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EMS

Police Responsible for Ambulance Bills on College Campus?

Boy should they be.

Here’s the story we’re talking about and I can tell you this is a topic too often visited upon those who find themselves looking from a Police Officer to an Ambulance and wondering why either of them is there.

University Police at GW seem to think a policy they have overrides the rights of a Student and the authority of a duly licensed ET or Paramedic.

Adorable, I know.

 

Students have come forward challenging ambulance charges when they were found to have been suspected to have ingested alcohol and UPD forced them to the hospital, citing their policy.  Even students who passed field sobriety tests and gave breathalyzer readings below those required to operate a motor vehicle were still forced, using authority, to be taken somewhere they did not wish to go.

There’s a word for that.  We’ve discussed it before and how so many EMS agencies don’t understand it.

If the students are violating policy and are speaking clearly, able to walk and understand the risks of not seeking a physician evaluation (which pretty much consists of “you OK?”) law enforcement can not coerce or force them to hospital unless they are taken into custody.

Otherwise this is cut and dry…

 

kidnapping by force.

Don’t think so?  Local laws are usually vague, and even though the Officers may not be seeking ransom, guess who operates the Ambulance?  The University.  The policy is written to increase billable transports of the parent organization.  I’d argue that’s enough, but include that the ambulance takes the person to a place where they may be harmed and I’d say we have a decent argument.  Far better then the policy to transport anyone who had a couple Bud Ice at a dorm party.  You can’t force them to the hospital!  Give them a stern lecture?  Fine them at tuition time?

Or cite them.  Or arrest them, but you can’t force them into the hospital.

So there’s a simple bow on the UPD policy.  Took me 2 minutes.  Each and every student should file charges and demand UPD cover all ambulance and hospital charges relating to the forced relocation.  If campus drinking is such a problem, why not try some police work and prevent the drinking, or perhaps focus on those who over-imbibe and might actually need an ambulance?

Too much effort and paperwork?  I know.  Imagine the paperwork and effort you just forced all those healthcare professionals to waste, not to mention taking an ambulance out of service and clogging a hospital bed for 15 minutes.

 

You are liable for the events you created and you created one hell of a mess.  Drop the policy and pay the bills.

 

To any students seeking to challenge UPD or the university policy, I’m available as an Emergency Medical Services Subject Matter Expert for deposition in your case.  No fee.

 

 

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4 Comments

  1. Andrew November 4, 2017 9:23 am

    You & I both know SFPD has grossly misapplied EMS to their calls. AND they have No known ( to my knowledge ) accountability for the overuse of EMS. With the continuing rise of 911 use, accountability & realistic policy by law enforcement would be appropriate.

  2. Daniel Gerard November 5, 2017 9:05 am

    There are some misconceptions stated here.

    When you discuss the authority of an EMT or Paramedic I am confused. Paramedics and EMT’s are not taught how to screen patients for impairment, and they are not taught which patients that are impaired are safe to AMA. It is not contained in any curriculum, it is not contained in the EMT or Paramedic National Educational Standards, and it is certainly not contained in the scope of practice for EMT’s or paramedics.

    With that stated Paramedics and EMT’s are not independent practitioners, meaning this is not something that they should be ‘cowboying’ on their own. Their authority stems directly from their medical director. I love the term ‘paramedic discretion’, as a concept, exists in only in the minds of the self-righteous.

    Paramedic discretion only exists to over-ride clinical protocols to higher standards of care. A trauma patient who does not meet trauma center criteria that you use your descretion to transport to the trauma center anyway, because something doesn’t sit right.

    Transporting a chest pain patient to a STEMI, even though the patient does not have a STEMI, because you believe it is an evolving event.

    This called erring on the side of the patient. It does not allow you to do otherwise. There is nothing in your education, scope of practice, or protocols that allow you to ‘counsel’ a patient on not going to the hospital…or releasing the patient who has consumed EtOH to go home and fend for themselves.

    Show me the training program where they taught you how to screen patients safely for release.

    Show me the EMT or paramedic textbook that discusses how to screen patients, when it is safe and when it isn’t.

    Show me your medical director approved protocol for releasing patients who have consumed alcohol.

    How do you define a patient?

    A patient is an individual who (personally) requests EMS, or for whom a caregiver (in this case the police would be considered caregivers) or family member requests EMS, or who has a visible injury or illness once an EMS provider (dispatch life support, first responder, Basic, or Advanced Life Support ambulance) arrives on scene. The patient-provider relationship is established via telephone, radio, or personal contact. It is the provider’s responsibility to ensure all potential patients, regardless of the size of the incident, are offered the opportunity for evaluation, treatment, and/or transport.

    Truth be told this is a medical director decision and the medical director should be made aware that this is not in the EMT and paramedic scope of practice and it is not contained in their education or training. It is the medical director’s decision who goes and who doesn’t. If the medical director says you should not be transporting these patients he has to train you; provide you with a protocol; and QI these calls to no end to make sure that you are doing what is right by the patient.

    Trust me you are not ‘helping’ the system when you ‘independently’ ‘divert’ impaired or EtOH people away from the ER, just as you are not ‘alleviating’ ED over-crowding when you use coercive methods to ‘convince’ patients they are better off served staying home or to see their primary care physician in the a.m.

    Without the proper training, education, protocols, and a QI review process you roll the dice with a human beings life and that is unacceptable. In the hospital there is a process of screening, one of which is to get a blood alcohol level on a patient.

    I know that in the background of this conversation is lurking this idea that competent patients can refuse medical assistance. The reality is is that with FEW exceptions no EMS provider is adequately trained in this area and most of them get it dead wrong. It is easily proven when you ask a provider how they determine if someone is competent. They generally fail to provide the definition within the first 10 seconds.

