options...
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