Input on SOP "gray area" call

[mshow00]

I wish it was, beleive me I really do

[MSDeltaFlt]

I believe this would be pretty much the same regardless of the state you live in, so here it goes:

I would explain to her, her family, Dr, etc, that if she didn't answer these questions correctly then, according to my assessment, I would be forced to deem her a danger to herself and transport her to the hospital as any normal and competent person would want me to do as a patient advocate.

1. What's your name?

2. Where are you?

3. What day/month/yadda is it?

4. Why are you here?

Then I would advise her of what might happen if we leave, and have her repeat the possible consequences.

If she could do any of that, then you can't touch her.

My humble thoughts.

[JPINFV]

POA is irrelevant to this situation as it stands. If she is A/Ox4 and understands the risk, then she can go and tell the POA:HC to take a hike. POA only comes into play when the patient defers to them (e.g. billing) or when the patient is not able to make his or her own decisions. People are confusing POAs with conservatorships. If she had a conservatorship, then she would not be able to make her own decisions, period. Consult? Sure. Final say? No.

[hr:1dd4f63b89]

PS the DON at the SNF was highly upset we did not just come in throw her on our strecher and leave regardless of her mental status. I personally feel as though I could not trust what she was saying due to the fact that she was hell bent on the pt leaving. The nursing home is not a 'nice' one and has a hx of bending/breaking rules.

I've had a staff member at a SNF pick a patient up and man handle him to my gurney once. Let's just say that that facility ended up getting a visit from county inspectors.

[hr:1dd4f63b89]

1. What's your name?

2. Where are you?

3. What day/month/yadda is it?

4. Why are you here?

Then I would advise her of what might happen if we leave, and have her repeat the possible consequences.

If she could do any of that, then you can't touch her.

My humble thoughts.

That's the conundrum that I'm seeing. She might very well be capable of doing so, but by refusing she is putting the crew in a bind.

[vs-eh?]

I believe this would be pretty much the same regardless of the state you live in, so here it goes:

I would explain to her, her family, Dr, etc, that if she didn't answer these questions correctly then, according to my assessment, I would be forced to deem her a danger to herself and transport her to the hospital as any normal and competent person would want me to do as a patient advocate.

1. What's your name?

2. Where are you?

3. What day/month/yadda is it?

4. Why are you here?

Then I would advise her of what might happen if we leave, and have her repeat the possible consequences.

If she could do any of that, then you can't touch her.

My humble thoughts.

You forget one thing...there is a DOCTOR there/readily available that was part of the whole reason that EMS was called and is a much better person to make that call. You don't have to/shouldn't have to make that call.

If my family called for me, disagreeing with the choices the I have made (relatively lucid, the religious context aside) and I am the maker of my own demise, then so be it.

You CANNOT decide for me, especially if there is a physician on scene/readily available related to the call that obviously cannot deem me a danger to myself within the limits of the law.

Just because you are called and a patient refuses to answer any questions (regardless of anything) doesn't give you the auto-right to take them to the hospital. I could hypothetically say that my mother is a danger to herself and give a whole story (presuming I dislike my mother), if she is lucid and says no, she doesn't go. Call details don't override everything else...

EDIT - So if I answered your questions as

1. John

2. Where do you think?

3. The present

4. What kind of a question is that?

What would you do? Given the scenario outlined.

[MSDeltaFlt]

I think you miss my point. Everybody wanted her to go the hospital except her. If she can answer all those questions I mentioned appropriately, then you need informed consent to treat and transport. Until then, you can't touch her. It doesn't matter what everybody else says. You get the refusal, explain to everybody there, even her Dr on the phone, that you can't touch her, and to please call you back if anything changes.

Also, the operative phrase was not what you highlighted. It was just before. it said "according to my assessment".

Plus something else you missed the point on. Why was the crew called in the first place? Grandma kept losing weight. What's the most common symptom a geriatric shows when sick? Altered LOC. When you have an ALOC, you can't refuse, because you're not in your right mind.

With respect.

[vs-eh?]

Yes, and you've seen how she answers questions... I assume these are not "correct" answers "according to your assessment".

Again, so what if she answered like I did?

EDIT - Because MS edited his initial question. Altered LOA? Ok... So why is EMS making this decision when a DOCTOR is involved in the reason that this patient is going to the hospital. This appears to be a relatively chronic issue, one that the MD is likely to be (at least superficially) involved in.

[streethealer535]

VS... Why are you putting so much faith in the "DOCTOR" who was not there but on the phone.. A medical doctor (PCP) I am assuming would have no more a right to as you put it "form" a patient then we do as EMS... with out proper legal criteria met they have no ability to even touch a patient without consent. If the criteria is met as EMS professionals we could transport the patient with out the doc saying so anyway. I think we need to give this crew some credit for taking a difficult call and making the best out of a tough situation.

I will be the first person to walk away from someone who does not want to be treated. I refuse to push medical help on a competent pt who wants to be left alone. However sometimes making the distinction between who is competent and who is not can be very difficult. Although it may be nieve I tend to belive if you have a good heart, make the best decision you can with as much knowledge as possible, and document the crap out of the call you should be able to defend it to anyone.

I think MSDeltaFit got it right just cause someone is AOx4 does not mean they are competent. they need to understand the consequences of their decision.

mshow00 good job..

JJ

[vs-eh?]

VS... Why are you putting so much faith in the "DOCTOR" who was not there but on the phone.. A medical doctor (PCP) I am assuming would have no more a right to as you put it "form" a patient then we do as EMS... with out proper legal criteria met they have no ability to even touch a patient without consent.

Except a physician can do it legally and over the phone (at least where I'm from). EMS cannot (again where I'm from) force patients to go to the hospital that meet the criteria as outlined in this case. They are not under any "mental health act" or anything. The MD in this case (unless I'm reading this totally wrong) has knowledge of this patient and was likely involved in the reason why EMS was called. The MD and family both likely knew that the patient would refuse.

I think MSDeltaFit got it right just cause someone is AOx4 does not mean they are competent. they need to understand the consequences of their decision.

Ya, you're right. Given what the patient was going on about, I would seriously rethink her mental stability too. Obviously the MD did not though (this is all relative).

[mshow00]

The major point here, aside from the 'unusual' religious comments made by her, she would not give us enough to assess her mental status. So it boils down to what do you do if you can not prove if she is A&OX3 or 4 or not. We made our decision based upon the fact that she was making said statements about God, refusing meds for at least 3 months, and refusing all food and drink for 2 weeks save for what little family basically forced down her. Medical control was no help, and her Dr. just wanted her to go and thats where he ended it. So when you have minimal information with which to judge you do the best you can, in the end I do believe we did what was right medically for the pt, however the question remains was it legal? Given only what was in this post alone not one person could say she was mentally fit to make her own choices.

[Don1977]

Well, if you get no info, treat as best as you can, specify in PCR and when you give hospital report specify that. No brainer there.

I do not see how you can "302" her, PA term, for her being a danger to herself. I would have called Medical command and see what they say.

But all in all.....it really hurts to say this...but.......*sighs*-........I agree with vs............*chest pains starting*