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Old September 9, 2009, 02:45 PM   #26
OuTcAsT
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BTW most states have a provision in the law to temporary hold for observation anyone doctor or an officer believes to have a mental or emotional problem that may make them a threat to themselves or others. In California it's called a 5150 hold. Usually the hold is 72 hours or less unless extended by a judge. Within 72 hours the government must make a case to a court (due process) for a longer hold or release the person. I don't see allowing a doctor to do the same for a serious communicable disease to be an infringement of due process.

There is a huge difference between the two. Typically a hold for mental health evaluation requires some largely unambiguous signs or symptoms, therein lies the problem. You keep referring to a "serious communicable disease" yet you fail to see how difficult it would be to come up with a subset of symptoms that could be relied upon to determine if the person does have some exotic disease, versus the most widely spread set of viruses known to man: The common "cold".

What exact symptoms would have to be present for someone to be "quarantined" ? or compelled to submit to treatment? How many "communicable diseases" share symptoms with otherwise benign ailments?

Consider your answer carefully, because what you suggest could have you quarantined, or forced to take a treatment for a specific disease, when you merely have a hay fever flare-up, or a simple "cold".

Sorry, but the end does not justify the means, and I don't want "compulsory" health care any more than I want federalized health care, and I certainly do not want to run the risk of being institutionalized every time I sneeze.
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Old September 9, 2009, 02:53 PM   #27
azredhawk44
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So if someone is firing wildly into a school would you say don't stop him until after the grand jury comes back with an indictment or the police get a court order for him to stop? Wait for due process?
Ridiculous argument. Firing wildly into a school is not on parity with having the flu, any flu, even a superninja H1N1 flu.

You also have officers witnessing the event in situ which gives them more than enough latitude to interdict in the home and stop the shooter. Warrants aren't necessary to halt the projection of lethal force from the distance of the remote home to the school... probably at least 75 yards.

Quote:
If someone is sick and isolates themselves that's a good thing and in most cases should be left alone. However if someone has a deadly and easily communicable disease and insists on spreading it then they are at least as deadly as the nut taking target practice at a school because each person that they infect will infect others and so on and so on.
Wrong again. Bullets are projected force with lethal range measuring in miles. Each bullet has the power to kill.

"Deadly" disease? The lethality of disease is a function of many things, foremost of which are the cleanliness and health of the potential host to the disease. Diseases are very deadly to adult-onset diabetic obese people that live off of twinkies and the McDonalds menu. They tend to be merely an annoyance to people that eat their vegetables and wash their hands a couple times a day.

Remember that the mortality rate of this disease is below 0.5% in western countries. Filthy, nasty India has a mortality rate for H1N1 at 2.5%.

Quote:
In my opinion anyone with a deadly communicable disease should be isolated immediately and if the isolation is involuntary then a court hearing should be held within 3 business days to order the infected person isolated until safe.

However the current flu does not fall into that category.
Depends on what you define as "deadly." AIDS is deadly. SARS is deadly. Mumps/measles/chickenpox can be deadly. Syphilis can be deadly.

H1N1 is a joke. A sick, twisted power-grabbing joke.

I'm glad that you agree that it doesn't fall into the same category as a true pandemic like the Bubonic Plague (mortality rate from 50% to 90% when not treated with antibiotics).
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Old September 9, 2009, 04:02 PM   #28
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"a reenactment of the Spanish flu of 1918"

My grandfather had it. He told me it wasn't all that bad. Back then, pretty much anything would kill a lot of people because there wasn't a treatment for most common illnesses.

Penicillin wasn't even discovered until 1930, much less commonly used.

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Old September 9, 2009, 07:05 PM   #29
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At least the law hs this provision:
"An individual who is unable or unwilling to submit to vaccination or treatment shall not be
410 required to submit to such procedures but may be isolated or quarantined pursuant to section 96
411 of chapter 111 if his or her refusal poses a serious danger to public health or results in
412 uncertainty whether he or she has been exposed to or is infected with a disease or condition that
413 poses a serious danger to public health, as determined by the commissioner, or a local public
414 health authority operating within its jurisdiction."

