Evaluations

Some towns’ police departments call us to check out prisoners’ medical complaints, typically those suffering from jailitis. The cops get annoyed when we bring the stretcher in. He’s not going to the hospital, we just want you to check him out, they say.

If you want to make the cops happy, you finesse a refusal out of the prisoner. You say: “You look okay, sign here.”

But that is sort of against official EMS policy. In this state, we are required to offer treatment and transport three times before getting a refusal.

The issue of evaluations is murky. We cannot tell anyone they can’t go to the hospital if they think they are sick. You have a complaint, we transport. That’s the nature of the job. That’s how the system is set up.

So I ask the prisoner if he wants us to take him to the hospital and he says yes. When I tell this to the sergeant, he says, “Bull-!” He isn’t going to the hospital!”

I want to say, “Then why did you call us?”

It seems they want us to evaluate the prisoners so they can write in their report the patient was medically cleared, but we can’t clear people. It’s not in our scope of practice.

This has now been communicated again to the towns and for a little while now, we have stopped getting prisoner evaluation calls. But we do get other requests for evaluations.

We get called to evaluate the 2 year old who was locked in the car for ten minutes. We get called to evaluate the man punched in the nose. We get called to look at the scratches a woman got on her arm during a fight with another woman.

Your kid looks fine.

You got punched in the nose.

Yes, you have scratches on your arm.

The refusal form says “I am refusing treatment and/or transport against the recommendation of…”

But the thing of it is as a man of I hope some common sense I really don’t want to recommend to someone that they sit in a waiting room for five hours only to be told:

“Your kid looks fine — I mean he was only in the car for ten minutes.”

“Yes, you got punched in the nose. Medical science hasn’t yet figured out how to unpunch someone. Suck it up.”

“Yeah, those are scratches. Don’t lick them.”

Legally we have to recommend treatment and transport to everyone.

“While it appears you are fine and not hurt, legally I must recommend treatment and transport to you. It’s just something I have to do. It is standard policy.”

The other day we get called for a fall at a business. We find two women sitting on couches in the lobby. One tripped on the escalator, the other says she hurt her knee helping the other up. Two patients, one ambulance. I’m wondering if I need another ambulance. My first question is “What hospital do you want to go to?”

“I don’t want to go to the hospital,” says one.

“Me, neither,” says the other.

Okay…

“I just want to be evaluated,” says the one.

“Me too. I just want an evaluation,” says the other.

What do I say:

1. “I have nothing available today, but I can try to fit you in at 10:30 tomorrow.”

2. “I can take you to the hospital and they can evaluate you there. In fact, I recommend (times 3) that you be treated and/or transported. If you refuse my recommendation (times 3), sign right here at the ‘X’ times one.”

3. “Evaluation! Get out of here! Just go on! Get! What are you doing? Calling an ambulance for an evaluation? Go on! Git!”

What did I do? I told them I could take them to the hospital where a doctor could evaluate them or they could go see their own doctor. They shrugged and got up and walked back to their offices.

Later the first responder told me the women had been joking while waiting for us (He had slowed us down to a non-priority response.) “Good thing we’re not bleeding to death.”

***

I guess I have no real problem with someone wanting to know my opinion. My problem is that I am not supposed to tell them what I really think. Or can I? I don’t think you need to go to the hospital, but you might want to go see a doctor or someone with more specialized training. I’m just a paramedic, and while I think I am good at my job, legally I can’t give you the medical opinion you seek. If you don’t want to go to the hospital with us, we just ask that you call us if you change your mind or your condition changes.

That’s what I say and it usually does the job.

I don’t know why I get so worked up about it.

Nature of the business, I guess.

As far as the cops go, if they don’t want the patient to go, I say, well, he may not be hurt or sick, and I’m not convinced he is, but if he wants to go and you don’t want him to, then I’m going to need you to sign my run form, clearing me from liability.