    The actions of the campus police may stem from 2 different perspectives:

    How do I get this ‘call’ off my plate?

    What is best for this individual?

    Now we can take the attitude that the police just want to pass this person off (get it off their plate). The reality is, and the police are highly cognizant of this, that without a policy and process to safely manage this person there is a high degree of liability. Every police academy has case reviews of individuals who are in custody and suffer an undesirable medical event due to alcohol or drugs…and ended up at the morgue.

    To infer that the actions of the police are based on anything otherwise is unsettling to say the least. I was a professor at GWU and I am very familiar with EmERG the GWU campus EMS responder. I also worked in the busiest EMS system per capita in the United States, so I do not make these statements lightly. I have over 25 years experience dealing with a diverse and complex population.

  3. Mark Peck November 5, 2017 7:50 pm

    Dan, I dont fundamentally disagree with the concept you are expressing but do disagree with some of your points.
    When I graduated, CPAP, external pacing, amiodarone and fentanyl did not exist,. My class and the national curriculum did not cover these skills or qualify me to use them, yet CME, refresher, and department protocol make me well versed and qualified to do these today.
    The issue of what is covered in basic training are the concepts of altered mentation evaluation, neurological and vital signs of drug abuse/ impairment and intoxication, evaluating basic complaints of suicidal or self harm thoughts and acts, what constitutes a competent patient and one who can both consent and refuse treatment and transport.
    The next and more important level of discussion is department, regional and state protocol, addressed and approved by your department based medical director. Some departments have extensive protocols, others have long buried their heads in the sand thinking its the good old days when you would and could allow an intoxicated patient who believes you are Lincoln and he resides on the planet Ork to refuse transport.
    NYC has had very specific and tiered protocols to deal with refusals of the impaired and incompetent patients. Decisional Capacity has been addressed repeatedly over the past 25 years or so in both protocol and department CME and publications. Patients who are refusing and impaired by drugs, alcohol, dementia, are AMA, as well as all patients in the extreme young and elderly ages must actually hold a recorded conversation with our telemetry physician in order to refuse. This not only allows a clear and defensible record of attempts to convince the patient to accept care, but also the patients demonstration of mentation and understanding in any future legal action. It also involves the physician in the decision to force transport in borderline instances. EMS administrations have already settled procedure so that NYPD will usually be on the same page and take an incompetent patient into custody if requested by EMS.
    Returning to your commentary, the objective of EMS in general should not be aimed toward excluding patients from transport( unless you develop a specific protocol to reduce unnecessary transports or encourage/provide alternate transport) but rather to differentiating who is and is not competent to make their own medical decisions and refuse care/transport.
    Even with the competent patient, efforts should be directed by protocol to insuring that he understands his condition and risks, is not impaired by drugs or hypoxia, is not suicidal, and you have exhausted all reasonable means to convince them to accept care.
    The problem in this college situation is that the department administration and medical director, and their attorney if needed, have not sat with campus police and reached an procedure accord of what is and is not appropriate to force transport. If PD believes the student is impaired and the crew does not, there needs to be a predetermined response. If the patient is not incompetent, then PD needs to have a basis( under age of consent, self harm thoughts or acts, other crimes) for them to place the patient in protective or legal custody for other reasons to force transport. This would also entail them accompanying the patient in the ambulance, every time.
    Students will consume alcohol or drugs. They have done so for decades and will continue to do so. The line must be drawn between protecting the impaired and minimal but still illegal or even legal levels of consumption. If you are not impaired but under the drinking age, this is a legal and school administrative/conduct issue, not one for EMS or a hospital to solve as PD abdicates their legal remedies.

    • Daniel Gerard November 6, 2017 12:24 am

      Mark all valid and excellent points.

      If I may, many medics think they understand competence, but competence is all or nothing under the law. What medics are really doing is determining decision-making capacity. I know you realize this because, if I recall correctly, you were the first paramedic to refuse transport in the NYC*EMS system under medical control and utilizing guidelines approved under REMAC. For you this is old hat .

      Unfortunately, this is not true of all paramedics.

      If I remember correctly the NYC system, when they instituted their initial program of refusal for certain patients went through many iterations, and like everything else in EMS is a work in progress. But I do give you and the good men and women of NYC kudos for as usual being on the cutting edge. When you guys instituted that program it was under intense scrutiny and was written up not only in the trades but appeared in the news and major media outlets. You had a solid protocol, information that was pushed out at the command and field level, education, an instructional guide, etc.

      None of that exists by large in many systems.

      My rationale for bringing up the National Educational Standard for Paramedics is that even with this latest iteration of a guideline is that this is an issue that has bedeviled our profession since the first civilian ambulance rolled out after the Civil War, yet it has not been adequately addressed for EMS providers, whether we talk about the first paramedic curriculum that came out of NHTSA when Nancy Caroline wrote it in the mid-70’s up until the latest iteration of the educational standards now, written in 2009, scant information at best is provided and nothing is covered or delineated in the how or when to release a patient, although they did devote 2 whole pages to the history of EMS.

      You are spot on as usual though, this is best addressed during departmental basic training, solid protocols, CME, and medical director involvement.

      The other key issue here, and you touched on it, is that the police and EmERG do not have a good protocol. One of the challenges for EmERG is that it is a totally student based system, meaning that there is a continuous turn-over, making retaining institutional memory a challenge at the very best. If you look at UCLA on the other hand, they have paid members who may work there for longer periods of time, and that knowledge gets transferred from one to another.

      Great stuff and thank you, Mark, for the feedback. Danny G.

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