From what I've read of the 1918 Spanish Flu pandemic, it seems to have had two waves. The first wave mild and the second wave deadly. As a previous poster mentioned many died not from the flu but from a secondary infection such as a pneumonia which can be treated today. The mortality rate of those actually infected ranged between 10% to 20% from all causes.

If the mortality rate is cut by use of anti-viral medications for the primary infection and use of antibiotic treating secondary infections; the mortality rate should be well below 10% of those infected. In the 1918 pandemic about 1/3 of the population was infected.

Extrapolating to a population of 350,000,000 in the U.S. that could mean more than 10,000,000 deaths.
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Old September 9, 2009, 07:32 PM   #30
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Sholling

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So you're saying we should just shoot anyone that sneezes in our presence?
??? I'm not sure how in the world you derived that from what I said, but to answer your question: no.

I'm really confused about how I supposedly implied this...

For reference, here is my post in its entirety.

You said:
Quote:
So if someone is firing wildly into a school would you say don't stop him until after the grand jury comes back with an indictment or the police get a court order for him to stop? Wait for due process?
emphasis added

I said:
Quote:
If they allowed school staff to carry (concealed or openly, I don't care which), then that wouldn't be much of a concern anyway would it?
Enlighten me please...
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Old September 9, 2009, 07:39 PM   #31
roy reali
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Why Worry?

Why should anyone be worried about the Federal Government. There are many examples of things they have run with a high degree of success. When I think of one I'll post it.

Remember when Reagan asked what are the ten scariest words in the English language?

I'm from the federal governemnt and I'm here to help.
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Old September 9, 2009, 09:17 PM   #32
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I'm not sure how in the world you derived that from what I said, but to answer your question: no.
I equated allowing someone with a deadly communicable disease to spread it at will to allowing someone to fire into a school. You responded that the teachers could kill the shooter. My question was if you advocate killing a shooter that's a threat to the lives of hundreds do you also advocate killing someone that's a threat to tens of thousands?

BTW I don't for a minute believe that H1N1 is a major threat. On the other hand if someone like Iran were to release a true bio engineered killer plague I would want the government taking action NOW and stopping the spread of infection in its tracks. And I don't want them to wait 6 month after it happens while congress debates giving them the power.
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Old September 9, 2009, 09:46 PM   #33
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My question was if you advocate killing a shooter that's a threat to the lives of hundreds do you also advocate killing someone that's a threat to tens of thousands?
I think that's an unrealistic question, but to indulge you...

No I do not advocate killing someone that may or may not have a disease/virus that may or may not infect others. Since I nor you are the persons doctor, the level of their infection is not for us to know.

An active shooter in a school is an immediate threat to the safety of everyone in the vicinity. Someone with a serious disease/virus can be treated, as can everyone they infect. We have some of the most advanced medical technicians in the world, I think we can come to a reasonable solution. Something to the effect of a vaccine, antibiotic, etc. to resolve it, I don't think we'll have to resort to fast-moving lead pills for our medical issues.

Didn't think I'd ever have to clarify that particular issue, but oh well.
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Old September 10, 2009, 12:37 AM   #34
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I think all the handwringing and hyperbole should be toned down. There are already laws in place that allow for someone to be quarantined if it's suspected that they have a dangerous disease. That's no more an imposition on the person's constitutional rights than it is for you to be arrested if they think that you may be a serial killer.

And second, I don't worry about swine flu. Mostly because I remember the panic over bird flu. And before that, SARS. And before that, West Nile Virus. We've gotten really good at containing infectious diseases, and creating effective vaccines fast. A lot of the trumpeting of these things has to do with the media looking for a way to keep people watching, and various research agencies looking for a way to keep their funds flowing.
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Old September 10, 2009, 01:54 AM   #35
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Since I nor you are the persons doctor, the level of their infection is not for us to know.
As always I respect your view. Here's why I have mine illustrated with three scenarios. If you look at HIV tens of thousands have died because the original carrier was allowed to go free. Now it's too late to take such action but when there was only one carrier in the US it was criminal to allow him to infect others. I have no clue what the answer should have been. Lock him away for the 3-4 years he lived? Tattoo "deadly STD infection" on his belt line and let him go? Just let him go do what he did which was hit every sex club and bath house he had the energy to visit before he died? I don't know the answer but he deliberately became a bio agent serial killer after his release.

