Triage scenario, opinions needed.

Guest219794 · Oct 29, 2018

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

AA- Alcoholics Anonymous? I'll assume Auto Accident, but haven't heard that.

The question was not whether those involved in a MVC should be checked out. The question was around how to manage somebody who wants to leave prior to a MSE, or to any exam. Whether or not the hospital has any authority (or obligation) to hold a person in this situation against their will.

On another note- I am an ER nurse, and actually don't know that all persons involved in AA should be checked out. If a family member called me and said- "I was just in a car accident. I caught a ride home, and feel fine, but was wondering- should I get checked out? Nothing hurts."

Even if they described a minor bruise, or abrasion, I probably wouldn't advise them to seek a medical evaluation. I might ask a few more questions, probing for something that they might be overlooking. Would you go to the ER for an abrasion or a bruise, spend hours there and pay $200?

I would not tell them to drive to hospital, sit around a waiting room for a couple hours, incur a major expense for them to tell an ER doc that nothing hurts, but they would like to be checked out. And, rarely do I see anybody who bears any part of the cost of an ER visit coming in without a specific complaint, "to be checked out".

Editorial Team / Moderator · Oct 29, 2018

I thought perhaps morte was being sarcastic.

bgxyrnf, MSN, RN · Oct 30, 2018

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

If the patient wants to be.

And generally speaking, very few patients from an MVC have occult injuries... especially among the demographic herein described.

bgxyrnf, MSN, RN · Oct 30, 2018

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

One of my pet peeves... people brought to the ED under coercion by EMS or law enforcement.

allnurses Guide · Oct 31, 2018

The only "legal" time we have is for suicidal, and even then the doc has to write a hold order. We used to hold intoxicated until sober enough to walk and manage their own secretions, but we turn them loose a lot sooner these days. If you are upright, breathing and not staggering, we tend to let (encourage) you to leave.

Unless the LEOs brought them in for med clearance, and had charges, anyone can refuse care.

bgxyrnf, MSN, RN · Oct 31, 2018

Unless the LEOs brought them in for med clearance, and had charges, anyone can refuse care.

Even they can refuse care unless there's a court order mandating same.

Pretty much the only people who can't refuse care are those who (a) lack capacity and (b) have in a condition for which lack of immediate care is reasonably expected to result in serious harm.

Capacity is, of course, somewhat subjective, particularly in the case of obvious intoxication.

Rebelution · Nov 1, 2018

You can't hold them, and without a blood test there is no proof of intoxication vs. somebody on the street bumped into them and spilled their Miller onto the patient. Besides, the contradiction that I've always wondered about this line of thinking is this-the person chooses to drink and get drunk, and under any legal circumstances in which they make a poor choice under the influence of alcohol, they are still legally responsible. Why would their poor choice suddenly become our responsibility just because they happened to waltz into our 4 walls?

PeakRN · Nov 2, 2018

Intoxication absolutely impairs judgment and is (depending on your state) a justifiable reason for a medical hold to be placed. If patients present to our ED we can legally hold them against their will if intoxicated including physical and chemical restraints if needed if we believe that they are not safe to discharge. We have had many out of state tourists challenge us on this and lose, but this is something that you would need to run past your legal team. Depending on your state there are many reasons to place a medical or mental health hold, when I was in EMS we often restrained patients and took patients to the ED if they seems altered by drugs/ETOH, SI/HI/gravely disabled, or otherwise were incapable of making their own medical decisions; RNs in my state can place emergency mental health holds (as well as NPs/MDs/DOs/LPCs/LCSWs/Licensed clinical psychologists/trained LEOs).

Not only can judgement be impaired but it can also impair the ability to perceive pain and can globally alter sensorium resulting in missed injuries and complaints that may present when the patient sobers.

If your patient presented to our ED, appeared clinically intoxicated, and was involved in a MVC of significant mechanism we would absolutely place them on a hold.

BassCatchingNurse · Nov 6, 2018

We keep people all the time...until...a) a responsible adult assumes care of them...or b) the doctor believes the pt is no longer intoxicated.

Here is a good read if anyone is interested.... Management of the Intoxicated Patient in the Emergency Department | 1998-

EDtom · Nov 8, 2018

This is one of those gray areas, You signed responsibility for these patients from ems, now it really comes down to documentation. In your triage did you identify these people as intoxicated? If they left and got hit by a car could you explain in court why someone that you felt was under the influence was able to make a decision to leave on their own? Think about it as someone you just gave IV morphine to now decides they want to leave, do they have the ability to make the best choices or do you say you need to a have sober responsible adult here to leave or you need to wait till you sober up. Its about a safe discharge and/or AMA, we have a duty to keep everyone safe, so if intoxicated they need a sober person to take responsibility for them or metabolize to freedom. They have the right to refuse treatment.