Under the influence

[fudgie]

Reviewing some standing orders at EMS work. Freedom of stuff we are allowed to do to pts without a doctors permission. One came up the other day that I pushed for some clarity as I have went rounds with a supervisor about in the past. It was inreferance 'signing off' a pt that has consumed alcohol. It says we have to have doctors permission inorder not to transport him if he appears to be under the influence of alcohol or drugs, street or prescription. I had a guy that apeared not to be under the influence but admitted to having some drinks. No slurred speech, alert & oriented, etc. He rufused transport, he signed, we left, got chewed out. Supp said we need medical control to release him since he had some drinks. Blah blah blah. That was 3 yrs ago.
So I asked the new boss lady on Monday what her take was. She said anyone that has anything to drink is under the influence. I disagree. I believe having one or so does not make you under the influence. Medically and legally are 2 different things. We cannot test BAC in the field, nor do we need to. Further down the SO it talks about intoxication which is a whole other ball game. We are going to look into this further in a few days with the doc.

What are your guys take?

[Hoser]

Agree with you, has the new boss ever rode out?  You'll be on the phone to the doc all the time. Are you workin for a private service?  Sounds like a way to enhance revenue to me!  hoser

[fudgie]

Agree with you, has the new boss ever rode out?  You'll be on the phone to the doc all the time. Are you workin for a private service?  Sounds like a way to enhance revenue to me!  hoser

Yea shes a paramedic but been off the streets running ems for 10 yrs or so. We are hospital based, as is most in this corner of the State. We are owned by a big regional hospital that owns about 5 community hospitals. I don't think it is a money thing. The ER docs are pro EMS and trust our judgment and 99% of the time if a pt is refusing transport and we don't think its necc for them to go in, the docs will agree. I guess its all in how you chart it!  Revenue would be good tho, we charged for $3 million worth of services in 09 and wrote off $2.1 million. 

[Robert]

Fudgie, had a interesting thing happen to me the other day. At around 2 am there was a car stopped in front of my house just idling with the lights on and it was there for a good 5 minutes. I was trying to see who was in the drivers seat, (no passenger) and couldn't make them out. So I called the police they come driving up behind the car lights blazing and no reaction so the cop goes around and since this is a t intersection comes with lights pointed at the drivers side of the car. still no reaction then another cop pulls up behind with lights blazing and still no reaction. At this point both get together at the rear of the car with guns drawn because they cant see the driver because it looks like a sheet over the window. They get on the car bullhorn and still no response. So they slowly approach the pass side of the car and look in and rap on the window so loud that I clearly heard it in the house. No response. They decide to break the window and before they do they see the pass side tires are flat. The window breaks and the driver is a woman and still no response. At this point we think either the woman is dead or dead drunk. As they approach the drivers side and try to wake the woman no luck and they dont smell any booze or see any drugs. Well here comes the emts as the cops are looking through the car. The side curtain airbag had gone off that was why they couldn't see the driver and the front nose had a big dent on it. Well after the EMT s examined the girl seems she had narcolepsy and had a prescription in her possession. Seems she hit the median  blew both tires then drove down the street and went into the ditch into the neighbors driveway which is a circular drive came out on the street and stopped then fell soundly to sleep. What are the chances at 2 in the morning the person wasn't drunk.   

[Farther]

Sorry Fudgie, as a retired firefighter/medic I would have to agree with your boss.  For what it's worth, I thought those words would never come out of my mouth.

[fudgie]

Sorry Fudgie, as a retired firefighter/medic I would have to agree with your boss.  For what it's worth, I thought those words would never come out of my mouth.

No need to be sorry, thats why we have to get clarification on it. Everyone has a different opinion on what is UTI. 

[sugerbear]

isn't that when it burns like heck when you pee??  no, wait............your talkin bout somethin else i guess..

[Challenger]

I know what your saying Fudgie, As a Vol EMT we have to get Med Directive for a refusal. Even if all vitals and loc are fine, if we mention ETOH involvment, We have to transport. That makes us the bad guys when the pt says there is no way in hell he is going.

[ArmyValker]

Well, I don't know about he "technicals" but, if I had one beer, and for some reason or another had to be checked out by EMT's, we would definitely have problems if I was being "forced" to go to the hospital. Can you legally force someone who's not legally UI to go?

I guess you can if it's even a question, but I can see why you'd say what you did.

[fudgie]

Well, I don't know about he "technicals" but, if I had one beer, and for some reason or another had to be checked out by EMT's, we would definitely have problems if I was being "forced" to go to the hospital. Can you legally force someone who's not legally UI to go?

I guess you can if it's even a question, but I can see why you'd say what you did.

Can we force? No, its kidnapping. We have to if your a minor, under implied consent, unless parent says no. If your drunk, technically yes. Your not able to make your 'responsible decisions' since you have a altered mental status.  ??? In my 12 yrs I have never heard of our docs saying bring them in against their will. Legally UI is something we cannot decide. Technically we cannot say someone is drunk. We can only say they appear to be UI which resembals ETOH. Hell, technically we cannot diagnose medical problems, only treat the 'symptoms'. Since we are not doctors.

[fudgie]

I know what your saying Fudgie, As a Vol EMT we have to get Med Directive for a refusal. Even if all vitals and loc are fine, if we mention ETOH involvment, We have to transport. That makes us the bad guys when the pt says there is no way in hell he is going.

Luckily we don't have to for all refusals. Just ETOH and treatments at the scenes like diabetics. I bet they do put up a fight. But then again I like wrestling with drunks! 

[Jabba]

So the moral of the story is deny consumption if you don't want to go in against your will.

Personally, I don't like the idea that you can transport against one's will.  Sort of goes against my Libertarian philosophy.

I have been on a couple ambulance rideas.. one of which I didn't really want to go on but they talked me into it.  Put me on a backboard with my head taped to the board... then left me in the ER for a couple hours like that.  It was awful.  I eventually got pissed and told them they had 1 minute to get me off the board or I was going to myself.  When I started extricating myself... they finally came and got me off it.  To this day I think it was just a game to them.  My head hurt like HELL where it was being pushed against that backboard.  The treatment hurt WAY more then the accident.

Jabba

[fudgie]

So the moral of the story is deny consumption if you don't want to go in against your will.

Personally, I don't like the idea that you can transport against one's will.  Sort of goes against my Libertarian philosophy.
I have been on a couple ambulance rideas.. one of which I didn't really want to go on but they talked me into it.  Put me on a backboard with my head taped to the board... then left me in the ER for a couple hours like that.  It was awful.  I eventually got pissed and told them they had 1 minute to get me off the board or I was going to myself.  When I started extricating myself... they finally came and got me off it.  To this day I think it was just a game to them.  My head hurt like HELL where it was being pushed against that backboard.  The treatment hurt WAY more then the accident.
Jabba

Has to due with your altered mental state. If your wacked out in the head we cant leave you like that. Its abandoment which is another issue! Are you drunk? Did you have a stroke? Seizure? Head injury? We dont know. If your in your sound normal state of mind and dont want to be transport, its your right. If they do, its kidnapping. Like I said, chances are so slim if you had a few and don't want to go, you wont. But yes, deny deny deny!