But let's look at what concerns me more. If Iran, and they have the technology, were to release a modern bio engineered and very deadly plague there would be no time to develop vaccines and you can count on it being antibiotic proof. If it achieved a 10% fatality rate that's 35,000,000 Americans. 3% is 10,000,000. Is it worth locking up the those infected first if it has a chance to stop the spread? Just for a couple of weeks until they are over it? This isn't a TEOTWAWKI scenario but a real possibility for terrorism because it's untraceable.

Ok let's leave that one aside. A tourist returns from Africa. Within 24hrs of getting home his wife takes him to the family doctor who being from Africa suspects Ebola. Ebola is transmitted by touch, is roughly 90% fatal, and as a virus is immune to antibiotics. Do you send him home if he refuses hospitalization or forcefully isolate him? How about those he came in contact with? If infected they will be contagious within days. Do you let them go to work and little league games with their kids? Or do you isolate them for testing? Remember the spread isn't linear its logarithmic.

My point is that this isn't 1930 when by the time someone with a disease could get here they would be displaying symptoms. In 2009 you can fly from Africa in a day and be home well before symptoms appear. Symptoms that previously would have stopped you could at customs.

I don't want the government to be able to lock up someone with the flu but if someone is carrying an incurable disease with a high probability of fatality yes. But they should be allowed due process and a judge decide if they pose a threat just like a mental health hold. Set the bar very very high but it has to exist.
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Old September 10, 2009, 05:16 AM   #36
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Guys- this is a paranoid non-issue. As a paramedic, I already have the power which you are all putting on your tinfoil hats for. There are quite a few situations where I can detain you or take people into the hospital against their will, and that isn't just limited to suicidal ideations. I can use reasonable force, I can sedate them, I can tie them down. It is done routinely. Calm down, this is a non-issue.
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Old September 10, 2009, 10:11 AM   #37
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^^^ Strangely, i didn't find the "tie them down" part very comforting. (makes another note about thinking it over before calling 9-1-1)
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Old September 10, 2009, 10:36 AM   #38
OuTcAsT
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As a paramedic, I already have the power which you are all putting on your tinfoil hats for. There are quite a few situations where I can detain you or take people into the hospital against their will, and that isn't just limited to suicidal ideations. I can use reasonable force, I can sedate them, I can tie them down. It is done routinely.
Really? Those "powers" do not exist in my State, please elaborate, in which state are you licensed? Are you attached to a public service organization (LE) or simply an EMA?

In TN. a patient has a right to refuse treatment under all but the narrowest of circumstances (IE: Suicidal, dementia, drug or alcohol abuse) and even then LE has to make the call, and bear the responsibilities. not to derail the thread, just curious as to what State already allows such latitude.
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Old September 10, 2009, 03:30 PM   #39
divemedic
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Actually, that is a common misconception. The law states (in every state) that you have the right to refuse care if (and only if) you are mentally competent to understand the refusal and the consequences that follow. There are many situations where a patient is not capable of an "informed refusal," these include:

1 Intoxication (drug or alcohol)
2 The patient is a minor (and no competent legal guardian or parent is available to give or refuse consent)
3 Head injuries
4 suicidal ideation
5 hypoglycemia
6 any other situation or condition which affects you ability to understand the medical ramifications of refusing care

Generally, Law Enforcement only makes the decision in suicide cases. A patient who lacks capacity to make or understand health care decisions cannot give consent or refuse, and the courts (again in every state of which I am aware) not only allow, but require the paramedic to decide in favor of caring for the patient. This is referred to as "implied consent" and is put in place to protect the rights of the patient.

This is an area of law that has long been debated and litigated. I have known many a medic to get in trouble for under treatment, but I have not yet met a medic who got in hot water for overtreatment.

