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Jasel Jasel (Member)

Triage scenario, opinions needed.

Emergency   (2,729 Views 22 Comments)
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So I was in Triage the other night and there was a pretty bad MVC. I think there were 6 accident victims total and we got the 3 least injured. Since triage was slow, there were two of us and we had 4 empty beds in our triage waiting area so we took the patient's from EMS.

All of them had stable vitals, were ambulatory, no LOC, wore seat belts. None of them had been driving and all had been drinking (they were all 22 or 23 so legal age). The police were on scene. They had some slight abrasions we put bacitracin on and that was basically it.

Now here is my concern. I could tell these guys wanted to leave because one of them had a brother (the driver I think) who went to another hospital. Charge nurse was a bit adamant that they couldn't leave (to me and the other nurse, not the patients). So not a huge shock they abscond when we were basically expected to watch them and she gets upset, but turns out they stepped out for a smoke and security basically brings them back in and watches them.

She gets the attending back there to assess the patients after a couple of minutes, two of whom he discharges immediately. One he decides to draw an alcohol level on and move her to the main after it comes back positive. I'm not sure what the plan was after that since my shift was over at that point and my mind clocked out about the same time.

The only thing I can think of them doing was running more tests, treating her as an ETOH and keeping her until she sobered up or got a ride, or a combination. Or maybe getting her etoh as an excuse to keep her to run more tests?? Because before he ordered the alc on her he had to have seen she was ambulatory and cognizant. And why just her and not the other two?? The whole situation just seemed weird to me.

Where I am once the girl's blood alcohol came back he couldn't just discharge her. (Blood alcohol was like 250).

Now once security brought them back after they went outside, they stayed with no problems, at least not by the time I left. But earlier they had clearly wanted to leave to check on their friend. Even if the doctor had seen them and wanted to run tests they would have signed out AMA.

I guess I'm wondering if we had any type of legal basis to hold them to begin with? If they had been more adamant about leaving after security brought them back, I don't know how comfortable I'd have felt keeping them there. And I'm usually pretty aware of which patients just can't up and leave and which ones can.

Just looking for some feedback. Maybe there's something obvious I'm missing.

Edited by Jasel

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Intoxication isn't a legal basis to hold a patient. Steady gait, wants to go, free to go. Your triage obligations are GCS, +/- LOC, +/- seatbelt sign, pain/tenderness, and extremity CMS. All good to go, or clinically sober as above and wants to leave... bye.

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I'm trying to imagine a scenario where hospital staff would have a legal right to hold anyone; that's a law enforcement role. Decline to discharge, yes, and the patient is then free to leave AMA. Try and keep them here is very different from don't let them leave - asking you to be persistent in your efforts to see they stick around for appropriate treatment versus keeping them prisoner which you have no standing to do so. Ditto with security, they can ask patients to go back inside, but they can't legally detain them.

I'm glad you would not have felt comfortable doing that.

Edited by Katillac

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I don't get it. The girl should have told the physician to suck rocks about the blood test. Now look at the gift she was given as to her permanent medical record.

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There was no legal cause to hold the two guys per your description. Maybe the CN preferred they not LWBS, but you either have a legitimate cause to hold someone or you don't. In this case you didn't.

I also don't know the reason for checking an EtOH level on the woman; can't say we would've done that. You could ask the physician about their particular rationale next time you're on duty together.

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"I guess I'm wondering if we had any type of legal basis to hold them to begin with? If they had been more adamant about leaving after security brought them back, I don't know how comfortable I'd have felt keeping them there."

Simple answer- no.

What would you do if you were uninjured and your friend was in a trauma center, or just another ER, condition unknown.

Personally, I would leave- If somebody physically tried to stop me, I would probably start recording on one phone, and use the other to google a good lawyer. I would have mentally spent that settlement money 100 times before I even saw a dime.

But why did these bozos even get into an ambulance? What a complete PITA.

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Thanks for the responses and I'm glad to see I'm not the only one who thought that whole thing seemed off.

I could try asking the MD next time I see him.

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Another thing, Jasel -

Don't be afraid to pleasantly inquire about a situation in real time if you don't think something is right and you believe that a patient is not being treated correctly with regard to their rights. Just be careful to keep your tone of inquiry appropriate while making your concern known and it'll be fine. That is the appropriate thing to do.

"Charge Nurse, I am concerned because in this situation my understanding would be that we can't keep these guys here and that this is a simple matter that they would like to leave without being seen. I don't believe we have reason or authority to try to keep them. Is there something I'm not understanding correctly?"

Also, you can definitely inform your physician/provider when these situations arise. LWBS may not seem to be a big deal but it is a situation to be avoided if at all possible.

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If the situation had escalated and they wanted to leave I would have spoken up, or at least asked the MD why we needed to keep them. But once they brought them back he assessed and discharged two of them within 10 minutes (one was a female the other a male btw) and ran the etoh on the other female patient. Never heard them complain and once the Blood alcohol level came back I saw a note for her on the tracking board "move to the main" and the MD came back to speak with her. That's when I left.

Next time I see him I'm going to ask him about it. He's a pretty laid back and approachable MD.

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But why did these bozos even get into an ambulance? What a complete PITA.

Car was probably wrecked, and it was probably a choice of riding with the red lights vs. blue lights!

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Car was probably wrecked, and it was probably a choice of riding with the red lights vs. blue lights!

Good point- taxi ride, and a shot at a turkey sandwich.

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all persons involved in AA should be checked out. ED nurses should know that.

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