Saturday, November 11, 2006

The Letter v. The Spirit of the Law

Got a rather panicky call on the radio from some out-of-county EMTs the other night. They had been called to a roll-over MVA with two young women who appeared injured, perhaps badly. One was acting "heady"- she appeared lethargic and exhibited repetitive questioning. She had an obvious bonk on the head without a laceration but the potential for a brain injury was high. The other girl complained of abdominal pain and had an initial pulse of 140. She had a chest or solid-organ blunt trauma injury until proven otherwise.

I ended up taking both of these patients as my colleagues were busy. The younger girl, 16, appeared well. She did have a pulse of 140 and a slightly tender abdomen but soon another possible reason for her tachycardia was apparent... She had been out with her "friend" popping pills (xanax and dexedrine) "I don't know... For fun I guess." She also simply volunteered that the driver (my other patient from the crash) had been drinking "a lot". They had been driving without headlights (knocked out when they ran into a tree before the excursion), but thought they could drive "by the moonlight".

She got a complete workup and she was uninjured but for some bumps and bruises. The most concerning thing about her was that she was living with her 23 year old sister who was acting as her "guardian", but the patient herself was unaware that her sister was her guardian. The girl had two parents somewhere, neither of whom cared enough to even show up at the ED. Sad. I called child protective services to have them get her into their system and make sure she was okay. The girl, unfortunately, was about as sharp as a sack of wet mice. Life is hard, it's even harder when you are stupid.

Now the driver of the car is the real story. This girl was Axis 2 all the way. From the moment she arrived to the moment she was discharged from the ED she made everyone involved in her care angry, frustrated, and hoping (against all our training) that she could be injured in some way that would be a wake-up call for her or produce a moment of clarity in her drug addled brain. Nope.

She must have been drinking vodka and must have been a pro because when the medics left her with me she did not smell of alcohol, was not slurring her speech, and had no complaints of pain. I was therefore able to take off her C-collar and take her off the spine board immediately. After meeting her friend though, I knew she had been drinking. I went back into her room and put her collar back on. I asked her again if she had been drinking... "No".

"You are lying to me, I know you have been drinking and popping pills because your friend told me.... This is not a game and I am not the police. I am doing all this to make sure you are not seriously injured." She rolled her eyes.

Fast forward 1 hour. The 23 year old had taken her C Collar off twice AND had gone to the bed of the 16 year old and taken HER collar off. If these patients had an unstable C-spine injury this action could have paralyzed them.

As the 23 year old declared herself as undeserving of a driver's license, respect, free money from the state, freedom from incarceration, free medical care, and everything I can think of (short of redemption from the Supreme Being) I became more and more interested that the authorities become fully informed regarding this "victimless" accident.

By law I was required to make sure that the appropriate authorities knew that a serious car crash had occurred. At the same time Federal law prohibited me from telling the State Trooper that the driver was unrestrained, drunk, and probably high on prescription medicines when she rolled her car into a ditch.

Now, federal law be damned, this driver was a menace. As she was crashing her car my wife was driving home from her work. Luckily there was not a chance meeting between them. When the State Trooper arrived I made sure to tell him the following, "Sir, I can not tell you anything about the driver or her passenger other than that they are apparently unhurt and will not require further care at the hospital... and by the way, the driver will be discharged if and when I can find a sober ride for her." She salted away the victory for me by calling the Trooper a "Pig" and pulling open the wound on her forehead that I had just glued together. Bizzare.

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