A Day In The Life Of An Ambulance Driver - Latest Comments

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

CajunMedic — Wed, 16 May 2012 19:04:57 -0000

I don't know what fantasy world TJIC lives or works in, but it ain't the great state of Louisiana. Where mental health care is deficient and there is a lawyer on every commercial break and billboard; ready to destroy you economically at the drop of a hat. I hate having to take the ones in that were making the hollow threat in the heat of the moment and really didn't mean it (I know, I'm not really qualified to make that decision, but we can pick those out fairly easily) but the Schizophrenic clearly off their meds but is A&O enough to refuse, I can't do anything with other than "I can't force them, you'll have to call the coroner on Monday"

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Foo — Wed, 16 May 2012 18:47:28 -0000

California's WIC5150, as Joe noted, is a 5 year prohibition. Per [J Am Acad Psychiatry Law 35:3:330-338 (September 2007)]: "In the District of Columbia, Hawaii, Illinois, Maryland, and Oklahoma, [...] voluntary treatment can be enough to trigger a [permanent] prohibition." (Certainly including involuntary treatment, however brief.)

DoD Form SF-86 requires disclosure of (essentially) any mental health encounter in the last 7 years; answering untruthfully is, of course, a felony itself.

Re: Lines In The Sand

tjic — Wed, 16 May 2012 18:38:00 -0000

> I in no way blame you for enforcing the law as written. It isn't your duty

You've got a very small and legalistic understanding of duty.

Re: Lines In The Sand

tjic — Wed, 16 May 2012 18:35:28 -0000

> Threatening to kill yourself: Extortion. It is exactly the same as threatening to kill a hostage.

I find the logic whereby one has the right to do a thing, but one does not have the right to mention out loud the plan to do a thing confusing.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Ambulance_Driver — Wed, 16 May 2012 18:27:52 -0000

Indeed.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Joe Paczkowski — Wed, 16 May 2012 18:13:17 -0000

It really depends on the state. In California, the 72 hour hold (Welfare and Institutions code 5150) can be written by police officers, designated evaluation teams, and physicians and it comes with a 5 year state ban that can be appealed. The 14 day hold (WIC 5250) requires a court order, and because it comes with a court order it triggers the Federal ownership ban.

This is also one of the reasons I go slightly crazy when people talk about abusing 5150 orders for drunks or other patients who simply want to refuse care. 5150s are for mental illness only. If the patient isn't a danger to self, others, or "gravely disabled" due to a mental condition than merely mentioning the term 5150 deserves a smack down.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Ambulance_Driver — Wed, 16 May 2012 17:32:55 -0000

Not necessarily.

It's my understanding that it will only appear as an ED visit, which is as non-discoverable when it comes to your gun rights as an ED visit for any other reason.
It's only when a PEC is issued that some states may take away your firearms rights away.
And no, I don't agree with that, either.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Foo — Wed, 16 May 2012 17:27:06 -0000

Kelly, I'd be entirely with you (within the limits of statistical error) if it weren't for the last few comments: "And once you're home, you can go on about your life, with nothing other than an ED visit in the hospital records." If only it were so simple.
- Your state may not view that ED visit as a big deal, but in a number of states it's a lifetime or 5-year prohibition on firearms ownership.
- It's a required disclosure on US Federal clearance paperwork.
- etc.

Calling 911 on somebody for mental health reasons is right up there with calling CPS on somebody.

Re: Lines In The Sand

S Andrew Nicol — Wed, 16 May 2012 16:55:53 -0000

Yup, if you're gonna do it, then do it... quietly and alone.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

jer — Wed, 16 May 2012 16:55:16 -0000

I have a serious problem with your "jack booted nazi" butt. You're a bad speller. *eSpecially.

Re: Lines In The Sand

BH — Wed, 16 May 2012 16:42:21 -0000

Don't like the law, change the law- unless you're just a tough talker, of which we see many. Advocating lethal force against those bound by said law is irresponsible, stupid, and trollish.

