Consesnt vs. Responsibility follow-up;

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One point to be cleared- it did not happen in the US, but in Israel.

About law enforcment officers- none were at the scene, since the weren't 
activated. The night club owner probably did not want "any trouble", and the 
EMS were not acknowledged that it was the consequence of a fight.
You wrote-
>"since when does a 3rd party (employer or not) get to make ANY decisions "

Since he's the head of security of the night club. Arguing too much with him 
wouldn't have fallen right with the principle of "safety first" we embrace 
in pre-hospital acute treatment :)
And being serious- I'm sure that it wouldn't have been at the best intrest 
of the pateint to start arguing with the boss, since i'd be kicked out and 
the pateint left alone with out a professional.

About the possibility of intoxicication- it is very unlikely. The guy works 
at the club and gets his drinks from a bar tender he knows and works with. 
Moreover, they do everything they can so the club stays drug free, and as a 
veteran commer to the club, i've never encountered drugs there.  According 
to freinds, he had one drink all night long, which makes him even competent 
to drive.

And a thought- if the pateint does not know what happen to him, becuase of 
the amnesia, how deeply does it imapct his ability to refuse? He does not 
fully understand his condition, does he?


>From: "Shane Moore" <EMS-Shane at comcast.net>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
>Subject: RE: Consesnt vs. Responsibility follow-up;
>Date: Sun, 5 Nov 2006 16:05:48 -0800
>
>Maybe I'm not reading the post correctly but, since when does a 3rd party
>(employer or not) get to make ANY decisions re: emergency healthcare?  The
>EMTs onscene regardless of their certification level should have been
>dealing directly w/ the patient.  In the event that the patient refused, 
>try
>all the other tricks up the sleeve (contact online med control, enlist
>family/friends, etc).  If the patient still refuses and the concerns and
>risks have been explained AND understood, then reassure the patient that 
>EMS
>will gladly return if/when needed.  Then document the everliving crap out 
>of
>it; you WILL see this chart again.  You may even consider whether the
>patient falls under the implied consent parameters for your area, in which
>case you're home free (you state that the patient didn't drink alcohol to
>excess; did he drink any at all? That could affect the patient's legal
>decision making abilities).
>As far as the boss portion; send him to get clean towels and boil some
>water... whatever it takes to distract the guy.  His desire to stay out of
>trouble w/ the local law and/or alcohol board notwithstanding, he has no
>legal say (my opinion) as pertains to care of the patient.
>As for the environment:  Having been a manager of a very large nightclub in
>a previous life and an EMT for 19 years, I can tell you that I have seen an
>increasing number of 'spiked' liquids being unknowingly ingested by
>clubgoers.  S/S can be similar to excessive ETOH intoxication (decreased
>LOC, decreased resp drive, inability to maintain/protect airway, vomiting,
>etc) and can be misread by rescuers called to the scene.  GHB and Rohypnol
>are very popular in this area (Pacific Northwest, USA) and are often placed
>into unsuspecting persons drinks; odorless, mostly tasteless w/ effects 
>that
>are often synergistic.
>As an EMS educator I tell scary bedtime stories of EMTs that fail to
>properly document refusals and INFORMED refusals from patients.  Just my 
>two
>cents.
>
>Cheers,
>
>Shane
>
>"They say people fear public speaking more than they fear death. So
>technically, if you kill a guy who's scheduled to speak, you're doing him a
>favor."
>
>-Scott Adams
>
>-----Original Message-----
>From: Forrest Robleto [mailto:farcpr at gmail.com]
>Sent: Saturday, November 04, 2006 3:07 PM
>To: Trauma &amp, Critical Care mailing list
>Subject: Re: Consesnt vs. Responsibility;
>
>Yes the EMT-B's should make every attempt to get the victim to go.  EMT-B's
>particularly in my state (NJ) have very little liability exposure and
>statutory immunnity for most.  But the one area which is more likely than
>any other to get them into court and for which they have no immunity is 
>"the
>refusal." We teach EMT's to make every attempt to get patients to go.   
>They
>are much safer that way.
>
>
>Forrest Robleto
>EMT-Instructor
>
>
>On 11/4/06, oded private <tangentcarrot at hotmail.com> wrote:
> >
> > Young Man (mid 20's),thin and healthy appearing, working in night club,
> > crashes at the club. He is unressponsive to voice or pain (GCS score=3),
> > but
> > has a patent airway, is breathing Spontaneuosly and has a strong pulse 
>at
> > around 70 bpm. According to friends, he didn't take drugs or drink
> > excessive
> > alcohol, but might have been hurt by another clubber. I order the
> > activation
> > of the EMS. within ~1 min. he starts waking up and vomits. We take him
> > outside, where I learn his boss canceled the bus since "his Ok now". He
> > keeps on vomiting, has a thready pulse, is shivering, and has retrograde
> > and
> > antegrade amnesia. Claims are he had been stuck in the head. Finaly,I
> > manage
> > to convience him to take the bus to hospital. When the bus comes, the
> > boss,
> > once again, insissts that the owner will take him to the hospital.
> > Ambulance
> > personnel don't even argue and get away, inspite of my attempts. Finaly,
> > we
> > get to the hospital by car, at least 40 min post injury (?).
> >
> > The first dillema is- should EMS personnel (EMT-B'S, in this case) 
>insist
> > with such pateints? I tried conviencing them to "talk some sense" into
> > him,
> > but they refused,despite my description of coma and amnesia, saying they
> > couldn't force him and that "he looks fine now", and left the scene.
> >
> > What are your thoughts?
> >
> > _________________________________________________________________
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>
>
>
>--
>V/R
>
>Forrest Robleto
>R House Health & Safety
>www.RHouseTraining.com
>FRobleto at RhouseTraining.com
>609-792-9047
>
>
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>trauma-list : TRAUMA.ORG
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