98 | Fire paramedics and medical director panel | Assessing capacity | Suicidal patients | Involving medical control

New panel: Fire officer/paramedic John, fire paramedic Jason, retired fire paramedic Terry and EMS medical director Kash

How to determine capacity and how this differs from competency 

This becomes critical when doing refusals – when the patient decides not to be transported – a very high liability part of EMS

This is different than AAOX4

Capacity is very situational and specific, competency is determined by a judge

We determine capacity:

They must communicate a clear choice, an understanding of their current situation, understanding the risks and benefits of refusing or accepting care

Suicidal thoughts mean the patient does not have the capacity to makes decisions for that particular aspect of their care

Back when I first started in EMS, we would routinely force a suicidal patient to go to the hospital. The current culture puts EMS crew safety as a higher priority. Meaning, if we don’t have the support of law enforcement, we are not going to force patients against their will to get a mental health evaluation

We talk about our relationship and reliance on our mental health evaluators

Documenting these difficult cases involving suicidality and capacity can be tough

One of the current challenges is assuring cooperation between EMS and PD to help safely transport a patient with suicidality but that is also a potential danger to providers

Involving medical control is critical in these difficult situations, especially with technological changes decreasing the difficulty

When in doubt, just make the consult 

EMS trained physicians improve our ability to do our jobs as more and more emergency medicine physicians get this training, it can only benefit us

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Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.