What Would You Do is a regular feature in The Pulse by Bernard Heilicser, DO, MS, FACEP, FACOEP-D

In the most recent issue of The Pulse we reviewed the dilemma presented in the Fall 2019 issue regarding the 62-year-old male with a court order to be transported for psychiatric evaluation.

Our patient was unable to care for himself and was covered with maggots. EMS loaded the patient and he began wheezing and went into respiratory distress. The on-scene police demanded transport to the hospital ordered by the judge, not the closet hospital. Contact with that hospital resulted in the diversion to a closer hospital because of the patient’s clinical condition. EMS capitulates and transports to the initial court-ordered hospital.

Should the EMS crew have disobeyed the police? How would you handle this situation as medical control?

This EMS call presented quite a dilemma. Of course, as advocates for our patients, we have that primary obligation: the sanctity of our oath. Considering the police are not medically trained, one would hope they would defer to the medical professionals for the well-being of this patient. But, of course, police officers have their own orders to follow.

How do we mitigate this problem? Here’s our suggestion:

When EMS calls Medical Control, the ED physician is responsible for this EMS direction and outcome. This individual should get on the radio and ask to speak to the officer in charge of the scene. Explaining the medical necessity, and consequences of non-medical authority making medical decisions, can go a long way in politely “supporting” the police officer to reconsider his demand.

Of note, I did get a legal opinion on this and it supported patient advocacy, with the caveat that there could be legal problems in the future.

Although every situation in the ED is different, the best way to care for your patients is to advocate for them calmly and work together with different teams to find the best solution for your patients.

We invite your comments below exploring the complexities of this issue and situations like it.

If you have any case that you would like to present or to have reviewed, please email esernoffsky@acoep.org