Lemhi County Medical Supervision Plan Emergency Medical Service Patient Care Protocols



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45

Response to Domestic Violence

When domestic violence is suspected, the health-care provider will further assist the patient and take appropriate action in accordance with Idaho State Law.

PURPOSE: To ensure that battered woman and men that have experienced domestic abuse or neglect are identified and provided with comprehensive medical and psychosocial interventions.

INDICATORS OF DOMESTIC VIOLENCE: The following is a list of potential indicators of domestic violence. If the patient presents with one or more of the following indicators, further assessment is warranted.

  • The patients admit to past or present physical or emotional abuse, as a victim or witness.

  • The patient denies physical abuse, but presents with unexplained bruises, whip-lash injuries consistent with shaking, areas of erythematic consistent with slap injuries, grab marks on arm or neck, lacerations, burns, scars, fractures or multiple injuries in various stages of healing, fractured mandible, or perforated tympanic membranes.

  • The patient presents with injury sites, suggestive of battery. Common sites of injury are areas hidden by clothing or hair(e.g.. face, head, chest, breast, abdomen and genitals).

  • The extent of type of injury is inconsistent with the explanation offered by patient.

  • The woman is pregnant. Violence often begins with the first pregnancy, and with injuries to the breasts or abdomen

  • The patient present evidence of sexual assault, or forced sexual actions by partner.

  • The partner (or suspect abuser) insists on staying close to the patient and may try to answer all questions directed to patient.

  • The patient is afraid to return home and fears for the safety of her children.

  • A substantial delay exists between the time of the injury and the presentation for treatment. The patient may have been prevented from seeking attention earlier, or may have had to wait for the batterer to leave.

  • The patient describes the alleged “accident” in a hesitant, embarrassed or evasive manner, or avoids eye contact.

  • The patient has “psychosomatic” complaints such as panic attacks, anxiety, choking sensation, or depression.

  • The patient has complaints of chronic pain (back or pelvic pain) with no sustaining physical evidence.

  • The patient or partner has a history of psychiatric illness, alcohol and/or drug abuse.

  • The patient has history of suicide attempts, or suicidal ideation.

  • Medical history reveals many “accidents” or remarks indicating that previous injuries were of suspicious origin

  • The patient has a history of self-induces abortions or multiple therapeutic abortions.

  • The patient has a pattern of avoiding continuity in health care.





46

On-Scene Medical Personnel

The medical care provided at the scene is the responsibility of the highest level of EMS provider who has responded by usual dispatch system to that scene. Passersby who stop to help, even though possibly more highly trained than the system provider, may NOT assume responsibility (except as outlined below) but may be allowed to help in care at the discretion of the lead EMS provider and assuming they have proof of licensure.

*When an EMS provider, under medical control (on-or- off-line), arrives at the scene of an emergency, the provider acts as the agent of medical control, i.e., the on-line physician is ultimately responsible.

* Any healthcare provider (MD, PA, RN, nurse midwife, non-ID. Licensed EMS provider, ECT.) who is not an active member of the responding EMS unit, and who is either at the scene at the time of EMS’ arrival or arrives after an EMS unit provider has initiated care, and who desires to continue to participate, should be put in touch with the on-line medical control physician.

AT NO TIME SHOULD AN EMS PROVIDER PROVIDE CARE OUTSIDE OF THEIR SCOPE OF TRAINING AND/OR PROTOCOLS 46


47

REFUSAL OF CARE /CONSENT TO TREAT Adult

The following guideline is to be used by EMS Providers any time an adult patient refuses patient

care or transport:

1. For a patient declaring no need for emergency medical care, where no patient care

has occurred and no injuries, mechanism of injury or illness is obvious, do not treat

patient.

2. For a patient declaring no need for emergency medical care, where patient care has

already begun, and the EMT suspects injury or illness, proceed with the following:

For the alert, conscious, ill, or injured patient who requests no transport or further

treatment, the EMS Provider shall explain risks of refusal and benefits of transport.

Should the patient continue to refuse, the EMS Provider shall contact medical

control and try to establish communication between the patient and physician.

The EMS Provider shall accept the right of the patient to refuse treatment and

transport and document informed refusal.

The EMS Provider shall document general patient status including observation about

patient competence.

3. For a patient unable to declare his or her own decision due to diminished

consciousness or other incapacitation (alcohol, drugs or other) and where care is

refused:


The EMS Provider will contact on-line medical control at the receiving hospital and

attempt to establish communication among the EMS Provider, medical control, and

family member(s). After discussion, the EMS Provider will follow the orders of the

on-line medical control physician.

The EMS Provider shall document the general patient status, including observation

about patient competence and directions received from medical control.

Exceptions to the right to refuse may be altered mental status due to alcohol or drug

intoxication or under arrest by police. Confer with local law enforcement.



39-4302. PERSONS WHO MAY CONSENT TO THEIR OWN CARE. Any person of ordinary intelligence and

awareness sufficient for him or her generally to comprehend the need for, the nature of and the significant risks

ordinarily inherent in any contemplated hospital, medical, dental or surgical care, treatment or procedure is

competent to consent thereto on his own behalf. Any physician, dentist, hospital or other duly authorized person

may provide such health care and services in reliance upon such a consent if the consenting person appears to the

physician or dentist securing the consent to possess such requisite intelligence and awareness at the time of giving

it.

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