Consent in EMS?

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Treat the patient and worry about the "legal" consequences later.    
IMHO, it is our obligation to take care of the patient - and consent is
not an issue when the patient has (or is suspected to have) substances
on board.

Sorta like reporting a SUSPECTED  child abuse in the state of CT.  We
as physicians are oliged by law to report our suspicions, even when we
have no definitive proof.  If we don't and there was abuse, we can loose
our license.  In your case, the doc has no proof of substances on board,
just a suspicion based on heresay from the house mates.

Have the cops take the victim into custody, transport him to the ED and
go from there.


>>> MARK FORREST <atacc.doc at btinternet.com> 5/28/2006 11:03 AM >>>
Heard of an interesting case last year:
  Emergency domestic  call to a stabbing in a house. 
  Ambulance crew and an experienced Medical Team (doctor) arrive on
scene. 
  There is blood everywhere and the casualty has wounds to his arm,
chest and abdomen and is clearly still bleeding. This was an assault and
not a suicide attempt.
  The  scene has been declared safe by the police but the casualty is
agitated, confused and refusing treatment.
  -Ambulance crew stand-off as in their opinion the casualty is clearly
refusing treatment. They believe that he is well aware of his condition
and any attempt to treat him would be assault.
  -Housemates of casualty claim he is under the influence of drugs and
alcohol
  -Doctor believes he is 'incapacitated' by worsening shock and
possibly drugs and alcohol. He is 'not of sound mind' and 'it is in his
best interests to be treated'
  -Police just want him out of the house (crime scene)
   
  A heated debate then ensues between the doc and the paramedics,
whilst the patient deteriorates. Ambulance crew will not touch him until
he gives consent or loses consciousness.
  Finally, the crew agree to intervene as the police are man-handling
him out of the property.
  The casualty had a lacerated brachial artery, a large haemothorax and
a perforated bowel...he survived and was grateful but the arguement has
continued.
  Experienced paramedics vs doctors opinion vs police vs housemates vs
casualty?
  Any thoughts?
  Mark F
  UK
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