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Examination of her vehicle showed airbag deployment and a spidered windshield with an obvious point of impact where her head hit. I couldn't be positive of ETOH, there was a slight odor but nothing major. Immediately seeing this I started a helicopter due to protocols and MOI.

If that is your protocols, your protocols suck.

Run.

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Lets see. Substantial MOI, speeds over 55 mph, intrusion, airbag deployment, admittance to hitting her head, with windshield damage. Increased agitation, combativeness, and foreign odor. She's altered in my book.

She goes, against her will if need be.

You called for a helicopter, then allowed her to sign a refusal? The puzzle pieces don't fit.

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to clarify, helo wasn't started because I smelled alcohol, it was started due to the MOI. Yes, she was alert, knew what happened, how it happened, where she was, all that good stuff. I didn't just "let" her sign a refusal. If a pt in MD refuses transport or care and we think they need that, we can call police who can put them under emergency orders, where they have no control over if we take them or not. As stated, police here didn't help the situation, they wouldnt place her under emergency orders even after I requested, I couldnt force the woman to go. As for the airbags, I've seen windshields starred by them, but it wasn't just a general spidering. There was a point of impact that was pushed out, not completely broken, but pushed out and the size of a head with spidering out to the sides.

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Lets see. Substantial MOI, speeds over 55 mph, intrusion, airbag deployment, admittance to hitting her head, with windshield damage. Increased agitation, combativeness, and foreign odor. She's altered in my book.

She goes, against her will if need be. You called for a helicopter, then allowed her to sign a refusal? The puzzle pieces don't fit.

I think they have a law against that buddy called ...uhh ...hmmm.. oh yea, kidnapping!

If the patient is alert, orientated, no LOC , who are we to say she has lost her civil rights and far as that goes patient rights? Just because a patient gets agitated is not always an ominous sign, I would be monitoring yes. As well, why always a helo? Man is that flight service going to be happy to spend a five hundred dollars on fuel for a refusal... they may tell you next time, call us when it is real. Let's not punt the ball. Use them, and use them a lot when needed. I have flew on scene flights with MVC patients because they were pregnant, although the injuries were not associated with or to the fetus... just because they were pregnant and it was trauma ( fxr. ankle, sole injury site), or the patient that was supposedly having posturing to turn out he was attempting to remove his C-collar (he was C/A/OX4).

We need to be very careful and of course err on the side of the patient, but as well not all trauma needs or should go by helo, or to a Level I (that is why there are multiple levels). There is such thing as over triage, and it is running rampant. Trauma centers are getting over loaded by medics over estimating injuries. MOI is usable, but be sure it is within reason as well. This scenario has multiple questionable points, but so does trauma scenes.

Let me clarify, (some misunderstand) take major trauma to trauma centers, per ground, air, train, boat... the smoothest, fastest way possible... just use good assessment techniques as well as history taking.

:wink:

R/r 911

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to clarify, helo wasn't started because I smelled alcohol, it was started due to the MOI.

Again, if your protocols mandate aeromedical evacuation simply based upon MOI, your protocols suck, and your agency probably sucks too.

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Combative, agitated, odor of ETOH after hitting her head. Strong MOI.

These factors make me question her competency. Was she alert and oriented? Or did she get angry and sign?

This still sounds shady.

PRPG

Exactly.

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Rid wrote:

I think they have a law against that buddy called ...uhh ...hmmm.. oh yea, kidnapping!

Oh... Well I cant remember the last time I heard of an EMS system be charged with kidnapping.

I ll take my chances fighting the kidnapping charge, rather then the negligence, abandonment, and wrongful death suit, not to mention the hole I would have in my stomach leaving an obviously altered pt on the side of the road, because "I couldn't make her go". If I think she is even slightly altered, she goes. End of story.

Rid Wrote:

Just because a patient gets agitated is not always an ominous sign

If that was the only sign yes, however it wasn't, it was stated she was also combative with a foreign odor. Along with the MOI, airbag deployment almost two feet of intrusion, the windshield damage, and the fact the damn woman's running around the scene stating she smashed her head on the windshield.

We all know that refusals are not worth the paper they are written on, any second year law student would have most refusals, including this one thrown out of court in about 60 seconds. They don't factor in duress.

Lets see how this would go:

Lawyer: So sir how did my client present to you on arrival of the MVC?

EMT: Agitated, and slightly combative.

Lawyer: State for me some of symptoms of a head injury?

EMT: Uhhhhh.....agitation, and combativeness,.

Lawyer: What other factors would need to be present at the scene to make a conclusion of possible head injury.

EMT: Ummmmm. ....MOI, windshield damage, unrestrained with airbag deployment.

Lawyer: It says in your narrative, the pt was running around the scene stating she hit her head on the windshield, was their windshield damage?

EMT: Yes.

Lawyer: You must have thought it was serious you called for a medical helicopter?

EMT: I did but when we explained to her that she needed to be evaluated at a level one trauma center, and she would be traveling in a helicopter she became more agitated.

Lawyer: Again for me I forgot. Is agitation a possible sign of head injury?

EMT: Uhhhh yes.

Lawyer: So when she became more agitated, you decided to cancel the helicopter and have her sign a refusal? Why?

EMT: The police said we couldn't make her go.

Lawyer: Your honor I would also like to add the Anytown police dept. to this negligent, abandonment, and wrong full death suit.

Lawyer: It states in your narrative you smelled a foreign odor? Did you know my client was brittle diabetic. Did you attempt to obtain a BGL?

EMT.: No

Lawyer: Did you ask her?

EMT No

We the jury find the Anytown EMS, police and fire liable for the death of so and so. We award her family damages in the amount of 100 million dollars, and all public service involved in this obvious display of negligence and abandonment relieved of their duties.

Might be a little far fetched but I have seen worse.

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Once again, it's not like I decided oh fuck it, just cancel the helicopter, to hell what happens to my pt. It frustrated me so much that even the fire fighters on scene were trying to help tell the woman that she needed to go. The pt was alert and oriented, she refused all treatment, examination, stabilization, transport. She wouldn't let me even take her blood pressure let alone her blood sugar. and since kidnapping is indeed illegal even in southern md, I was stuck. I wasn't being negligent or trying to push a refusal because I didn't feel like dealing with her.

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Once again, it's not like I decided oh f&%k it, just cancel the helicopter, to hell what happens to my pt. It frustrated me so much that even the fire fighters on scene were trying to help tell the woman that she needed to go. The pt was alert and oriented, she refused all treatment, examination, stabilization, transport. She wouldn't let me even take her blood pressure let alone her blood sugar. and since kidnapping is indeed illegal even in southern md, I was stuck. I wasn't being negligent or trying to push a refusal because I didn't feel like dealing with her.

[marq=left:05bc4ae0f4]If the person is intoxicated they are unable to refuse Treatment, Transport, Assment, etc.......PERIOD :!: :!: [/marq:05bc4ae0f4]

OUT HERE,

ACE844

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