Feedback requested: "Emergency Room"

Emergency medical services

Special thanks to: BigTrancer, Catch-22, Exx_head, Halo99, nursey and phase_dancer

Many of us have been or will be present at a drug-related medical emergency (overdose). As scary as the overdose may be, calling for an ambulance or taking someone to the hospital can be just as frightening.

The purpose of this FAQ is to provide information to people so they know what to expect and how to conduct themselves should they ever have an emergency situation. The idea is that if people are somewhat familiar with the process, they will not avoid getting medical assistance due to fear or ignorance. This is not meant to be a first aid guide.

When should I ring an emergency number?

• If you think that you or someone else is experiencing an overdose or other serious medical condition.
• If the person has symptoms of advanced cardiopulmonary/nervous depression (unconscious, not breathing, changing colours or has a weak/nonexistent pulse)
• If the person has symptoms of advanced cardiopulmonary/nervous excitement (overheating (>39°C/102°F, may be difficult to tell), manic behaviour, heart attack, etc.)
• If the person requires medical care, and driving them to the hospital is impractical or would take too long

Basically, if the situation is a medical crisis that you cannot handle, then it’s time to make the call.

If you have not already done so, please familiarise yourself with the emergency number in your area. This number is often different for hard lines and mobile phones, so take the time to learn both. The call is free to make from both mobiles and hard lines.

What will happen when I ring an emergency number?
If you are calling from a hard line, the call taker will be provided with your location and phone number. If you are calling from a mobile phone, this information may not be available.

The call taker will ask a series of questions. Try to stay calm, and speak in as clear and concise a manner as you can manage. Refrain from using slag, ie: my mate shot a point of blow (besides, who really talks like that?).

Answer the questions to the best of your ability, and be honest. Answer exactly the question that is asked, and do not confuse or impede the call taker with superfluous information.

Also, do not hamper the call-taker with questions of your own. They are a professional, and do this on a somewhat daily basis. They know what they need to ask, and do not need to waste time deflecting your questions. Often, help will be on the way while they are still asking questions. In most situations, call takers will gather enough information to make an accurate dispatch in approximately 30 seconds.

Never hang up on the call taker. Wait until they have terminated the connection, then hang up your phone.

What will the operator need to know? What will they ask me?

• What is the emergency? (Do you need medics, police, or fire-fighters?)
• Where is the emergency? They will ask this even if you are calling from a hard line, although in that case the question may be phrased: “Is this emergency at [location of phone from which you’re calling]?”
• What happened? This may come as a series of questions or as a broader single question. The call taker will probably ask a series of follow-up questions.
• When did this happen?
• Other questions – The call taker may ask your name, how many people are there, and if there are any other special considerations or obstacles that need to be noted.
• Instructions – They may provide you with instructions, such as clearing the airway or performing rescue breathing.

Can I dial the number and then run?
Yes. However, dialling and then running is not a good idea as the dispatcher will probably send police to investigate the call. This is bad both because you have now involved the police in a drug-related incident and because this will probably delay the arrival of emergency medical services.

What should I do after making the phone call?
There are two big post-call priorities:

1. Keeping the person alive – The call taker may give you some instructions to this end or you may be free to act on your own. If and only if you are capable of doing so, you should perform CPR/rescue breathing as necessary. If you elect to perform CPR, please be aware of the potential to receive or transmit disease via body fluids.

2. Sanitising the scene – Basically, this means getting your drugs out of sight. Although this is not nearly as important as the first item, it is probably unrealistic to think that people will not be concerned about this. Don’t waste time trying to diligently hide them, just discard them somewhere out of sight. If it is not practical to discard the drugs, then place them in a opaque bag and send them along with the casualty; indicating to the medics that the bag contains personal items.