Example: You are involved in a fall. You are angry and combative that the ambulance was called, and wish to refuse treatment. The Paramedic who arrives determines that you have altered mental status due to alcohol, or a bump on the head, or some other mechanism, so under the law, he has the power to take you to the hospital, and may use reasonable force to do so. That can include chemical restraint, or even physical restraints.

This is nothing to be paranoid about. It isn't as if medics run around looking for reasons to take you to the hospital. This is the law in Tennessee as well as everywhere else. Although centered around doctors, you can read a short article on the subject here. The same general principle applies to paramedics engaged in the prehospital setting.
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Old September 10, 2009, 03:36 PM   #40
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This whole thread is a rehash of the "government as my mommy" argument, just in a different area of control/choice (usually "mommy can i buy a gun?"). I don't need my mommy to tell me when to go to the doctor or get an immunization; i am a grown man. I certainly don't need a paramedic, a Congressman, or the President of the U.S. to tell me when to seek medical care (unless dear old Mom gets elected ).
Big Government < Limited Government, IMO.
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Old September 10, 2009, 04:24 PM   #41
OuTcAsT
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Actually, that is a common misconception.
There are certainly misconceptions however, refusal of treatment is not one of them.

Quote:
There are many situations where a patient is not capable of an "informed refusal," these include:

1 Intoxication (drug or alcohol)
2 The patient is a minor (and no competent legal guardian or parent is available to give or refuse consent)
3 Head injuries
4 suicidal ideation
5 hypoglycemia
6 any other situation or condition which affects you ability to understand the medical ramifications of refusing care
On these we agree however;

Quote:
Example: You are involved in a fall. You are angry and combative that the ambulance was called, and wish to refuse treatment. The Paramedic who arrives determines that you have altered mental status due to alcohol, or a bump on the head, or some other mechanism, so under the law, he has the power to take you to the hospital, and may use reasonable force to do so. That can include chemical restraint, or even physical restraints.

Not necessarily, and the paramedic has no "power" nor authority in the situation, any more than a physician has. In TN he may be placed in custody by LE and then transported against his will, but not on the "authority" of a paramedic. (who acts on authority of a physician)

And even given the inclusive list you have provided, none of that has anything to do with someone who may or may not have a communicable disease (unless he is unconscious) in which case he likely will not be aware he has/is being transported. Otherwise, he has full right to refuse treatment.
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Old September 10, 2009, 05:04 PM   #42
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so..who pays?

Quote:
Example: You are involved in a fall. You are angry and combative that the ambulance was called, and wish to refuse treatment. The Paramedic who arrives determines that you have altered mental status due to alcohol, or a bump on the head, or some other mechanism, so under the law, he has the power to take you to the hospital, and may use reasonable force to do so. That can include chemical restraint, or even physical restraints.
this is a catch 22. Obviously, because I refuse treatment, I must have and altered mental state. Kind of like the cops deciding that your refusal to permit a search is probable cause for a search. After all, why wouldn't an honest person, with nothing to hide, agree to a search?

So, say I fall down, go boom, bump my widdle head. Over protective nanny neighbor (girlfriend, whatever) call ambulance. Now, I have a bump on the head, have had them before, probably will again, and don't feel like spending $1,000 (after the insurance pays its part) to have somebody at the hospital tell me I have a bump on the head.

Now, divemedic shows up, and because I am a cheap curmudegon, who doesn't want to go to the hospital, decides I am having "diminished mental capacity", tranks me, trusses me, and off to the hospital I go! Against my wishes!

So, my question is, since you forced me to go to the hospital, are you going to pay the bill???

yes, I know sometimes you guys have to do these things for people's own good, but, why should I wind up stuck for thousands in bills, because of your opinion of what is in my best interest? And I am talking about those cases where there is nothing wrong with me, and we both know it.

