A new law in Ohio allows EMT-Is and EMT-Ps to draw blood from accident victims for which police suspect drug or alcohol involvement, but the law is getting a lukewarm welcome from the EMS community. It remains to be seen how many EMS organizations will agree to participate.
“A lot of the agencies in our area, as well in the other parts of the state, do not plan on doing blood draws,” says Daniel Mack, NREMT-P, assistant chief of the Miami Township Fire and EMS Department.
The EMS provisions of a larger bill were signed into law in September by Ohio Governor Ted Strickland. The law is designed to increase the options police have for getting blood drawn, especially for areas in which the local hospital is far away. Until now, only doctors, nurses, phlebotomists and technicians could draw blood in such situations.
As the law is written, EMS providers could be asked by law enforcement on the scene of an accident to draw blood as evidence. It can only be collected in cases in which EMS staff provided care. Therefore, EMS can’t be called just to draw blood, and police are responsible for getting the patient’s permission. The blood would also have to be drawn following evidence collection procedures, which are outside of the normal EMS scope of care.
But, a key provision worked in by the state’s EMS board is the word “may” rather than “shall,” which allows EMS agencies to decide whether they’ll participate.
Richard Rucker, executive director of the Ohio Department of Public Safety’s Division of EMS, says the law is geared for situations occurring in more rural areas where the run to the hospital could be 45 minutes because police have only two hours after an incident to gather accurate blood samples.
Rucker says the EMS community has multiple concerns, such as training requirements, increased costs and staffing. EMS officials are also concerned the law could negatively affect volunteers, who make up about 70% of the state’s EMS workforce. “If they draw blood, there’s a possibility they could be subpoenaed, and that could affect their day job,” Rucker says.
Rucker is planning 11 regional information sessions in November through late December with EMS, law and medical officials to discuss the parameters of getting EMS involved with the new law.
“We need to get together, so we all understand what the law says and what it doesn’t say so we don’t have an incident at the scene of an accident where law enforcement is getting into a confrontation over what the law says,” Rucker says.
Since the law was signed, Ohio Medical Director Carol Cunningham, MD, a JEMS Editorial Board member, has been urging local agencies to write their own policies. “I encourage medical directors to have a protocol, even if they elect not to participate,” she says.
Mack, like many others, says the participation challenges are in no way a suggestion that the EMS community doesn’t care. Indeed, EMS providers are usually the first to see the devastation of drunken driving. “The reluctance is not because we don’t care about making sure these people are held responsible for their actions. It’s more about the logistical issues,” he says.
Richard Huff, NREMT-B
Pediatric Transportation Guidelines Released
The National Highway Traffic Safety Administration (NHTSA) U.S. Department of Transportation recently released “Recommendations for the Safe Transportation of Children in Ground Ambulances.”
David Bryson, highway safety specialist with the Office of EMS at NHTSA, stresses the report offers recommendations, not mandates or requirements. The working group was made up of experts from children’s health, medical and emergency organizations, as well as NHTSA and Health Resources and Services Administration personnel.
They didn’t intend to provide the perfect solution to every situation, but rather a starting point for discussion. The idea is to be prepared so EMS providers aren’t caught unaware if they encounter a car full of kindergartners in a vehicle crash.
Nationwide standards or protocols for the transportation of children in ground ambulances haven’t yet been developed, so EMS agencies, advocates and scholars looked to NHTSA for guidelines.
The 54-page report contains literature review findings, child safety seat and car bed installation instructions and recommendations for governmental entities and manufacturers to consider. Most importantly, it presents an outline of five situations with an accompanying ideal arrangement. And, if those arrangements aren’t practical or achievable, alternative protocols are available. The five situations range from a child who is uninjured/not ill to a child whose condition requires continuous and/or intensive medical monitoring.
The draft is available at www.nasemso.org/documents/EMS_Child_Transport_Working_Group_July_
The Missouri Bureau of EMS is going paperless. The new, more environmentally friendly system allows providers to submit or renew their licenses via e-mail.
“Nobody loses in this proposition,” says Missouri Bureau of EMS Chief Greg Natsch. According to Natsch, the electronic system speeds up the licensing process and improves customer service, as well as eliminating unnecessary paper use. In the past, the application process could take up to three weeks, Natsch says.
Now, with the electronic system, the process can be completed in as short as three days. In addition, this increased efficiency gets applicants out into the workforce faster.
