Paramedic Case study for Legal and Ethical issues in health care
1
CNA308 Legal and Ethical Issues in Healthcare
Assessment Task 2 – Case Study Paramedic Students
Ed, a 49 year-old male who was attending a party, was found by friends lying on
the pavement with evidence of vomit around his face. After several minutes of
unsuccessful attempts to elicit a response from Ed, his friends called an
ambulance. The friends tell ambulance communications the last time anyone saw
Ed alert was 2 – 5 minutes ago when he went outside for a smoke.
You and your colleague Sarah are the paramedics called to attend. On your arrival
you find Ed looks vaguely familiar. He is now slumped but supported in a sitting
position by his friend Joe. He is holding his head and slurring his words, mumbling
“I’m fine, I’m fine, I don’t want any help”. With encouragement from his friend he
agrees to talk with you. You note he smells strongly of alcohol. His words are
slurred. There is vomitus around his mouth and you note a contusion developing
over the right side of his forehead. Ed is unable to recall how he hurt his head and
is increasingly agitated by your questioning and attempts at assessment.
You are unable to obtain any health history from Ed and his partner has not yet
been able to be contacted. His friends are also unable to assist although someone
thinks he has high blood pressure and is “stressed out heaps” but the information
is not confirmed. They report Ed has had “quite a few” drinks tonight, but cannot
specify how many. Neither can they specify if any drugs have been used. He
continues to slur his words and repeatedly mumbles he does not want to go to
hospital. Attempts to take vital signs make Ed physically combative. He refuses
to comply with your requests to lay still and immobilize his spine. He appears pale
and sweaty, and looks as though he is about to vomit again.
You and Sarah decide to transfer him to the emergency department for further
investigation. He continues to refuse, becoming combative and verbally abusive.
Ed shouts, lashes out, stumbles and is unable to maintain his balance. He is
mumbling and swearing, saying that he didn’t call the ambulance and he doesn’t
want to be touched. Sarah decides to call for police assistance to help restrain him.
Shortly after their arrival and further attempts to verbally calm Ed, he is physically
restrained.
Ed is guided to lie flat for transport to the emergency department. He has a c-spine
immobilization collar applied and you physically tape his head to the trolley, as
you are unable to stop him from attempting to sit up. Currently, his vital signs are:
Heart rate 110; BP 100/70; RR 12; Spo2 94%; Temp 36; Blood glucose 9.1mmol.
Neurological examination of conscious state reveals his Glasgow Coma Scale as 14
out of a possible 15. Best eye opening response: score 4 – opens eyes
spontaneously; Best verbal response: score 4 – confused; Best motor response:
score 6 – obeys commands. Pupils equal and reactive to light – size 3.
The police arrive, but Ed is still indicating his refusal to be transported, shouting
out “Leave me alone, leave me alone! I don’t want to go anywhere! You bastards,
I’ll have you for this!”
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Now that the police have become involved and Ed has been physically restrained,
you notice a large crowd has gathered around the scene and some of the
bystanders appear to be taking photos of the events on their phones. Ed is
thrashing about as best he can beneath the restraints, and is yelling abuse at
anyone within range. You pull the blanket up over Ed’s torso to keep him covered
while loading him on the trolley into the ambulance.
Before leaving, you attempt to gain intravenous access as you plan to commence
fluids, give an anti-emetic so he does not vomit while immobilized, and to be
prepared in the event Ed might have a seizure.
You make several attempts at intravenous cannulation but find it difficult because
Ed will not keep his arm still. On your last attempt you accidently jab yourself with
the cannula as well as Ed. Your finger isn’t actually bleeding where you jabbed it,
and you wonder if this exposure incident needs to be reported or if there is an
obligation to inform your patient. After this last attempt you decide it is only 10
minutes to the hospital and you might as well get underway without IV access.
Unfortunately Ed feels nauseous lying flat, taped to the trolley travelling in the
back of the ambulance. He vomits and you manage to suction it and clear his
airway successfully. On arrival at the hospital Ed’s Glasgow Coma Scale is 13 (Best
eye opening response: score 3 – opens eyes in response to voice; Best verbal
response: score 4 – confused; Best motor response: score 6 – obeys commands.).
Several of Ed’s mates turn up and accuse you and Sarah of taking Ed to hospital
against his will, saying “You can’t just tie him down and drag him off to hospital
when he clearly doesn’t want to go. He’s fine – just had a few too many, that’s all.
You haven’t heard the last of this!”