My point is, that when it comes to refusing treatment, we do not have the free will we think we do. You can make a purely BS call, and we get stuck with the consequences.
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Old September 10, 2009, 05:20 PM   #43
OuTcAsT
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My point is, that when it comes to refusing treatment, we do not have the free will we think we do. You can make a purely BS call, and we get stuck with the consequences.
Actually 44 AMP you do have the right to refuse treatment, the only "catch 22" is the part he slipped in about the alcohol. This gives the responding LE (yes, they will be there too) an opportunity to (if they wish) arrest you for "public intoxication" or something similar, and have you transported to the hospital, incidental to the arrest.

The LE around here will sometimes do this if they feel there may be a need for medical attention for someone with a diminished capacity, but the paramedic can only offer an "opinion", he has no authority to impose his own will in that situation...at least not in this State. And unless some sort of legislation is passed to allow for it, the same will apply to someone with a communicable disease.
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Old September 10, 2009, 05:25 PM   #44
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Because there were cases where a paramedic took a refusal, and the patient later sued the paramedic and his employer for not recognizing the fact that the patient had a head injury and thus was incapable of comprehending the ramifications of refusing.

Sort of like the people who sue the bar for allowing them to get drunk. Like it or not, the law is what it is. If I document the medical reasons why I feel you are not capable, then there you go.

If you would like to read the general guidelines, here they are.

The point is that all of you are assuming that paramedics are out there just chucking people into the hospital willy-nilly. I get paid the same whether I take you in or not. This is not some power trip, but an honest treatment that favors the condition of my patient.

This has exactly NOTHING to do with arrest, and everything to do with your inability to refuse. Sort of the same concept like: A woman with mental retardation cannot consent to sexual contact. Why? Because she does not understand what that consent means. Same thing here. This is not an arrest, but an attempt to get you the medical care that the law assumes you would want if you had the mental capacity to decide for yourself.

Implied consent states that a person who is incapable of making a decision is assumed to consent. Altered mental states are under the same umbrella. Note that Tenn law (along with other states) says that a COMPETENT adult may refuse care. If the paramedic can document that in his best medical judgment you were not competent, he must assume that you would consent, and may use reasonable force to take you to the hospital. If his report in any way indicates that he knew r should have known that you were incompetent to refuse, and he allows you to refuse, he is guilty of abandonment and is open to liability.

The law is what it is. Are there medics who will abuse it? Of course there are, but that does not erase the validity of the law for the rest of us. Just as you cannot blame one gun owner for the illegal and immoral actions of another, the same is true of medics. The leading symptom of serious head injury is altered mental status.

Real life example: Just two days ago, there was a young man who slid a motorcycle under a car. No helmet. He had all of the skin avulsed on his hand all the way down to the bone. He had road rash all over his back, and blood was coming out of his right ear. He said he wasn't hurt, and did not want to go to the hospital. He asked me if he could call his wife. We helped him find his cell phone, and he called her. Then we tried to convince him to agree to be transported. He refused. He then asked if he could call his wife. WE let him call her again. We continued our evaluation, and he asked to call his wife. We told him that he already had- twice. He said he didn't remember doing that, and he wanted to go home. I then told him that in my opinion, he was not competent to refuse, and we put him on a backboard with a cervical collar, and he resisted, so we restrained him. He then asked us if he could call his wife. We flew him to the trauma center for a trauma evaluation. If he did not remember calling his wife, how could he possibly understand an important medical decision?

Are you folks still insisting that paramedics should be permitted to accept refusals from such a patient? If you are, I have no problem with that, but you need to lobby your state legislature to change the law and make me immune from liability for doing so.
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Old September 10, 2009, 05:33 PM   #45
OuTcAsT
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Like it or not, the law is what it is
Correct, and you have not provided any "law" to support your claim, AMTS is a standardized test of cognition, but it is only a diagnostic tool, and has limited weight or bearing on legal refusal of treatment.

I would be interested to see exactly what State statutes grant a paramedic (or a physician for that matter) the latitude you perceive you have.


Quote:
Are you folks still insisting that paramedics should be permitted to accept refusals from such a patient?
Absolutely not, and you make a great case for head trauma and the like, but that has nothing to do with the flu.