This raises the possibility that a helper may fall on the wrong side of the law for handling controlled substances. phase_dancer shed some light on this problem (limited to Australia):

After expressing concerns that [harm reduction organisation] volunteers had in the past been faced with similar situations, I enquired at a departmental meeting as to what was considered the correct course of action to take i.e. of least consequence for both the helper and the casualty.

We were advised that if a situation occurred where workers had to remove personal items, and something came of it law wise, under duty of care the volunteer/worker would not be liable for prosecution. This did not come from a policeman, but the person was definitely someone who should be able to advise on such matters.

I would imagine this should also apply to the general public, but I couldn't be sure. To be honest I don't know whether this would stand up in court at all. There's never been a precedent that I'm aware of.

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What if the person recovers before the ambulance arrives?
In this case, ring the emergency number again and tell them that the person seems to have recovered. Emergency calls are prioritised, and someone who has OD’d and is near death is a pretty big priority. Letting them know that the person now seems to be okay may free the ambulance to save another life.

The call taker will tell you if an ambulance is still being sent, if you should take the person to the hospital, etc.

Under what circumstances will the police become involved?
Usually, police will only become involved for one of these reasons:

• The medical personnel fear for their safety. This is applicable to emergency responders and hospitals. It is not uncommon for ambulances to request police escorts when entering dangerous parts of town, or going to a dangerous location. This means that calling from a party could bring the police.
• There is a reasonable suspicion that a crime has been committed. Although this is more likely come into play when responding to violent crimes, police have been known to attend calls responding to drug related incidents (this is usually not the case in larger cities).
• You hang up the phone and run; or just dial and run without telling the call taker what you need. In this case, police will most likely be sent.

What will happen when they arrive? Will I/we be subject to search?
At the time of this writing, the FAQ team was unsure of the legally correct answer to this question. The following answer is based on the experiences of people on all three sides of this situation (users, medics, police):

If the police accompany an ambulance, they are basically there to make sure that things don’t get out of hand. They will probably stay with the medics and only intervene if it is obviously necessary - like if someone becomes violent. They will most likely not search the location or your person, but will act if something is in plain sight (don’t leave your drugs in view).

When should I take someone to the emergency room
You should drive someone to the emergency room for the same reasons that you would ring an emergency number; except that in this case it is practical to drive them yourself.

If you have not already done so, please take some time to familiarise yourself with emergency-care centres in your area. This is not something you’ll want to figure out in the middle of an emergency.

Can I drop them off at the door and run?
Yes, but this is not recommended for several reasons:

• Treatment will be hampered. The medical personnel will have an incapacitated and uncommunicative person on their hands. This means that they will have to spend time and effort figuring out what’s wrong with them, as opposed to you being able to tell them what happened.
• The medical facility may make efforts to contact the person’s family, or the police, or both. In any case, this is probably an undesirable outcome.
• When they recover, the person may be awfully teed off about what you did.

Will the doctors call the police?
In almost every case: No. Most hospitals see their share of drug cases and never call the police. Medical personnel are more concerned with providing adequate treatment than they are with reporting crimes.

Besides, police involvement is usually an undesirable situation at a hospital as it adds confusion, saps resources, increases stress and possibly frightens other patients. Some reasons they may call the police are:

• You are acting in an unruly fashion. If you are causing such a scene that they would normally call the police (regardless of cause) or they fear for their safety, expect to see blue lights.
• They have a strong enough suspicion that another, more violent crime was committed. Most hospitals are required to report things such as gunshot wounds, stabbings, etc.

What information can my doctor share with police?
Your doctor cannot share any information with the police unless a court orders them to do so. Straight from Exx_head: “There is a doctor-client privilege that can only be broken by court order, and that is very difficult.”

Okay, this was getting no action....let's see if it fares better in Australian Drug Discussion?

FEEDBACK PLEASE!

Good FAQ!

That covers most of the concerns I can think of regarding calling for help in a drug-based emergency. Police involvement is usually one of the biggest fears, besides not knowing what to do. Some other thoughts I've had which may or may not be beyond the scope of the FAQ...

