ETOH College Student Vs College Policy Vs State Law

[rsqsquad91]

Let me first start this post by saying, when someone is intoxicated how do we know if they are mentally capable of understanding a situation when alcohol consumption is different for every human being?


We have a college campus in town (catholic private school) who has a policy on campus that states, Any student that is caught intoxicated must not stay on campus. They also have an additional policy that states that sober friends and roommates are not allowed to watch the student on campus.


The real life scenario: We respond to a 18 year old male patient found by an RA laying down in bed sleeping who admitted to alcohol consumption. Upon arrival, we are met by the College's EMT squad, the RA and their supervisors and college security. The patient is conscious, alert and oriented to person, place, time and event. Patient has a patent airway, good breathing and excellent circulation with pink, warm and dry skin. Hes able to answer all questions appropriately with no slurred speech and denied any injury. The patient was evaluated in a sitting position on his bed side. Patient stated, "I had a few shots tonight and then my friends brought me back to go to bed. The next thing I knew security is in my room with the RA calling 911 for me." The patient was adamant about not going to the hospital. This is when everything went downhill. The college drilled into their RA's that the patient has two options, Jail or Hospital. So we have an RA telling this student that if he doesn't go to the hospital he is going to jail.


So this is what usually happens in this situation and it puts us in a sketchy spot. The patient refuses transport by us. PD may or may not write them a court date (depending on who and if they are in the mood). Every time this happens the RA steps in and says this student needs to go to the hospital, and we repeated tell them the same thing. "This student/patient is answering all of our questions appropriately and is coherent enough to know and understand the situation and risk with refusing transport. I cannot legally bring him to the hospital." Police will not arrest them. The college RA's are adamant about giving us a hard time by "letting this student refuse to go to the hospital."


In the end, the RA's or the college EMT's convince the patient to go to the hospital by continually saying to them they will go to jail if they don't.

 

[Qulevrius]

Let me first start this post by saying, when someone is intoxicated how do we know if they are mentally capable of understanding a situation when alcohol consumption is different for every human being?

It has nothing to do with individual response to ETOH. You have your guidelines (i.e. scope of practice) and you adhere to it. Whatever the RA says is of little importance, you do not answer to them. Your higher authority is your county EMSA, you do what they tell you to. I fail to understand how it puts you 'in a sketchy spot' with the college RA's repeatedly giving you a hard time; usually when something like this happens it's an incident report that clearly shows that the EMS crew followed the SOP to the letter and are in the clear. And frankly, it looks like purely a college security's problem - if the school has issues with ETOH, maybe they should educate their students better instead of trying to pin it on EMS (which has absolutely nothing to do with it).

 

[StCEMT]

Let me first start this post by saying, when someone is intoxicated how do we know if they are mentally capable of understanding a situation when alcohol consumption is different for every human being?

By this "The patient is conscious, alert and oriented to person, place, time and event" and "Hes able to answer all questions appropriately with no slurred speech and denied any injury." and "I had a few shots tonight". He had a few shots earlier that day. Not an entire fifth. Not only that, he is answering everything you ask. As far as I see it, it is your scene, tell the RA's to piss off. They have no business telling you how to do your job. This is one of those times the patient needs to be informed that he is getting billed for 1. transport to the hospital and 2. a hospital visit, all because his RA is an idiot. Then inform the RA of what 911 is actually for and to not call it unless there is an actual medical need. And this is all coming from someone who isn't the happiest person arriving on scene knowing they just downed an entire bottle of brandy and likewise doesn't coddle the local drunks....

Part of my problem with this situation is I am also a Sr. and I no longer care about the alcohol rul-....suggestions of my own campus.

 

[DesertMedic66]

Easy. "Dispatch, no patient found" go back to bed. In order for a patient to be a patient they must have a complaint. This patient (I call them subjects) is AOx4 and is able to refuse any care. The subject does not have a complaint and the subject did not request medical aid. Having several shots does not make someone intoxicated.

 

[WolfmanHarris]

I ask staff not in the circle of care to leave. They have no role in my patient care and no responsibility for decision making. As I have told many a nursing home or retirement home, "I am not beholden to your policy."

Coercion is medically unethical and I have no issue telling school staff that. If they won't allow the student on campus that is an issue between them and the student and has zero bearing on my medical decisions or the patient's capacity.

