Has this ever happened to you?

[kpeppermintpatty]

As for RMAs, protocols say that if a person is not alert/oriented and still refusing or refusing against medical advice and are a/o then police can be called and pt can be placed under emergency orders, then they have no choice. Police on scene would not place her under the orders when requested so I couldn't do anything the pt didnt want me to, which included everything.

[SSaint]

As for RMAs, protocols say that if a person is not alert/oriented and still refusing or refusing against medical advice and are a/o then police can be called and pt can be placed under emergency orders, then they have no choice. Police on scene would not place her under the orders when requested so I couldn't do anything the pt didnt want me to, which included everything.

There's nothing about trauma patients with potential head injuries being unable to RMA?

[Ace844]

As for RMAs, protocols say that if a person is not alert/oriented and still refusing or refusing against medical advice and are a/o then police can be called and pt can be placed under emergency orders, then they have no choice. Police on scene would not place her under the orders when requested so I couldn't do anything the pt didnt want me to, which included everything.

Yet, I bet if you re-read them you'll also find this neat little tidbit which also mentions that the person CANNOT BE UNDER THE INFLUENCE OF ANY SUBSTANCES...as well...

out here,

ACE844

[kpeppermintpatty]

I couldnt be sure if she was or not, she might have been diabetic, but as she wouldn't let me assess her, I couldn't tell

[Ace844]

I couldnt be sure if she was or not, she might have been diabetic, but as she wouldn't let me assess her, I couldn't tell

which makes you negligent and that is part of the problem here.

ACE844

[kpeppermintpatty]

How is that negligent? If a pt tells you not to do somthing and are a/o, you can't do it. If a pt says I do not want this, you can't do it. If thats the case than why don't we work or push cardiac drugs on DNR-B pt's in full arrest?

[SSaint]

It makes you negligent because you "couldn't be sure if she was or not" with reference to being under the influence of drugs or alcohol. You said you thought you smelled ETOH on her when you first assessed. Did you inform the LEO of that?

[Ace844]

How is that negligent? If a pt tells you not to do somthing and are a/o, you can't do it. If a pt says I do not want this, you can't do it. If thats the case than why don't we work or push cardiac drugs on DNR-B pt's in full arrest?

Are you really sure you want to go there as oppossed to doing as I suggested earlier?!?!?!? LAST CHANCE...

ACE844

[kpeppermintpatty]

yes I did, the officer maintained that she was over 18 and that he couldn't do anything about it.

Ace-I am not challenging you, I was asking sincerely, not trying to be a smart ass or anything like that.

[paramedicmike]

Patty:

(And Dust, this should help you in your concern with this thread, too.)

I suggest you re-read your Maryland Statewide Protocols. In fact, if you follow the trauma decision tree (it's page 128 in my copy), it says "CONSIDER helicopter transport". You are under no obligation what-so-ever to call for a helicopter simply based on MOI. Further, by stating that you had to call for it based on MOI tells me that not only are you unsure of the protocols, you didn't even really assess the patient or the situation appropriately.

I'm glad someone mentioned (sorry, I forget who) that airbags can star a windshield. They can and they will do just that. From everything that has been posted it doesn't sound like the patient hit her head. It sounds like the airbag cracked the windshield. What you included here regarding your assessment should've led you down that line, too. You said she had no tenderness or lacerations on her head. Don't you think that hitting a windshield at the speeds you mentioned might have caused some damage? Don't you think that maybe her agitation might have something to do with being annoyed/scared/freaked out at having just been involved in an accident? Now, I'm not saying she didn't hit her head...simply that the information posted doesn't lead me to think that's what happened.

As was mentioned previously, the patient was well within her right to refuse. Explain the refusal process, get her to sign the form, get the witness signature(s) and then document the hell out of this call. Sure, it can be tough when the person actually needs help. But what are you gonna do? Kidnapping *isn't* an option. Do the best you can and document accordingly.

You sound like you're relatively new to EMS. Looking for feedback from your peers in an attempt to learn and improve your ability to work in the field shows promise. However, hiding behind protocols doesn't. And since you're hiding behind the "my protocol says I have to do this" line it tells me you really don't need to be out on the street by yourself yet (never mind that you've just demonstrated to all of us that you don't even know what the protocol says). Maybe a discussion with the officers at your station to have you teamed with a seasoned provider who can help keep a better eye on what you're doing will better prepare you for life in EMS.

Good luck to you.

-be safe.