What should someone do, after making the phone call, until the ambulance arrives? (Clean up the area? Make sure the person in trouble has easily locatable ID? Should you take their drugs off them if they've not already eaten them all? What first aid is applicable?)

Does it cost anything to have someone put in ER/A&E by an ambulance?

What happens if the person recovers before the ambulance arrives? (Should you make them wait and get checked by the paramedics anyway? Should you call and cancel the ambulance?)

BigTrancer

Great work

BTs points pretty much sum up any suggestions I have to make.

Regarding BT's Q on Ambulance cost:

In the Australian context, it can cost around $300 upwards if the person requiring the ambulance does not posess a health care card or private ambulance cover as part of their health care 'package'.

This, and various other factors that relate to the health care system are going to vary in the NZ or middle eastern context. It's obviously going to vary from country to country, and health care system to health care system.

So is this an Australian specific FAQ?

i don't know if it's a bit of a big issue to touch on in this faq, but there's also the question of what to do if someone has a seizure.

in australia at least, if you are admitted to hospital for a seizure then you will loose your license for a period of time (3 months i think), and then if you have another seizure within a certain amount of time you will loose it indefinately.

it's a fairly interesting issue, and if there is someone present who knows what is going on and isn't freaked out by the intense situation that is someone having a seizure, they might be a little clearer thinking about that one...

i'm not saying jeapordise your friend's health/lives by not calling ambulances, but in the event of a seaizure at least wait until everything has settled down and checking for breathing/pulse and some response might be good advice?

Interesting topic RBB. I do think, however, that if someone needs an ambulance then regardless of ANY possible legal complications the emergency services should be called as soon as possible.

Administrative fallout resulting from such an experience (i.e., a high ambulance cost, loss of license for any reason, criminal drug charges from police, parents finding out about their child doing drugs, etc...) is really a small price to pay when you weigh up the potential costs of NOT calling an ambulance (i.e., brain damage or death). Furthermore, dealing with such repercussions after their recovery might make the person think about being more careful with drugs in future. Now, that's not to say that anyone who needs an ambulance is to blame for their own condition - but in a majority of cases the situation could be avoided with common sense and putting a bit of thought into personal harm reduction.

BigTrancer

"In the Australian context, it can cost around $300 upwards..."

Try $700-00 up.

We had ambulance insurance from the time of our first baby. One year we didn't bother to renew and of course it was the year we needed one. That was '96 in Queensland and it cost $750 for a 20 min ride. So I tend to be in favour of forking out for cover. Get as broad a one as you can afford.


With seizures, the main priority is the wellbeing of the casualty. As BT said, if in any doubt call emergency.

In regards to drugs being on a person who is to be hospitalised; we have been faced with this situation on occasion. From advice recieved, together with the often urgent decisions which have to be made, possibly the better options open to the carer would be:

1. (First choice) to ask friends to accept and look after any valuables or suspected illicit substances. That way no direct contact by the carer is necessary .
2. (Second Choice) if paramedics are due to arrive and the person is not accompanied by anyone, remove all items and place them into a tied, non-tranparent bag. Give this to ambulance personnel, explaining that these are the personal belongings of the casualty.
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   With the second choice, where the carer has had some obvious contact with the drugs, it seems the carer would generally be protected by duty of care (in Aus anyway).
   
   If the casualty does recover before the ambulance arrives, then yes the ambulance should be called. Location allowing, if you are looking after the person you should have some radio or phone contact with emergency. Chances are paramedics will come and check it out anyway.
   
   
   The FAQ looks great. Covers many of the typical "panic mode" fears and questions.
   
   

   Basically, if the situation is a medical crisis that you cannot handle, then it’s time to make the call.

   Click to expand...

   
   Possibly the most important message of all, relevant also for inexperienced HM workers. Always recognise the limits of your role as an assistant and unless it's unavoidable, never do anything which is outside of your training and experience.