 

[Gurby]

So this is what usually happens in this situation and it puts us in a sketchy spot. The patient refuses transport by us. PD may or may not write them a court date (depending on who and if they are in the mood). Every time this happens the RA steps in and says this student needs to go to the hospital

RA: "They need to go to the hospital!"
Me: "lol nah."

 

[Tigger]

Sounds like a meeting with the college is in order...

 

[EpiEMS]

Medical control surely can help, here.

Or maybe a meeting, as Tigger suggests, would be constructive.

 

[NomadicMedic]

Easy. "Dispatch, no patient found" go back to bed. In order for a patient to be a patient they must have a complaint. This patient (I call them subjects) is AOx4 and is able to refuse any care. The subject does not have a complaint and the subject did not request medical aid. Having several shots does not make someone intoxicated.

This wouldn't be a no patient for me. This is, without question, a documented refusal of care and transport. Even if a patient didn't summon EMS for themselves, someone did and EMS made contact. I would have to document the entire contact, including the fact that I explained the refusal to the patient three times. Then I could leave and go back to bed.

The only time we can "no patient" any dispatch is if the patient is actually gone on arrival.

 

[DesertMedic66]

This wouldn't be a no patient for me. This is, without question, a documented refusal of care and transport. Even if a patient didn't summon EMS for themselves, someone did and EMS made contact. I would have to document the entire contact, including the fact that I explained the refusal to the patient three times. Then I could leave and go back to bed.

The only time we can "no patient" any dispatch is if the patient is actually gone on arrival.

This is our county's definition of a patient. Allows us not to have to make patient contact for the bystanders who call 911 because someone is sleeping.

 

[ExpatMedic0]

What a mess, sounds like a waste of money and resources. Who pays for the ambulance and hospital bill, how does the medical director allow this? How do you justify the medical necessity for an ambulance transport in your report?

 

[Carlos Danger]

A ridiculous policy on the colleges part. Being drunk is not a medical emergency or a crime. If they want to have an anti drinking policy that is up to them, but I don't know what makes them think they can tie up valuable public safety resources to enforce it.

They are literally calling 911 for no reason. Local police should obtain a cease and desist order, just like they would for any serial 911 abuser.

 

[rsqsquad91]

This is our protocol which is very iffy in my eyes, due to the fact that we cant ASSUME a patient is intoxicated. That's like me saying, "Yeah I had one beer." Do you assume my judgment is impaired? I wouldn't

PURPOSE: Establish guidelines for the management and documentation of situations where patients refuse treatment or transportation.
Refusal of care There are three components to a valid refusal of care. Absence of any of these components will most likely result in an invalid refusal. The three components are as follows:
1. Competence: In general, a patient who is an adult or a legally emancipated minor is considered legally competent to refuse care. A parent or legal guardian who is on-scene or available by phone, may refuse care on his or her minor children’s behalf.
2. Capacity: In order to refuse medical assistance a patient must have the capacity to understand the nature of his or her medical condition, the risks and benefits associated with the proposed treatment, and the risks associated with refusal of care.
3. Informed Refusal: A patient must be fully informed about his or her medical condition, the risks and benefits associated with the proposed treatment and the risks associated with refusing care.

Patients who meet criteria to allow self-determination shall be allowed to make decisions regarding their medical care, including refusal of evaluation, treatment, or transport.
These criteria include:
1. Adults (≥ 18 years of age or a legally emancipated minor).
2. Orientation to person, place, time, and situation.
3. No evidence of altered level of consciousness resulting from head trauma, medical illness, intoxication, dementia, psychiatric illness or other causes.
4. No evidence of impaired judgment from alcohol or drug influence.
5. No language communication barriers. Reliable translation available (e.g., on scene interpreter, language line).
6. No evidence or admission of suicidal ideation resulting in any gesture or attempt at self harm. No verbal or written expression of suicidal ideation regardless of any apparent inability to complete a suicide.

EMS providers will make every reasonable effort to convince reluctant patients to access medical care at the emergency department via the EMS system before accepting a Refusal of Care. Consider on-line medical control for all patients who present a threat to themselves, present with an altered level of consciousness or diminished mental capacity, or have history or examination findings consistent with a high-risk refusal. The physician should be provided with all relevant information and may need to speak directly with the patient by radio or preferably a recorded landline. The physician should determine if protective custody is to be pursued in consultation with the Law Enforcement.

