What would you do?

[DaRock98 76]

At 0130 hours Fire and EMS get dispatched to a local highway for an MVA with injuries. Upon arrival you find a 1 car MVA with heavy front end damage and the driver already in police custody. EMS crews attempt to treat the person in custody and are denied access to the patient by police. Police state they never called for EMS and that EMS cannot see or treat the prisoner. After discussing the issues of not checking out the patient who is highly intoxicated for about 15 minutes Police finish up the report and clear the scene with the patient. As an EMS provider what do you do?

[JM15 386]

Document everything

[INIT915 1,119]

At 0130 hours Fire and EMS get dispatched to a local highway for an MVA with injuries. Upon arrival you find a 1 car MVA with heavy front end damage and the driver already in police custody. EMS crews attempt to treat the person in custody and are denied access to the patient by police. Police state they never called for EMS and that EMS cannot see or treat the prisoner. After discussing the issues of not checking out the patient who is highly intoxicated for about 15 minutes Police finish up the report and clear the scene with the patient. As an EMS provider what do you do?

Not really enough info in your post to answer your question. Did the person actually claim any injury? If you never interacted with the patient, how can you state he's "highly intoxicated"?

We need more details before offering an opinion.

[DaRock98 76]

It is unknown if the person actually claimed injury. Fire and EMS were dispatched to the scene for an MVA with injuries by the local dispatch. The police on scene stated the person blew twice the legal limit.

[INIT915 1,119]

It is unknown if the person actually claimed injury. Fire and EMS were dispatched to the scene for an MVA with injuries by the local dispatch. The police on scene stated the person blew twice the legal limit.

OK, that helps a little. I can only assume that the driver showed no evidence of injury and declined EMS. Also, twice the legal limit is 0.16%, which, from experience, I wouldn't call "highly intoxicated." Intoxicated sure, but in the grand scheme of things, I thought we were talking .20-.30 or higher, when you said "highly."

And as JM said, just document it. That's a good way to CYA.

Edit: Just to add, assuming injury based on dispatch information suggesting injury is highly suspect, as more often than not, that is based on passer-by reporting, often not stopping to check, just assuming based on what they think they see.

Edited October 3, 2012 by INIT915

[efdny2003 16]

If police are refusing to let you see the occupant of the vehicle, a potential patient, make sure you get their names and what agency they were from and write it all down on your PCR. Especially note that you didn't have any contact, something along the lines of "arrived on location at xyz, police informed the only occupant from the vehicle is in our custody. Police officer Bob and Police officer Joe from abc police department refused access to occupant."

[PEMO3 523]

First of all a highly intox can also be subject to a medical emergency such as alcohol poisoning and this along with your concern of mech of injury should be relayed to the ranking PO. You should remind them that it is CYA for both you and them to properly eval the patient and most of all DO NOT make it a turf war. Nobody wins when you flex your muscles. Going just on the facts present make certain you document everything including names and shields, request a PD supervisor to the scene, request the ranking PO refusing access sign the PCR of refusal to allow treatment of a prisoner, at no point push the issue as to put yourself in the position of risking arrest for obstruction. Remember that after this patient you still have to work together. Just document the heck out of the PCR and CYA so nothing come back to haunt you later.

[sympathomedic 383]

We have similar issues on my job- the PD wants to ride the victim of a street assualt around to look for the perp- but he is hurt and being removed from you.

One thing that has been absent from this thread is medical control. Use them. You making a decision however wise, carries way more weight if you can report/document "I spoke to Dr Smith at General Hospital and he asvised me to take this course of action". Also the doc may have his boss call the PD boss the next morning and make some kind of policy so you are not caught in the middle between law enforecment and medical care. Both of you want what is best.

[x129K 1,393]

The ACR is your friend.

[SSweet88MonteSS 0]

Are they truly intoxicated or are they diabetic? Herein lies at least one dilemma posed in the hypothetical, which only solidifies the necessity of an EMS assessment of the individual involved in the crash.

Taking into account the totality of the circumstances regarding the vehicle, in addition to the fact that EMS who is merely "passing by" would have an obligation to stop and assess the situation, and therefore the patient since they, due to their condition, could not make any informed decisions regarding their care, I'd stay on scene despite any PD protest. I'd radio for a boss from both agencies to respond to the scene and continue with my assessment. If I wound up wearing a pair of bracelets, too, well, then that's a risk I'd be willing to take. No grand jury in the world would vote to indict me for treating the subject, based on my EMS training and experience, but you can bet your next pay check that they'd indict me for negligence had I failed to treat, based on the same training and experience, if the hypothetical patient subsequently succumbed to injuries sustained in the crash.

Edited October 3, 2012 by SSweet88MonteSS

[x1243 141]

Document everything, including badge numbers and then....................................

[antiquefirelt 994]

We've had this issue a few times over the years. Luckily in our state, we know that if a person is in police custody, the police officer has the authority to make all decisions for them. This may be a huge extension of liability for them, but takes any responsibility away from us. Since we like 99% of our police force and the few others we routinely deal with, we might explain to them the potential for injury/illness much like we would any refusal to ensure they too are making an informed decision.

The only time "police custody" has been a significant issue was when the PD supervisor couldn't spare an officer to ride in the bus with the patient in custody, and wanted to un-arrest them so we could take them in without PD. This was not allowed to occur as the officers had already made a fairly big deal of how dangerous this guy was, thus we were forced to threaten to call in a state trooper of sheriffs deputy to transport with our crew, and the Sgt. decided not to take that option. The patient/prisoner had a minor injury, but the jail wouldn't take any prisoners with visible injuries without seeing the ED first.

Edited October 3, 2012 by antiquefirelt

[Jybehofd 85]

upon arrival found person in police custody. officer xzy badge #1234 st " he has no injuries and is in custody" no patient found.

[INIT915 1,119]

OK, aside from the lack of understanding how Grand Juries work, let me just address the medical aspects here. I feel fairly qualified, having been both a Paramedic for over thirteen years now and a LEO for over ten years. So, I've walked both sides of this line.

Generally, around here, no LEO's want anything to do with injured prisoners/victims/etc. That being said, they are more than happy to stroke it off to you in EMS. (Not sure if that is the same sentiment held all over the country.) If anything, LEO's are more likely than not to catch flak for calling out EMS on every drunk and disorderly. Now, you can't have it both ways.

At the same time, let's all use a little common sense. Just because someone is in a car accident, does that mean they have injuries? No, it doesn't. Just because someone is intoxicated and involved in a car accident, does that mean they are injured? Again, no. In fact, I'm willing to bet LEO's have more interaction with drunks then a good number of EMS personnel, giving them a pretty good perspective on who needs evaluation and who doesn't.

By the logic of some here, every single MVC, no matter how minor, EMS needs to respond? I don't think so. And in line with that, EMS should be called for every drunk that comes in contact with law enforcement? Seriously? Why doesn't EMS have personnel assigned to every bar, pub, wedding, party, barbeque, wine tasting, etc, etc, etc, in the nation? I mean, there are drunks at all those functions. How can we be sure anyone of the thousands of drunks at any moment in time are not diabetics???

Cops deal with drunks every night. I think, with pretty good results, they are capable of determining if they are injured. Where I work, even drunks that don't appear injured or ill get EMS if they ask for it. Even in the absence of any objective indications they need it.

So, if any EMS agency here wants to be called to every single MVC or drunk party, let me know. We can certainly keep you busy!

For those who think I'm wrong, can you provide me (us) with some studies, statistics, empirical data, anything, that suggests LEO's aren't good at these situations? I'm open minded that there could be problems outside my little corner of the world, but I generally don't see it.