Sunday, September 18, 2011

The Involuntary Commitment Dilemma, cont.

So...have you been pondering? Come up with anything exciting? If you did, I hope you'll consent to sharing...

But until I hear back from you, I shall now commence a monologue on my own thoughts.

The first thing that I would do is finish assessing my patient and going through my own checklist for getting a refusal. The patient, comes first, and Officer Congeniality may need a subtle reminder of that. Secondly, don't engage with crazy; coming back with a snarky, "You do realize that what you're suggesting amounts to kidnapping, Oh Officer of the Most Sacred Law?" won't get you anywhere productive. If there's one thing that I've learned in my two years in EMS (sparkie though I may be), it would be that you want to be friends with as many people possible that show up to a scene. (Especially if you run in a rural area like I do, and there's only one or two golden guns in town that regularly show up to bail you out when you get the call for "domestic violence, scene not secure"). So this is where I would remind you to play nice.

And now that you've consciously reminded yourself to choke back that witty, sarcastic rejoinder that would have felt so fricken' good, I would suggest that you invoke the inherent usefulness of your partner in distracting the patient while you request a word with Officer Congeniality out of the ear shot of said patient. (If the reasoning behind this is unclear, refer to above point: play nice and make friends). There is nothing you want less than to embarrass an officer of the law who is wrong about...well, the front of a patient. Calm and cool is the way to play this one, and hopefully you will get lucky and Officer Congeniality will see the error of his ways.

Should this not come to pass, you do have options. In our jurisdiction, medical command is always a viable option. Explain the situation, and most doctors will come back with a "Really?! Yes, you have permission to release the medically stable drunk man." On the off chance that your fail to get such a doctor with common sense, you may be told to transport regardless. In this case, put on your salesman hat and try for the transport one more time. If you fail yet again, go back to Medical Command and state your case. However, under no circumstances should you transport the patient without their consent. Even if the officer says that they will follow you to the hospital, that is going beyond your scope of practice and beyond his scope of the law. The officer, in order to properly invoke and ECO (emergency commitment order), MUST have legitimate proof that the individual is either a danger to himself or others without medical intervention.

So I've managed to muck things up for you and answer fewer questions than you thought I would, right? Well welcome to the world of refusals. Rarely is there an easy answer, and some of the most interesting ethical questions in EMS (I think) arise out of situations involving AMA and the art of the refusal, as well as the role of ECOs. So to pose a new question to you: has there been any questions or debates that have sprung up among you and your colleagues after a refusal or ECO?

Til next time, CW

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