5 Comments

  • Anonymous says:

    Not trying to one-up here. Call yesterday to the local lock up. Man found in vehicle after bouncing off several other parked vehicles. BAC=.398. Our system has a tiered response. The call came in as a BLS response. Then the dispatcher says, “alcohol content three-nine-eight.” BLS unit officer says, “that’s a mandatory transport, send the box.” Okay. We show up. Pt is AAOx3, GCS15, able to stand and walk on his own. Granted, he has some deficits but he’s otherwise just fine. Vitals WNL. Okay, what do you want us to do with this guy. Cops say, “we just wanted an eval.” BAC is not within our evaluation toolbox. We just rely on what the cops tell us.Now to most people a .398 would indicate pretty much fully intoxicated. But to this guy it seemed pretty normal as long as he didn’t drive.We get back to the house and the BLS officer says, “you didn’t transport?” Well, he said he didn’t want to go to the hospital. He signed the form. “You shoulda taken him.” Nowhere in the protocol does it indicate a BAC of .398 is a mandatory transport. As I said before, if this were you or me, we would have been taken via implied consent. But this guy was fully capable of making his own decisions. Really. No crap. This guy was talking and not slurring with a .398.I have since spoken to several MD friends. One said he saw a BAC in the .7 range with few deficits. Now that is a seasoned professional!!

  • Anonymous says:

    sorta like the phrase “just get checked out” on the surface it makes sense but when you really think about it does it mean anything at all? 30 yr old female crashes into a tree, Dad shows up insists she “goes to the hospital to get checked out” patients only real issues is she is emotionally upset. Why do we take her? “Just to get checked out…” Common sense, or lack of John Q. Public or Police Officer actually understanding the situation.

  • AlexD says:

    Fellow Medic,Jailitis I will definitely have to use that one the next time a Gangster decides to get a bellyache or misses his mommy. However here (down south) the jailers will need to see proof of your kidney falling out before they allow transport. However they still want the prisoner checked out and then refuse afterwards. Good post.Alex ~D~http://theapocalypsepaper.blogspot.com

  • Anonymous says:

    I get stupid calls like this all the time at the jail. Chest pain. PD asks, “So, does he need to go?” I say, well, 12 lead is negative for signs of a heart attack, his symptoms are inconsistent, but if someone is complaining of chest pain, that is a condition which should be evaluated at a hospital. The police get upset at this. I think, well then don’t call. And I tell them, don’t call us if you don’t want them to go.Then the police say, “We don’t want to withold medical attention from people.” And so it’s bad for you to withhold medical attention, but I should withhold medical care? Me, the medical provider?Also frustrating is when PD beats someone up, which happens frequently, and then calls us. Guy will have a broken nose, a cut, tooth missing, or something resulting from a tussle with the police. PD will say, “He’s refusing care, but we called anyway because he has this bloody nose.” So, he doesn’t want an ambulance, doesn’t need an ambulance, and yet you call anyway because you beat him up for no reason and want to cover your ass? Great use of the system. How about I call the police whenever I see people walking on the street at 3 am. Maybe they’re up to no good!Anyway, the guy the police beat up will say, “If they’re going to arrest me, I want to go to the hospital.” I say, “You realize that you will still go to jail after you leave the hospital?” I don’t care. The the police will say, “Does he really need to go? I say, no, he does not have a condition that would meet the medical necessity criteria for medicare, but by law he is asking for transport and we must provide it.”So now the police are pissed.You always lose sometimes in this job. I don’t think that people understand that my tools, training, and experience are designed for immediate life threats ONLY. Recent conditions for which I have been called upon to “fix”:Shingles.Cancer.Gout.Syphilis.Hunger.Tired.5 day old bite from maybe a cat. Maybe a spider. Maybe a bug. And I would hope that the police would understand this better than the general public. But they don’t.

  • fiznat says:

    This job has its moments, we all know that. …But occasionally, in situations like these, protocol requires that we exhibit some pretty awesome humility. People look up at us and, informed or not, assume that we are trained medical professionals who are capable of offering sound medical advice. …And each time, we must swallow our pride and tell them the truth of the situation. We probably even know what the answer is, but we are not allowed to supply it. Sorry, we can’t make those kinds of decisions ma’am. It is necessary of course, but it is a hit to the ego from time to time. …Or does it no longer bother you?

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Peter Canning

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