BT – I added a sections about what to do after the call and what to do if the person recovers. I wouldn’t worry about the ID thing. If the person has ID on them, the medics will find it. If they don’t have it on them, you as the initial care taker shouldn’t waste time looking for it.

Trillian – Thanks for the input! This is not an Aus-specific FAQ.

rbb – I’ll just echo what BT said and add that unless the seizure is a result of an ambulance-requiring condition (heatstroke, etc.), then there really isn’t a need to make the call.

phase_dancer – Thanks for the input! I agree with almost everything you said, although I don’t know that I agree with the second choice. My inclination would be to discard or hide the drugs rather than send them along with the person. I think sending them with the ODer is a recipe for more trouble, as this can increase the chances of provoking police involvement. If you never see the person again, so be it. They’d probably be willing to give the remainder of their supply to be alive. Regardless, it’s just a personal call.

Just a quick point, from my personal point of view - I know that personally I would feel bad if I was put in the situation but I probably still wouldn't do CPR on someone that I didn't know.

I'd hate to put myself at risk of body fluid contact from an unknown person, or have them vomit on me for any reason; or put them at risk of having their ribs broken due to me panicking and pressing too hard on their chest, or doing CPR wrongly... but I guess I'm not trained in first aid, so I'd definitely leave it to someone who was. In the absence of such a person, the paramedics would have to deal with it.

BigTrancer

also this might be a good one to add that the call is free, even from a mobile. even if you are on a credit system and have no credit. it is still a good idea to keep your phone on you incase something like this happenes.

1. Very small point: Sadly many Americans have no idea what Celsius is, so I would put ">39C (or >102F)" in the text.

2. Here is a random idea I have heard before....I am 90/10 against it being added but let me throw it out for discussion.

If someone is fearful of getting involved but wants to help their friend, they can always claim to have arrived just as the situation was starting. When relaying the facts to emergency personnel, they can modify things slightly and claim to be recounting what someone else told them. "I walked in and found my friend having seizures. Some random guy who I had never seen before told me the situation and asked if I could help. I went to call the paramedics, but before you guys could get here the stranger got spooked and disappeared."

3. Possible idea. At some point (maybe the end?), ask the reader to take a moment to be sure they know the emergency number for their country of residence. Further, ask the reader to spend ten minutes becoming familiar with the names and locations of nearby hospitals. It is much easier to learn such information with a clear head than to try to figure it out during a stressful emergency.