Re: 73,740 Rabid Gun Nuts Descend Upon St. Louis…

JMD — Wed, 16 May 2012 16:33:32 -0000

I am a 20 something year old mother of a 5 year old boy and we LOVE a good gun show....Almost as much as I love your blog. EMS and guns in one place....oh yes :)

Re: Lines In The Sand

Kristopher — Wed, 16 May 2012 16:29:16 -0000

It ain't the government that would sue him for failing to intervene.

The suicide's relatives will sue him in poverty.

Deal with this first, before you expect others to uphold an idiot's right to idiocy. Said idiot could have just bought an N2 tank and plastic bag and played spaceman spiff in the bathroom.

He decided to attention whore and put EMS on the lawsuit hotseat.

That little attention whore can screw himself. If he wants to own his body, then he should own it, and not expect EMS persons to put themselves at any liability risks while he ends it.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Ambulance_Driver — Wed, 16 May 2012 16:27:08 -0000

So I'm a moral coward and contributing to the slide into full-on socialism.

Gotcha.

Nice to know that you checked hysteria at the door and wore your Reason Hat, Aaron.

You know who you sound like? The standard Brady or VPC troll, that's who; every bit as strident and unyielding in your rhetoric as they are.

And every bit as wrong and delusional.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Ambulance_Driver — Wed, 16 May 2012 16:23:02 -0000

Well, he did lose all his guns and his approval by the state to own them, based on his blog comments, so I guess he did.

I think he was denied due process in that matter, and I'm sympathetic to his cause.

Then again, if his approach to the Arlington PD was anything like his behavior on my blog, then I can see why it happened.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Kristopher — Wed, 16 May 2012 16:21:11 -0000

Bullshit.

If someone wants to kill themselves they can just buy a garbage bag, a nitrogen tank, some hose, and an elastic hair band, and go quietly play Spaceman Spiff in the bathroom.

They are calling 911, friends, or relatives because they are little attention whores.

They will get plenty of bad attention very quickly.

If you want to own your own body, then fucking well own it. Don't expect emergency staff to hold your hand when you threaten to do stupid things, and don't expect them to eat a lawsuit from your relatives ( who absolutely will sue them, you fucking dumbass! ) to protect their right to be stupid.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

LL — Wed, 16 May 2012 16:06:28 -0000

I'm not going to read all the crazy because I already had indigestion right now from having spicy Popeye's chicken, but might I say, their arguments ONLY hold true if any and all family members lose their right to sue because you "didn't do your job." Yeah, none of those people can guarantee that sobbing mommy can't accept that they slit their own wrists and so it would be YOUR fault for "letting them go," and therefore, they get to take your home and all property in a negligence suit. I'm libertarian, you know that, and I actually understand and agree with the THEORETICAL point of having free choice to kill yourself. But in the end, if you call someone else who has some sort of responsibility to DO SOMETHING and it leaves them open to all kinds of liability, fuck your freedoms on that one. By the way, if you're crying about how you want to kill yourself, call your buddy instead. I've been in that position, getting that call, and it is the SCARIEST THING EVER to try to figure out what to do and if he had gone through with it...oh lord, the guilt, I can just imagine. See, normal people feel a moral obligation to try to help people like that.

Ugh.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Bobball — Wed, 16 May 2012 15:56:17 -0000

Geez Aaron, where to start? I sincerely believe that any appreciable swing into "full-on socialism" will swing back the other way eventually. Why? Because people won't like it either. Things would be far better balanced and left alone if all the extremists (from right and left) would just STFU and listen for a change. The world is not black and white. Trying to make it so only serves to screw everyone else.

