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Mon Nov 6 19:12:08 GMT 2006

The pateint didn't seem to be a violent guy at all. I can't know that for 
sure becuase of the condition he was in, but he's brother, who later drove 
us to the hospital, seemed like a very reasonable, responsible and setteled 
guy, and I do beleive "it all stays in the family". Morever, what i did 
understand that happened was that he was struck trying to relax the 
altercation, and was not at all physically invovlved in it. What I am saying 
is, that he wouldn't physically resist treatment himself, but the 
"geurillas" might have done it "for him".

The police are called here for any report of a fight as well, but since the 
guy who called the EMS was the head of security, he simply didn't notife 
them it was a fight. When I called the EMS, it was before I had been told it 
was the case.

I think that the invovlvment of authority figures (parents, bosses, etc.) in 
PHTLS
is a whole chapter for a discussion.
>From: Krin135 at aol.com
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: trauma-list at trauma.org
>Subject: Re: Consesnt vs. Responsibility follow-up;
>Date: Mon, 6 Nov 2006 08:43:50 EST
>
>In a message dated 11/6/2006 2:33:56 AM Central Standard Time,
>tangentcarrot at hotmail.com writes:
>
>
>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?
>
>
>
>
>Item the first: I'm not sure about Israel, but here in the US, the Head of
>Security in a situation like that should have been the first one urging the
>chap  with the problem to go to the hospital, as the *Club* could be held 
>liable
>if  the chap really did have a serious problem. This is even more true if 
>the
>patient was an employee of the club. It would have looked even worse for 
>the
>head of security and the club if they had kicked you out for trying to help
>the  patient and the patient had later died...such things can result in
>negligent  manslaughter charges being filed here in the states.
>
>Also, in many areas of the US, a call for a possible altercation
>automatically results in a police response, for crowd control if nothing  
>else.
>
>As far as the amnesia causing problems with his refusal, again, it depends.
>The main problem remains that the patient is still 'walking, talking and 
>potty
>  trained,' and capable of forcibly resisting physical attempts to bring 
>him
>to  the ED. Lacking training in safe take down techniques (usually provided 
>by
>the  law enforcement folks), I'm not sure that I'd want my medics trying to
>bring him  in, especially if the Club management is resisting the 
>situation.
>
>Documentation of good faith efforts on the part of the responding EMS  
>folks,
>as well as coordination with on line medical control (and hopefully,
>documentation on the part of the doc at the other end of the radio) will go 
>a  long
>way to providing recourse if the situation does go south....but there is
>little that I can see to be done for the patient in the situation you are
>describing.
>
>ck
>Charles S. Krin, DO FAAFP
>
>
>
>
>
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Consesnt vs. Responsibility follow-up;