The prices for ambulance transport in Victoria is around the range phase_dancer quoted for Queensland. I can provide some information based on personal experience, but I don't know if it's reflective of the general community. I had to go to the hospital in 2002 in an ambulance (drug related), I don't feel comfortable about mentioning the hospital's name or my suburb, but I live in an area where the hospital is a scant 3-5 minutes away. That 3-5 minute trip cost me A$659 dollars! The figure is still very clear in my head because I had to eat instant noodles for a whole month to absorb the cost!
I got billed about 2 weeks after the transport, and there was a threatening follow-up letter from a solicitor one week after that. I paid the invoice and the hospital sent me another invoice amounting to A$370 for an overnight stay, medication etc. It was the most expensive weekend I ever had...the hospital visit resulted from the consumption of 450 mg of meth (over two days) and 4 strong MDMA pills over the course of 8 hours. I had a very low tolerance then, and I started to throw up everything (including water) at the end of the weekend. I couldn't get anything down, not even water so I smoked some strong cannabis and that triggered a freakout episode. Long story short, the ambulance was called, I got admitted into ER throwing up blood (don't know why) and I told the doctor and nurse about everything I consumed.
I got treated for severe dehydration (IV drip) and was given a shot of Valium (didn't know it then, it was listed in the invoice), and I slept for about 4 hours, woke up and was given breakfast before being discharged. There was no problems with the police or anything, I asked the nurse and doctor, and they said they have no obligation at all to report drug use to the police, and they don't. I was given a bit of a lecture by the doctor before being discharged though, and was offered (not forced) a consultation with the hospital's substance abuse counsellor, which I declined, again with no problems.
I was worried (for no reason) that the hospital would notify the police even with their assurance that they won't, so I flushed everything illegal down the toilet. And they were right, nothing ever came out of that incident, which leads me to believe the hospital won't report drug use to the police. Anyway, I checked myself in again the next day (had panic attacks and still couldn't drink), was treated with IV drips and given a prescription of Valium (short term) and metoclopramide (Pramin) - supposed to be an anti-emetic to avoid me throwing up. Surprisingly, I never got charged for the second visit, only the first, even though I stayed 4 hours again. *shrugs*
Well, some final notes regarding the incident - I had to pay for the ambulance and hospital stay because I made the stupid mistake of forgetting to renew my medical insurance. I just missed it by a couple of weeks, and because of that, I had to pay over A$1000 - not an easy thing to do for a student. Oh, and I'm neither a citizen nor a PR, I'm on an international student's visa, and my Medibank Private health coverage would have included the ambulance transport and the majority of the hospital bills. I would urge everyone to keep up to date with medical insurance premiums because you never know when things might happen. Ambulance transport fees are very expensive! The amount on the invoice was a real eye opener for me...never slacked with health insurance ever since.
Another thing that I notice is the fact that hospitals and ambulances expect very prompt turnaround in payment, both times had only a lag of one week before a Threatening Letter came in the mail. I'm not sure if this is true for everyone or I just tend to get my mail late. The final thing I wanted to say is, there is no long lasting rammifications from the incident. I admitted and detailed my drug consumption to the doctors both times, and I'm sure it got on my record, but I never had any problems with doctors after that.
What I mean by this is, I don't think (but I can't say for sure) that there is some sort of "flag" to mark you as a drug user in the medical insurance records, which would prevent you from getting restricted medications in the future. Again, I can't say if this is true for everyone, since I'm using Medibank Private and the situation is somewhat unusual. I think they are aware of the incident because I didn't realize my card had already expired and handed it over to the hospital. I got a reply from Medibank saying that the admission and transport cannot be claimed back because it happened in the period where my health coverage has expired.
I had another incident not so long ago (I seem to have an affinity towards emergency rooms) and my friends took me to the hospital, didn't mention anything about drug use, declined to be admitted to a bed after the triage nurse tested me for reactive hypoglycemia (sp?) and it came back negative. My experiences with triage nurses have not been good, and it's not just because of me, I've seen other people interacting with the triage nurse, and my conclusion is that you have to be 3 minutes away from death (slight exagerattion) to get a doctor to see you straightaway. I've seen a guy with bloody, broken hands get told to wait, and a woman who had a heart attack earlier in the day also being told to wait.
So I don't think leaving people at the door and running would be a good idea either. It'll be best to ensure that the triage nurse knows whats going on. They might not be the friendliest or most symphetatic people around, but they're just doing their jobs - which I think it seperating the serious emergencies from the ones that can wait and scheduling it accordingly. Thus, it'll be good to tell the triage nurse everything, lest the emergency is treated as a non-urgent fainting spell.
One final note about police, in the three times I've gone there, I've seen police escorting people in twice. However, those seem to be people already under arrest for whatever reason, and it's not like they're coming to the hospital to arrest people reported as drug users. I'm pretty sure doctors will not report anyone for drug use, not only because they don't have the time, but it could be part of their code of ethics or something. Discarding everything illegal would still be a good prevention measure, as many have mentioned, but it'll be good to ensure that the person needing emergency help is getting the proper attention fron the triage nurse before leaving them, or else they might slip through the cracks...the hospital I went to has CCTVs in the ER waiting room, and the triage nurse is behind a glass panel, with a door leading to the waiting room. However, they didn't seem to come out to check on suspicious cases, like unconcious people, so I would stay with them if it's a friend. My apologies for this rambling post, hope that somone would find this experience (in Melbourne) useful.
Oh, and remember to keep up with your health insurance premiums.

