Legal Issue

[altamedic]

I just came on and my crew prior to me had a call and they signed the guy off. We are in alberta and legal issues vary from province to province ; state to state. Let me know what you think.

Call: OD / Poisoning for a 43 Yo Male.

Got on scence, a 15 yo female byster approaches ambulance and states that you are not allowed to come into the house. Female appeared intoxicated, and did not own the house where the person that was injured lived. The house was a known crack house. RCMP was called at this time.

The crew went into the house after they talked the female into letting them into the house with out RCMP. On arrival the pt was semi-concious (responded to verbal, no response on deep pain). The pt and the bystanders were definatly intoxicated.

The pt passed out and the crew preceeded to load the pt. on the stretcher. Bystanders state he was coming down off of crack, meth and cocaine high and described it as a speedball high.

The pt came concious and became violent and began to run. Bystander physically pinned the pt. to the ground. The pt. was attimate about refusing care. The pt eventually agreed to care prior to passing out again. Vitals were stable...for a crack head.

One of the emt's stayed with the pt, and the other one went into the house to get a hx from the bystanders.

The pt. woke up and became violent as well as the bystanders. The pt. stood up and falls on the wood burning stove. Pt. was taken back into the house where received 3rd burn from falling on the stove. The pt was pulled off the stove due to no sensory and did not respond to pain.

The pt. began to vomit and aspirate and was put into the recovery position. The bystander became very violent at this time.

The crew went to the ambulance to wait for RCMP.

RCMP show up approx. 60 min after they retreated to the unit.

The RCMP was briefed and went into the house with the crew. The pt was woken up and the pt refused care and passed out again.

The RCMP refused to come to the hospital along with crew. The RCMP stated he wouldnt take custody of the pt and take him to the drunk tank.

The RCMP asked a bystander to be a legal gardian of the pt. The bystander appeard to intoxicated.

The crew signed the pt off with the guardian signing for the pt.

Now I am saying that they should have taken the pt. to the hospital wether or not he said yes or no because he was not compitant to sign off himself, especially with 3rd burns and the intoxication.

Where would I find the act or case in regards to taking custody against their will and what would the conditions be.

[scratrat]

All I can say is wow......

They thought this was ok? Why would one partner abandon the other to gather history when the pt already had been violent once? That was a stupid mistake. You should impress on both of them that, that could have ended their lives.

In response to whether or not to transport, absolutely. Intoxicated people can't sign a refusal. At least not in the states. I don't know about where you're from. Judging from the limited information (LOL) I would say this person was definitely not capable of making decisions for himself. They should have transported with or without consent. Get the police to go with if need be. I know that here in Florida, they have different Acts that basically state a police officer may, if he feels the person is a danger to himself or others, force him to go to the hospital whether they like it or not. They don't get the choice in that case.

This whole call sounds like a SNAFU from the beginning. That crew made several grave mistakes that they need to understand.

[altamedic]

All I can say is wow......

They thought this was ok? Why would one partner abandon the other to gather history when the pt already had been violent once? That was a stupid mistake. You should impress on both of them that, that could have ended their lives.

In response to whether or not to transport, absolutely. Intoxicated people can't sign a refusal. At least not in the states. I don't know about where you're from. Judging from the limited information (LOL) I would say this person was definitely not capable of making decisions for himself. They should have transported with or without consent. Get the police to go with if need be. I know that here in Florida, they have different Acts that basically state a police officer may, if he feels the person is a danger to himself or others, force him to go to the hospital whether they like it or not. They don't get the choice in that case.

This whole call sounds like a SNAFU from the beginning. That crew made several grave mistakes that they need to understand.

I tried to explain that they screwed up big time, and they opend their selves up to a law suit. Thier first mistake was going in without backup being there

[becksdad]

Oh, Lord! Scratrat touched on what I think was the main problem with this call. Actually it is 3 problems, and they are: scene safety, scene safety, and scene safety.

First, this crew runs to a "known crack house" met at the door by a "15" year old intoxicated girl trying to refuse entry. There is violence threatened. There is no LE. Not only does the crew attempt entry into the house without it being secured, but they managed to talk their way in despite obvious danger and despite having no LE on scene.

Once inside, everyone there appears intoxicated, more threatened violence, patient alternating between unresponsiveness and violent behavior. And then.... according to the account given, this patient somehow must have been removed from the house.... only to be brought back into the house!!!! WTF!?!?

Then, to top it all off, the 2 partners split up so one could go back into the house again and try to get a history on the patient. Never lose sight of your partner!!!! And why REPEATEDLY and DELIBERATELY insert yourself and/or your partner into dangerous situations? I don't get it. This was sheer lunacy!

I know your post was actually trying to address a question of transport vs. refusal for intoxicated persons, but nothing trumps my safety or my partners safety. And from what was said about this call, the entire thing is a glaring example of disregard for anyones safety.

