EMT Martin Posted September 25, 2009 Share Posted September 25, 2009 So I just got in from an...oddball 911 call. Ambulance 68 was alerted to the report of someone jumping from a car into a roadway. At the time of the dispatch, police had been alerted since the subject in question had run into the woods. When we got to the scene, we find the guy sitting on the hood of the deputy's car. No cuffs or anything, and the only visible injury is a small scrape on his arm. The patient's awfully beligerant, won't sit still while I'm attempting to auscultate his B/P, and is more concerned with saying he's just going to leave than anything else. Apparently, he and his girlfriend got into a fight and she'd hit him. After a half mile of being hit, he jumped. The last I saw before we cleared, deputies were simply advising the girlfriend not to go home with him as he walked away. Without his copy of a refusal, I might add. Guy wasn't ETOH either, ergo there was no reason for them to keep him. So here's the $25,000 question. Should we have taken him? I continue to think that it was better we didn't, but given that we had no idea the speeds at which he jumped, nor the police taking him, I wonder if we should've. Thoughts? Link to comment Share on other sites More sharing options...
funkytomtom Posted September 25, 2009 Share Posted September 25, 2009 The moi is a bit scary, especially because you don't know how fast they were going. I've heard stats that as many as 75 percent of people that are tossed/jump from a car die. BUT...if he isn't ETOH (oh btw, what does ETOH stand for? i know what it means), is a and ox4, you can't take him. Link to comment Share on other sites More sharing options...
P_Instructor Posted September 25, 2009 Share Posted September 25, 2009 The moi is a bit scary, especially because you don't know how fast they were going. I've heard stats that as many as 75 percent of people that are tossed/jump from a car die. BUT...if he isn't ETOH (oh btw, what does ETOH stand for? i know what it means), is a and ox4, you can't take him. Some Medics in our area stupidly use ETOH to mean the patient is intoxicated (ie. 'smell of ETOH on breath') The patient's awfully beligerant...... Thoughts? Link to comment Share on other sites More sharing options...
DwayneEMTP Posted September 25, 2009 Share Posted September 25, 2009 Definitions of EtOH on the Web: Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. ...en.wikipedia.org/wiki/EtOH Link to comment Share on other sites More sharing options...
EMT Martin Posted September 25, 2009 Author Share Posted September 25, 2009 The patient's awfully beligerant...... Could his beligerance be onset of AMS? Tough call, probably should have been evaluated due to MOI, but looks like unsure of all the details. Very unsure. The cops basically wanted him to just go about his business. The more and more I sat and stewed on it, the more I couldn't agree more. If I had to load him onto the ambulance and deal with him for a whole 25 minute ride to the hospital, I'm 99% certain someone would've pissed him off and we'd have had to break out the restraints. Which, honestly...isn't a fun night for me. I'm the 'big guy' on everyone's crew, and ergo, the de facto one who's supposed to contain a patient when they get violent. God knows I didn't want to be bashing on a hippy (should be noted he was wearing an awfully shagadelic tie-dye shirt and had long, I'm-the-son-of-God hair). Link to comment Share on other sites More sharing options...
HERBIE1 Posted September 25, 2009 Share Posted September 25, 2009 Some Medics in our area stupidly use ETOH to mean the patient is intoxicated (ie. 'smell of ETOH on breath') The patient's awfully beligerant...... Thoughts? Could his beligerance be onset of AMS? Tough call, probably should have been evaluated due to MOI, but looks like unsure of all the details. Link to comment Share on other sites More sharing options...
ERDoc Posted September 25, 2009 Share Posted September 25, 2009 EtOH is an acceptable abbreviation. It is used by organic and biochemists to denote ethyl alcohol (ethanol). The Et is used to represent the Ethy part of the molecule. The OH represents the -OH group on the molecule which is what make it an alcohol. Methyl alcohol (methanol) is often represented by MeOH (though you don't come across it too much in the clinical world so some may not understand what it means). As for this pt, I'd be leary letting him go. He is pretty combative with a possible traumatic injury. Just because there is no external findings does not mean that there isn't something going on inside (I will agree that it is probably unlikely given the mechanism). A little etomidate and sux should help his disposition. More than likely this guy is just an ass and got beat up by a girl. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted September 26, 2009 Share Posted September 26, 2009 A catch phrase I kept hearing over the years was, if they walk away, we (EMS) are not paid to chase them. I don't know if I hold to that. However, as a call report must be generated, we make an official entry of these being an "RMA by Walk-Away" (RMA=Refused Medical Assistance). We never use such wording on the Call Reports, and either tell dispatch that the "Patient" left prior to EMS arrival, or declined any and all EMS assistance, including signing the RMA. Link to comment Share on other sites More sharing options...
HERBIE1 Posted September 27, 2009 Share Posted September 27, 2009 A catch phrase I kept hearing over the years was, if they walk away, we (EMS) are not paid to chase them. I don't know if I hold to that. However, as a call report must be generated, we make an official entry of these being an "RMA by Walk-Away" (RMA=Refused Medical Assistance). We never use such wording on the Call Reports, and either tell dispatch that the "Patient" left prior to EMS arrival, or declined any and all EMS assistance, including signing the RMA. I also don't know the legal ins and outs of someone who walks away from us, but as long as they are not obviously impaired or seem dangerous but to me, to chase after them is dangerous. They are not under arrest, you are there to provide them medical care, and if they want no part of it, that is their choice. They also may not care about your protocols for refusals. Most places do have a provision for a "refusal" with no signature, and if you have established patient contact in any meaningful way, then you need to document that encounter to CYA. Like you said, the terminology used on the air is not the same as what you would use on your report. I keep it brief on the radio- no need to tie up the radio with some long winded explanations- save it for the report, PRN. We may use "Pt walked away". "Mistaken caller- nobody on scene wanted EMS", etc. Link to comment Share on other sites More sharing options...
P_Instructor Posted September 27, 2009 Share Posted September 27, 2009 Could his beligerance be onset of AMS? Tough call, probably should have been evaluated due to MOI, but looks like unsure of all the details. ETOH is a commonly used and recognized abbreviation, and I've been using it for 30 years in my reports. What's the problem with the term? I use it in a description- such as "apparent ETOH on breath", or Pt admits to ETOH ingestion, etc. I've never heard anyone who claims there is ambiguity or a problem there. Everyone uses the term around here- from docs to nurses, to medics. As for the PT- belligerence could be because of a head injury, but the only trauma mentioned was an abrasion to an arm. Could the belligerence be because the guy had just been in an argument with his girlfriend and beaten? Could it be because the guy is ALWAYS a jerk? No, we don't know how fast the car was going, but unless the patient was scraped up, dirty, and other signs of trauma, I wouldn't be too concerned about this refusal. Unless the person showed signs of being incompetent, I see no reason to force this issue. Link to comment Share on other sites More sharing options...
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