Having had the flu several times, chicken pox, scarlet fever, etc. I was never in a state of "diminished capacity" such that I could not make a rational decision about my medical condition, and unless I somehow became unconscious, would have the right to refuse treatment.

You continue to compare apples to oranges. speak to the issue.
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Old September 10, 2009, 05:36 PM   #46
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Didn't mean to come off like I was picking on you...

Or anyone in your profession. You have a tough job, and most of you guys (and gals) do it well.

But, those kinds of situations do happen. Fortunately, they are the minority, if not outright rare. But I had something vaguely similar happen to me. In my case, the fireman/emt made it very clear that I was coming with him, and no amount of refusal would do me any good. So, I went. 5 hrs later, the professionals decided what I knew all along, that there was nothing wrong with me (besides being an old, fat, lazy, and ugly curmudgeon).

so, don't feel I am picking on you, I'm not. But I know the way the world works.
and I was stuck with the bill. Because I "agreed" to go.
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Old September 10, 2009, 05:43 PM   #47
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Bill allows cops warrantless entry, detention

I don't. It should make for an interesting day.
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Old September 10, 2009, 06:00 PM   #48
divemedic
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Quote:
I would be interested to see exactly what State statutes grant a paramedic (or a physician for that matter) the latitude you perceive you have.
Not a lawyer, but I do know procedure. Let me quote from the paramedic textbook used by a large portion of the country's paramedic programs:

Quote:
A patient must be competent in order to give or withhold consent. A competent adult is one who is lucid and understands your questions and recommendations, and he understands the implications of his decisions made about medical care. Although there is no absolute test for determining competency, keep the following factors in mind when making a determination: the patient's mental status, the patient's ability to respond to questions, statements regarding the patient's competency from family or friends, evidence of impairment from drugs or alcohol, or indications of shock...

Unconscious patients cannot grant consent. When treating them or any patient who requires emergency intervention but is mentally, physically, or emotionally unable to grant consent, treatment depends on IMPLIED CONSENT (sometimes called "emergency doctrine"). That is, it is assumed that the patient would want life-saving treatment if he were able to give informed consent.
I would speak to the issue, but we keep getting dragged into irrelevancies. The legal authority is already there to allow health professionals to treat you against your will. Under the doctrine of involuntary consent, people are routinely forced to be treated for diseases that threaten the community- tuberculosis is a fine example. Sometimes the law specifies that a court order is necessary, sometimes a LEO must order it, and other times, a paramedic does so. The differences there aare small, and change little, unless you are a trial lawyer.
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Last edited by divemedic; September 10, 2009 at 06:06 PM.
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Old September 11, 2009, 10:41 AM   #49
Rangefinder
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Join Date: August 4, 2005
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Can we say.... Wag the Dog?

This isn't about someone with a history of suicidal dendencies or mental illness being restrained/detained for thier own safety. It's about authorizing a forced vaccination with an experimental substance for a virus that, by many accounts appears to have been genetically engineered, in response to a so-called pandemic where the claims aren't even close to matching the events in the first place.

We live in a world where information travels faster than common sense. I read an article last may written by a doctor who was vacationing in Mexico with his family at the time of the supposed swine flu "explosion", right in one of the reported critical outbreak areas. He didn't even know anything was happening until he talked to his daughter here in the States, who in a panic filled him in on all the media claims puked out on every channel and station. Worried, he immediately went to the hospital with his creds as a doctor to inquire and offer his services in response to the "outbreak" only to find out even they--the hospital reported to have such a critical outbreak--had absolutely no idea what he was talking about. So how is it the US media had so much detailed information about the outbreak when the medical professionals IN that area had none? Seems a little fishy.

So--if I fall off my ladder, crack my skull open, and an EMT insists I get to the hospital with me mumbling "I'm fine, I'm fine" while sitting in a couple pints of my own blood---take me and I'll thank you later. BUT, if you think you're going to kick in my door SWAT style towing body restraints and needles full of some fast-tracked experimental substance, I got news for you---my needles are larger in diameter and the injections they give are gonna really screw up your day.
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