Combative and psychiatric patients pose a significant challenge to EMS responders in Arizona and elsewhere. The situation does not provide the comforts of an institutional setting where a patient is more easily controlled. Instead, decisions must be made quickly with the patient's well-being and comfort as the first priority. There are also legal considerations involved in these critical situations. Accepted practices in the industry help to guide EMS responders and on-site medical responders in their decisions regarding treatment and transportation of combative and psychiatric patients.
Consent to medical care includes the right of an Arizona EMS medical service provider to legally touch a patient. EMS responders have no legal authority to touch or physically restrain a patient without this consent, which is necessary regardless of the patient's state of mind. This presents a dilemma when the patient is hostile or in a state of mind that renders them incapable of expressing their consent. Fortunately, there are guidelines and laws that protect the EMS in these situations.
In the legal world there are two forms of consent, express and implied. These forms of consent apply to emergency medical treatment and transport. Express consent occurs when the patient voluntarily agrees to treatment and transport. Implied consent occurs when the EMS technician implies consent on behalf of the patient, taking into consideration the patient's condition and the immediate circumstances in which the patient is found.
Many laws are in place, both on State and Federal levels, on how to deal with combative patients and those unable to express their consent. However, these laws can be inconsistent. Some courts have decided that EMS workers are protected from negligent liability in the course of their duties. Other courts use an "objectively reasonable" standard to determine whether the EMS responders were professionally performing their duties. This standard asks the question "Was the act performed by the EMS responders reasonable in light of the circumstances?"
The competency of the patient is factored into the Arizona EMS technician's decision when implying consent on behalf of the patient. These same factors determine whether an EMS technician's actions were reasonable. Factors such as whether the patient is alert, oriented, capable of understanding the circumstances at the time, under the influence of alcohol or drugs, is of legal age and whether the patient is a danger to himself or others all come together to determine whether the EMS technician's actions are reasonable.
EMS providers must be knowledgeable in how to assist the combative or psychiatric patient. The danger involved in these situations must be diffused, while protecting the dignity of the patient. At MedEvent911 our technicians are fully trained in assessing the needs of these patients and in providing the necessary emergency medical treatment required in these critical situations.