If the patient is intoxicated and in need of medical treatment or protective custody, and refuses care, police can take custody of the individual under RSA 1 72:B3.

Examples of high-risk refusals include but are not limited to:
1. Treated / resolved hypoglycemia.
2. Patient with obvious head trauma and taking anticoagulant medications.
3. Intoxicated patients.
4. Abnormal vital signs.
5. Treated / resolved narcotic overdose.
6. High risk mechanism of injuries, see Spinal Injury Protocol 4.5.
7. Patient / witness reports suicidal ideations.
8. Possible Apparent Life Threatening Event, see ALTE Protocol 2.3.


I WILL POST THE RSA LAW NEXT POST BUT CAN SOMEONE HELP ME CLARIFY THIS TO THE T.

 

[rsqsquad91]

172-B:3 Treatment and Services. –
I. When a peace officer encounters a person who, in the judgment of the officer, is intoxicated as defined in RSA 172-B:1, X, the officer may take such person into protective custody and shall take whichever of the following actions is, in the judgment of the officer, the most appropriate to ensure the safety and welfare of the public, the individual, or both:
(a) Assist the person, if he consents, to his home, an approved alcohol treatment program, or some other appropriate location; or
(b) Release the person to some other person assuming responsibility for the intoxicated person; or
(c) Lodge the person in a local jail or county correctional facility for said person's protection, for up to 24 hours or until the keeper of said jail or facility judges the person to be no longer intoxicated.
II. When a peace officer encounters a person who, in the judgment of the officer, is incapacitated as defined in RSA 172-B:1, IX, the officer may take such person into protective custody and shall take whichever of the following actions is, in the judgment of the officer, the most appropriate to ensure the safety and welfare of the public, the individual, or both:
(a) Transport the person to an approved alcohol treatment program with detoxification capabilities or to the emergency room of a licensed general hospital for treatment, except that if a designated alcohol counselor exists in the vicinity and is available, the person may be released to the counselor at any location mutually agreeable between the officer and the counselor. The period of protective custody shall end when the person is released to a designated alcohol counselor, a clinical staff person of an approved alcohol treatment program with detoxification capabilities, or a professional medical staff person at a licensed general hospital emergency room. The person may be released to his own devices if at any time the officer judges him to be no longer incapacitated. Protective custody shall in no event exceed 24 hours.
(b) Lodge the person in protective custody in a local jail or county correctional facility for up to 24 hours, or until judged by the keeper of the facility to be no longer incapacitated, or until a designated alcohol counselor has arranged transportation for the person to an approved alcohol treatment program with detoxification capabilities or to the emergency room of a licensed general hospital.
III. No person shall be lodged in a local jail or county correctional facility under paragraph II unless the person in charge of the facility, immediately upon lodging said person in protective custody, contacts a designated alcohol counselor, a clinical staff person of an approved alcohol treatment program with detoxification capabilities or a professional medical staff person at a licensed general hospital emergency room to determine whether said person is indeed incapacitated. If, and only if none of the foregoing are available, such a medical or clinical determination shall be made by a registered nurse or registered emergency medical technician on the staff of the detention facility.
IV. No local jail or county correctional facility shall refuse to admit an intoxicated or incapacitated person in protective custody whose admission is requested by a peace officer, in compliance with the conditions of this section.
V. Notwithstanding any other provisions of law, whenever a person under 18 years of age who is judged by a peace officer to be intoxicated or incapacitated and who has not been charged with a crime is taken into protective custody, if no needed treatment is available, his parent or guardian shall be immediately notified and such person may be held at a police station or a local jail or a county correctional facility in a room or ward separate from any adult or any person charged with juvenile delinquency until the arrival of his parent or guardian. If such person has no parent or guardian in the area, arrangements shall be made to house him according to the provisions of RSA 169-D:17.
VI. If an incapacitated person in protective custody is lodged in a local jail or county correctional facility his family or next of kin shall be notified as promptly as possible. If the person requests that there be no notification, his request shall be respected.
VII. A taking into protective custody under this section is not an arrest, however nothing in this section shall be construed so as to prevent an officer or jailer from obtaining proper identification from a person taken into protective custody or from conducting a search of such person to reduce the likelihood of injury to the officer or jailer, the person taken into protective custody, or others. No unnecessary or unreasonable force or means of restraint may be used in detaining any person taken into protective custody.
VIII. Peace officers or persons responsible for supervision in a local jail or designated alcohol counselors who act under the authority of this section are acting in the course of their official duty and are not criminally or civilly liable therefor, unless for gross negligence or willful or wanton injury.