To apply for a license online, applicants simply e-mail their information to the bureau. The bureau replies, sending the license as an e-mail attachment. If an individual doesn’t have a computer, they can have their license sent to their department or the e-mail address of their choice. As a security measure, a Star of Life has been added to the licenses, which are otherwise identical to paper licenses.
The transition to the electronic format has been a smooth one. “We haven’t run into any problems,” Natsch says.
The FDA issued a warning in August about counterfeit combat application tourniquets (C-A-T). The C-A-T is a one-handed tourniquet that’s widely used by the U.S. Army and some EMS, fire and police departments. When tested, the windlass in suspected counterfeit tourniquets broke or bent before there was enough pressure to stop blood flow.
The FDA warning says the suspected counterfeit C-A-Ts have “subtle differences in stitching, printing of the logo and molding of plastic parts. They may be packaged and labeled for [an unauthorized] distributor.”
Purchasing agents may have inadvertently bought counterfeit tourniquets after shopping around for the best prices. The C-A-T is manufactured by Composite Resources and distributed by only five companies in the U.S.: North American Rescue, LLC, Greer, S.C.; Cardinal Health, Mcgaw Park, Ill.; Owens and Minor, Mechanicsville, Va.; American Purchasing Services, Opa Locka, Fla.; and Phoenix Textile Corporation, O’Fallon, Mo.
If you suspect you have a counterfeit C-A-T, contact Special Agent Alex Alvarado, FDA Office of Criminal Investigations, at 240/276-9407.
Assisted-Living Facility Patient Transfers
Consider this scenario: You’re called to an assisted living facility, nursing home or other patient residence, and the staff (or a family member) tells you they want the patient to be transported to the hospital. The patient emphatically tells you, however, that they don’t want to go. How do you reconcile these conflicting instructions?
First, you must determine whether your patient has decisional capacity. This means they must have legal and mental capacity. In most states, legal capacity means the patient is at least 18 years old, although some states have exceptions that permit persons under 18 to consent to medical care (or, by implication, to refuse it). Mental capacity means the patient must be able to make an informed decision about their medical care and understand the risks if they refuse care.
If the patient has decisional capacity, they have the right to make their own health-care decisions and to override the wishes of caregivers or family members. If the patient lacks decisional capacity, then the wishes of a legal guardian, power of attorney, family member or caregiver (usually in that order of precedence) generally can be followed.
Also, if a competent patient refuses treatment or transport, it’s imperative that EMS providers fully inform the patient of the risks that might arise from that decision. The specific risks you must advise the patient on will depend on their condition. For example, a patient with chest pain must be advised that the cause might be a heart attack and that refusing care could result in death, but a patient with a possible broken toe doesn’t require such dire warnings to make an informed refusal decision.
Finally, be sure to fully document the situation, your assessment of the patient’s mental status and your decision on whether to transport. Obtain a release signature from the patient (or their legal decision-maker) in all refusal cases.
What if an EMS provider follows the instructions of the caregiver or family member and transports a competent patient against their expressed wishes? Courts in some civil cases have held that this could constitute false imprisonment or battery. Although such cases are rare, providers could be found liable for monetary damages. However, on the criminal side, it’s extremely unlikely that EMS providers would be charged with a criminal offense, such as kidnapping, if they made a good-faith decision to follow a caregiver’s wishes to transport an ill or injured patient. In fact, we’re unaware of any such cases.
For a sample patient refusal form, visit www.pwwemslaw.com
Names in the News
The National Association of EMS Educators (NAEMSE) honored National Registry of Emergency Medical Technicians (NREMT) Executive Director William E. Brown Jr., RN, MS, NREMT-P, with a Lifetime Achievement Award. NAEMSE has only presented this honor three other times in 15 years. Brown was nominated by his peers and recognized for his 25 years of service with NREMT.
JEMS Editorial Board Member Jerry Overton, MPA, has accepted a new position as chairman of the emergency clinical advice system and standards board for International Academies of Emergency Dispatch (IAED). According to an IAED statement, Overton’s new position will “oversee the processes that clinically and technically combine emergency medical dispatch protocols with nurse triage for health-care access management.”
This article originally appeared in November 2010 JEMS as “New Ohio Law Allows Providers to Draw Blood: EMS could take samples for suspected drunken drivers.”