Good work Orlando, very useful information.

Orlando I agree that when acting in a non-official capacity this would normally be the most sensible and hopefully less consequential thing to do.

But if you are assisting as a HM worker/ volunteer, then this has to be considered carefully. If tradegy resulted in police enquiries, it would be difficult to explain a large amount of drugs temorarily in your posession , and stashing them elsewhere isn't always an option.

BigTrancer: The person would be charged for the ambulance even if someone else called it for them. This is true for Victoria's Metropolitan Ambulance Service, I saw that when I went to check the prices last year. I thought I had been misbilled coz it was such a shocking amount...I'll dig up the link so you can have a reference.

http://www.ambulance-vic.com.au/faq.html

If I don't request an ambulance why should I be billed?
Although you may not have requested an ambulance personally, an ambulance was called on your behalf and the service was delivered.

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Re: "In the Australian context, it can cost around $300 upwards..."

phase_dancer said:

With the second choice, where the carer has had some obvious contact with the drugs, it seems the carer would generally be protected by duty of care (in Aus anyway).

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hi phase_dancer, just wondering if you could clarify what you mean by duty of care? are you using this in the sense of a medical officer or harm reduction volunteer who has come into contact with drugs?

bk

temporary_nick: even if I had full private cover (which most Australian's don't) I would not ask to go to a private hopsital in a life or death emergency. You will get as good, if not better care at a public hospital (for those with a Medicare card) without the heinous gap fees etc. As for this:

I've seen other people interacting with the triage nurse, and my conclusion is that you have to be 3 minutes away from death (slight exagerattion) to get a doctor to see you straightaway.

Click to expand...

This is pretty much true, basically becuase very day hundreds of people turn up at emergency depratments for trivial complaints that could have been dealt with by a GP. People abuse ED's because they are free (for those with a Medicare card).

I should also point out that in Victoria, a person arriving via ambulance will always be triaged before anyone "walking in" (or being dragged in for that matter). So if the situation is really serious, calling an ambulance will definitely get much quicker treatment.

Re: ambulance costs, don't holders of Health Care Cards get free ambulance transport?

blue kitten After expressing concerns that RaveSafe volunteers had in the past been faced with similar situations, I enquired at a departmental meeting as to what was considered the correct course of action to take i.e. of least consequence for both the RS helper and the casualty.

We were advised that if a situation occured where workers had to remove personal items, and something came of it law wise, under duty of care the volunteer/worker would not be liable for prosecution. This did not come from a policeman, but the person was definitely someone who should be able to advise on such matters.

I would imagine this should also apply to the general public, but I couldn't be sure. To be honest I don't know whether this would stand up in court at all. There's never been a precedent that I'm aware of.

Over the past 5 months, our family have had to put all we own at risk through operating as outreach organisors without insurance. We have all discussed this at length and up till now have accepted these risks. However that is us knowing of the risks, not volunteers who can occasionally find themselves in tricky situations. We simply wanted know they wouldn't be charged or liable for an act of good intention which wasn't covered under standard departmental guidelines.

I guess its still a grey area law wise, so any discussion is very welcome.

randomblondeboy said:

in australia at least, if you are admitted to hospital for a seizure then you will loose your license for a period of time (3 months i think), and then if you have another seizure within a certain amount of time you will loose it indefinately.

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Just a tiny point
I've been taken to hospital 3 times in the last 7 years for seizures, one of them so violent i dislocated my shoulder
None of them related to drug use,infact the Doctors still can't tell me why they occur.
Anyway losing my license was NEVER mentioned,the closest they came was reccommending i didn't drive for a few days.

Besides whats more important your license or life??