Threatening suicide is essentially extortion. I'm with Kelly 100% on this. There's a great way to not have the police, EMS, hospitals and mental health organizations involved in one's suicidal ideation. Don't tell anyone...just go do it and be done. The folks who are threatening put everyone else in an awkward spot. Like it or not, "honoring" someone's threat and leaving them will more likely ruin the cop/medic's life than the person who threatened suicide. If they were serious, they'll be dead. The cop or medic will instead likely be jobless and expected to somehow pay restitution to the family of the deceased for "not doing enough". Right to die is fine. Right to threaten to die...no, at best, it's bad manners.

As for people not calling 911, but threatening to others...that's beyond rude. Frankly, I find that criminal. How dare someone be selfish enough to mess up my rights and life as a human by calling me and putting that burden on me (friend or family or not), and not expect me to try and stop them. Perhaps people threatening suicide should call strangers with a blocked phone number instead. Still incredibly rude...but hey, they can talk and mind-screw someone, and we in EMS won't have to get involved.

Give it a rest, pally.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Ernie Sharp — Wed, 16 May 2012 15:49:57 -0000

I have had the discussion of transporting people against their expressed refusal countless times before, and I have been called a 'jackbooted thug' for taking your position.

A man has cut his wrists with a knife in an apparently unsuccessful attempt to take his own life, but refuses to go to the hospital. Are you seriously proposing that I leave you there? Then what happens when I do
so, and you are killed? Only this time, you used a gun and took your wife and children with you?

How about the man that I ran on last week who was intoxicated and hit a telephone pole in his truck. He had a large bump on the head and was acting confused? He didn't want to go to the hospital. Is he confused
because of the alcohol, or the blow to the head? Do I leave him there because he refused? What if he dies as a result of a head injury, and his lawyer can show that he was not intoxicated, just confused from brain damage?

I go to your home, and you have deep lacerations on your wrists that are consistent with a suicide attempt, and you tell me that you did it because the voices in your head told you to, I absolutely will Baker Act you.

If your girlfriend calls and tells me you tried to commit suicide because the two of you got in a fight, I probably won't, unless I also find an empty pill bottle that should still have 30 pills in it because it was prescribed yesterday.

This sort of thing isn't done because you won't go to the hospital for the flu. I have to have a reasonable belief that you are an active harm to yourself or others.

I tell you what: I will never again take anyone to the hospital against their will, if the law is changed to make me immune from legal liability if I accept a refusal from a person, and they die, even if it turns out that they were mentally incapacitated at the time I accepted the refusal. You see, as long as you keep the law the way it is, what it boils down to is this: You want to be able to refuse care, and still hold others liable when your decision turns out to be a poor one.

OK, how about as a thought exercise, I give you a few examples, and you tell me what you think you would do as the paramedic on scene:

A motorcycle rider is in an accident, and is not wearing a helmet. He takes a blow to the head and is dazed and confused. He does not want to go to the hospital and threatens violence if you try. Do you accept his refusal?

A 16 year old teen is in a car accident. He has an obviously broken arm, but does not want to go to the hospital. Do you accept his refusal?

A man is intoxicated and gets in a fight. He does not remember what day it is, nor does he know the name of the city he is in. He is refusing care. Do you accept his refusal?

In each of those real life cases, the person is not legally able to refuse medical care because of altered mental status or because they are a minor. The law REQUIRES you to treat them, and the medic who does not is civilly and criminally liable if they do not. If you accept refusals from any of the above, you can lose your license, go to jail, and be sued for everything you own.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

JB on the Rocks — Wed, 16 May 2012 15:47:52 -0000

I'm sure that, facing criminal AND civil legal action, as well as loosing his job, his income, his ability to provide for his family, and a thousand sleepless nights, TJIC would remain a stead-fast bastion of personal freedom and refuse to take the same actions that you did, AD.

Yrro and Roberta nailed it. Bravo, both.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Mike Phillips — Wed, 16 May 2012 15:43:01 -0000

Well said, AD. Those two guys obviously just don't 'get it'.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

David Neylon — Wed, 16 May 2012 15:20:36 -0000

To me ending your life is your right. If you really wanted to kill yourself just do it. Threatening to end your life is a cry for help and by publicly announcing it you're going to get the help. Whether or not it actually helps is something else.