Source. 1979, 378:2. 1988, 89:20. 1989, 285:10, eff. July 28, 1989

 

[Qulevrius]

If the patient is intoxicated and in need of medical treatment or protective custody, and refuses care, police can take custody of the individual under RSA 1 72:B3.

^ The only relevant part. Are they 'in need of medical treatment' ? If yes, why ? Is it reasonable ? If any of these 3 is a 'no', you can safely tell the imbecile RA to GTFO.

 

[MonkeyArrow]

^ The only relevant part. Are they 'in need of medical treatment' ? If yes, why ? Is it reasonable ? If any of these 3 is a 'no', you can safely tell the imbecile RA to GTFO.

Sure, from an EMS perspective. But that doesn't change the fact that the RA will still try to get the patient arrested, which is doing a huge disservice to people with young promising lives ahead of them for whom one arrest may change their opportunities. As a responsible EMS provider, you need to escalate this up the chain of command and resolve this issue, because you still should try to help the "patient" out, even if that means no medical care is rendered (ie. establishing social help).

 

[Qulevrius]

Sure, from an EMS perspective. But that doesn't change the fact that the RA will still try to get the patient arrested, which is doing a huge disservice to people with young promising lives ahead of them for whom one arrest may change their opportunities. As a responsible EMS provider, you need to escalate this up the chain of command and resolve this issue, because you still should try to help the "patient" out, even if that means no medical care is rendered (ie. establishing social help).

EMS is EMS is EMS. Not social workers, not cops, not security guards. I can draw a nice lil flow chart showing how the 'patient' got to this point. and it won't include anything with 'EMS' on it. As a medical provider, It is not my job to care about some dumbass' future. And I sure as hell won't go out of my way to substitute for this 'young promising' individual's parents, school instructors or counselors.

 

[Bullets]

EMS is EMS is EMS. Not social workers, not cops, not security guards. I can draw a nice lil flow chart showing how the 'patient' got to this point. and it won't include anything with 'EMS' on it. As a medical provider, It is not my job to care about some dumbass' future. And I sure as hell won't go out of my way to substitute for this 'young promising' individual's parents, school instructors or counselors.

Why is this person a dumbass because he, as an adult, chose to partake in alcoholic beverages and did so in a way that did not impact anyone else until a 3rd party felt the need to intrude upon his life? Why do you feel you do not need to be a patient advocate? Its not you vs the patient. Its you and the patient vs everyone else.

I also work in a town with a Ivy League school and equally zealous public safety. On many occasions i have said the words, "Thankfully, your policy is not my policy." If i feel the patient is of sound mind and can reasonably comprehend the choices being offered, i will happily have them sign the RMA. I inform PD that unless he is being placed in protective custody because PD believes that they pose a danger to themselves and other, then we will take him with an officer riding in the back of the ambulance. RA can shove it

 

[EpiEMS]

Don't forget -- in many states, being a minor that has consumed alcohol is not a crime. In others, it is. As a patient advocate, you should know the law, too.

 

[Qulevrius]

Why is this person a dumbass because he, as an adult, chose to partake in alcoholic beverages and did so in a way that did not impact anyone else until a 3rd party felt the need to intrude upon his life? Why do you feel you do not need to be a patient advocate? Its not you vs the patient. Its you and the patient vs everyone else.

I also work in a town with a Ivy League school and equally zealous public safety. On many occasions i have said the words, "Thankfully, your policy is not my policy." If i feel the patient is of sound mind and can reasonably comprehend the choices being offered, i will happily have them sign the RMA. I inform PD that unless he is being placed in protective custody because PD believes that they pose a danger to themselves and other, then we will take him with an officer riding in the back of the ambulance. RA can shove it

He's a dumbass because he knew the policies of the school he's attending, yet chose to violate them and got caught. He's not my patient, because there's no medical reason for him to become one. As a responsible adult, it is his choice, his mistakes and he must own it. Everything else is BS penny philosophy. DIxi.