As for the question about refusals by intoxicated persons: usually they go with us. Most times, they are a danger to themselves or others, and states of intoxication render them incompetent to make intelligent decisions. For those resistant to a nice ride to the hospital, LE can be fairly persuasive. Failling to obtain consent is still not a problem - there's always the Baker and Marchmann Acts.

Speaking of Baker Act - I think those 2 partners you told us about would qualify as recipients. They definitely placed not only themselves, but others in danger!!!........ sorry, I just had to get another one in

[altamedic]

I do have to give kudos to the one attendant, she realized what was going on and locked herself in the unit until the police came. Had she not, the other guy a fresh emt from a crappy school would have stayed at the scene.

This actually came to an argument with the newbie, he keeps trying to tell me that you cannot under any circumstances take custody of a pt without the police permission. Honestly what are they teaching people in school? He was the senior medic calling the shots, and the junior had to say no, im not taking this anymore.

I remember we had a lawyer come into class for a week in my emt class to teach us legal.

[scratrat]

This actually came to an argument with the newbie, he keeps trying to tell me that you cannot under any circumstances take custody of a pt without the police permission. Honestly what are they teaching people in school? He was the senior medic calling the shots, and the junior had to say no, im not taking this anymore.

Tell the newbie he's wrong and right. There is one time you can't do it. When they are awake, alert, and oriented x 4, and they are a compotent adult, with NO alcohol or drugs on board, and they are not considering suicide/homicide, then you can't take them without LEO intervention. Otherwise, if they are drunk (or sorry, intoxicated), under the influence of drugs, suicidal, or otherwise a threat to themselves or others, you can certainly transport without intervention by LEO.

But this thread still goes back to scene safety. I still can't fathom the fact that they did that.

[altamedic]

Tell the newbie he's wrong and right. There is one time you can't do it. When they are awake, alert, and oriented x 4, and they are a compotent adult, with NO alcohol or drugs on board, and they are not considering suicide/homicide, then you can't take them without LEO intervention. Otherwise, if they are drunk (or sorry, intoxicated), under the influence of drugs, suicidal, or otherwise a threat to themselves or others, you can certainly transport without intervention by LEO.

But this thread still goes back to scene safety. I still can't fathom the fact that they did that.

Thats the problem, scene safety is the hardest thing to teach and the easiest thing to forget in the heat of the moment. In my ifrst aid classes I always teach "Whos the most important person in the world?" I think people, especially inexperienced people get excited at scenes and forget to just breath and remeber to slow down and its thier emergency not yours. Also remembering why you are there.

[scratrat]

Amen brother!

[medic001918]

The transport decision wouldn't have been an issue had they gone in with police presence in the first place. As others have mentioned, there's a number of problems with this call. Why would you talk your way into a potentially dangerous situation w/o police present? Why would you stick around when people are getting violent? Especially when it's a group of people larger than the group of two you came with (yourself and your partner)? And I would be asking for a new partner if my partner left me with a patient that's already been getting violent and where violence is threatened. If they want to roll the dice and see what happens to themselves when they push the issue, that's one thing. Don't risk my safety for your stupidity.

Once they showed up and they were refused entry, it's time to wait for backup to show up before doing anything. All in all, a poorly run call no matter what the experience level of the provider was.

Shane

NREMT-P

[kevkei]

Where would I find the act or case in regards to taking custody against their will and what would the conditions be.

The simple answer would be the following:

The Health Disciplines Act: EMT Regulation.

Duties of registered members

13 A registered member shall

(a) execute duties in a safe and competent manner being guided at all times by the welfare and best interests of the patient;

You have a duty to protect the patient when they can't protect themselves.

--------------------------------------

Add to this The Mental Health Act

Part 3

Treatment and Control

Mental competence

26 For the purposes of this Part, a person is mentally competent to make treatment decisions if the person is able to understand the subject‑matter relating to the decisions and able to appreciate the consequences of making the decisions.

1988 cM‑13.1 s26

Part 1

Peace officer’s power

12(1) When a peace officer has reasonable and probable grounds to believe that

(a) a person is suffering from mental disorder,

( the person is in a condition presenting a danger to the person or others,

© the person should be examined in the interests of the person’s own safety or the safety of others, and

(d) the circumstances are such that to proceed under section 10 would be dangerous,

the peace officer may apprehend the person and convey the person to a facility for examination.

-----------------------------

I won't even comment on the gong show going on at this scene. Simply removing ones self to the ambulance and locking the door doesn't make you safe. Driving about 10 blocks away would be a much better choice.

As for the RCMP, never assume that they will be experts when it comes to medically related law. They tend to only be concerned with criminal law. Did they consider contacting online medical control for input?

The crew was dumb, the cops were lazy and they should consider themselves lucky that the patient didn't die (yet).