AD is required by duty AND the law to transport such a person against their will. If you don't like it tough. Next time just do it. And remember, it's down the river not across.

Oh and for any of you bleeding hearts out there that decry my lack of sympathy and feel that I don't understand the damage that is caused to a family of a suicide? Go fuck yourselves. My father killed himself when I was four and my youngest brother was 9 months old. Don't even start to tell me I don't understand.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Joe Paczkowski — Wed, 16 May 2012 15:04:47 -0000

"If you are so wrapped up in what you do that it defines who you are--what happens if you get fired?"

The problem is that it isn't just losing a job. Deciding to simply not take a patient with suicidal ideations to the hospital who does commit suicide could easily lead to professional consequences at the licensure level (i.e. find another field entirely, not just another job), civil consequences (malpractice isn't just for physicians), and depending on the circumstances, an argument could be made for involuntary manslaughter ('unlawful killing without malice.. in the commission of a lawful act ... without due caution and
circumspection.' California Penal Code 192. Other state laws may vary).

Due to limited resources, training, and scope of practice, EMS is rather limited. Tell your primary care physician that feel like dying and your physician is likely going to ask about your plan before deciding to write a hold or not. However the physician can also prescribe therapy, medication and partner with the patient to provide a safety net in case the patient's condition worsens. All things which EMS can't do, hence magic words results in a trip to a local ED.

Granted, the patient doesn't, and shouldn't, lose all rights. The patient should still be allowed to decide which hospital to go to, within reason (and please, don't take the hospital social worker who is distraught because she broke up with her boyfriend to the hospital she works at) and decide whether leather bracelets are applied, but the choice not to go is no longer present.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

aaron — Wed, 16 May 2012 14:42:29 -0000

[quote]If that makes me a moral coward in your eyes, then so be it. Your opinion of me doesn't cost me much sleep.[/quote]

It does. Hopefully that will comfort you when we actually do slide into full-on socialism.

[quote]Threatening to kill yourself: Extortion. It is exactly the same as threatening to kill a hostage.[/quote]

Yep--the government makes a lot of money off us. You're threatening to take your productivity away. That is not allowed. So you will be handcuffed, taken to 'psychiatrists' , and given drugs to think the way we want you to. Er...I mean 'normally'.

What's the difference between threatening "If you do $x, I'm going to kill myself" verses "If you kick in my door at 3 AM, I will shoot you?"

[quote]Youdo have a right to self-determination. Just don't get me or my livelihood entangled in it by threatening first.[/quote]

And how many of these people actually call 911 verses someone else calling 'on their behalf' and having the situation thrust upon them against their will?

[quote]It isn't a "line of work" for me. It's who I am.[/quote]

If you are so wrapped up in what you do that it defines who you are--what happens if you get fired? What happens if you injure your back and can't be a paramedic anymore? Will you be so distraught you'll say something stupid like "If I can't be a paramedic, I'd rather be dead"? I hope you don't say it too loud. The state might be listening.

Re: In Which a Bunch of Libertarian Types Go Full Wookie…

Sean Murphy — Wed, 16 May 2012 14:25:35 -0000

Very well stated AD. Involving the police/EMT/Government agents in any other form, is usually detrimental to ac-complishing your goal, be it running business, restoring your stolen property, preventing violence, or ending your own life. There are situations in which even a dedicated anarchist like myself will call state agent though. Mostly those requiring the immediate attention of specialists in a field that has been coercively monopolized by the state. Medical trauma or fire spring to mind. There are private EMT services, but the level of regulation, and the legal liability imposed by the monopoly court system makes them little different from a state service, at least in terms of how they respond to suicide.

EDIT: I really should run these things through a spellcheck first.