Posted by: medicblog999 | July 30, 2009

A Moral Dilema. What would you do?

door-with-deadbolt-was-kicked-inWe had an interesting job a little while ago. The discussion that was had on scene between me and my mate and the police officers who arrived to assist us, threw up a bit of a dilemma.

I was working on the ambulance with another paramedic colleague. It was my turn to attend and we were sent to a ‘concern for occupant’. The time was approximately 10pm, the roads were quiet, so it took less than three minutes to get on scene.

We were met by the patients neighbour. He informed us that he “usually, sometimes” sees Marjorie every day, but he hadn’t seen her today and all of the lights in her house were off. We could hear her dog barking away inside the house, but other than that, there was no response from either shouting her name through the letter box, or ringing the doorbell.

Marjorie’s neighbour appeared really quite concerned (and also not just a little bit under the influence of alcohol)

Shortly afterwards, the police arrived on scene and straight away said:

“Do you know who this is? She has loads of mental problems, we get called here loads, and shes an alcoholic”

Personally, I didn’t know who the patient was. I was working outside of my area that night and so wasn’t familiar with all of the regulars.

“Shes probably passed out drunk on the floor in her bedroom again” the officer said.

The police questioned the concerned neighbour and decided that due to his state of intoxication and poor history over timings and frequency that he actually saw Marjorie, that the concerns were not really founded. He contacted his supervising officer and discussed the case with him.

The police officer came over to me and stated that since it was really unclear when she was last seen, and if it was ‘only a day’ anyway, then they were not going to force entry to the house as the greatest likelihood was that she just wasn’t home.

Okay……….

That left me a little concerned though. Just because the patient was an alcoholic with psychiatric problems, doesn’t mean that she was ‘only drunk and asleep on the bedroom floor’. What if she had fallen and fractured her neck of femur and was going to be stuck on the floor until the following day. What if she couldn’t speak or get to the door because she was acutely short of breath or had a CVA?

If anything, her chronic alcoholism and psychiatric problems, leave her at a greater risk of something going really ‘bottoms up’! Or maybe I was just being paranoid and assuming the worst in a situation which may have a number of safe and logical explanations to it.

So the question is this:

Would you happily just leave the decision to the police (after all, its there job to decide if they should force an entry or not) or would you force the issue and try to get them to force entry to the house to check for the patient.

Feel free to leave comments as well as click on the poll.

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Responses

  1. A few minths ago R-1 was called for a 911 hangup with police at 0345. Nobody answered, place was locked up tight. Police decided to not force entry, the house was a nuisance. 0630 hrs we were called back. The police were called to the adress first, found an estranged husband holding his wife at knifepoint and terrorising their children. Just before we arrived, the cops shot the guy dead, right in front of the family.

    Should have forced the door the first time, rear view is aways easier. The guys wife had snuck a 911 call, then hung up. Her husband shut the lights and kept quiet till we left.

  2. Tricky one!
    A couple of years back we were called by a concerned neighbour who hadn’t seen the man across the road for a couple of days. The police decided to force entry and as soon as we entered the property me were met by an overwhelming whiff of ammonia!
    The gentleman had been lying on the bedrom floor for atleast 4 days! His body covered in burns, caused by his own urine. Faeces and vomit surrounding him, he was barely concious.

    Since then I try to temp the police force entry. After making sure a neighbour dosn’t have a key of course.

    I’d always rather be guilty of doing something, than guilty of doing nothing!

  3. Great situation and excellent addition of the live poll. I might try that on some You Make the Calls in the future. this is a no brainer for me, they force entry or I get fire to do it.

  4. If you’re the public safety person and you have reason to suspect that there is an emergency situation inside of a residence, you have an obligation to investigate.

    I’ve had a bunch of those, but the most memorable is this one. My paramedic partner and I were called to a “Lifeline Alarm” (The buttons that people wear around their necks and push to get an ambulance) at a private residence. We arrived with fire and found no lights on in the residence, no cars in the driveway, and all doors and windows locked up tight. There were no signs of life in the house.

    We were about a minute away from clearing the scene on the order of the Fire Capt. and the Police officer on scene when a car pulled up. It was this homeowner’s family, who the lifeline company had also called. They were extremely distraught and advised us that the homeowner never left the house and that she always answered her phone. They had a key and we made entry, with the family in tow crying their eyes out.

    Then we found her. She had taken a wrong turn in the dark and tumbled head-first down the basement stairs. She hit the closed door at the bottom of the stairs so hard that her head had broken through the wooden door. She was semi-conscious and breathing but was obviously banged-up from the fall. We packaged her and treated her for the trauma, including full c-spine precautions.

    Good thing we did because of the 3 cervical vertebrae that she fractured.

    With the circumstances as they were, She was discharged in good condition to rehab and made pretty much a full recovery. However, if the family hadn’t gotten there when they did… or if we had cleared the scene, it would have been a much different situation.

    Force the door.

  5. I would rather force the door to find the patient passed out drunk and have the dept. pay a few hundred bucks to repair the door then to leave the scene only to find out the person had died or suffered serious injury. No brainer

  6. At the end of the day it was only one day that she hadnt been seen in.

    Personnally i think i would have went around witha flash light to all the doors and windows and peeked around. After all, people are entitled to go away once in a while!

    And plus, the niehgbor was slightly drunk and said he “usually sometimes” sees her, that means to me not every day,

    Its still a hard situation!

  7. Other ask the police to conduct further enquires ie who her next of kin, do they have house keys etc. Leave a note asking her to contact the police as soon as she gets it, if she doesnt get back with 6hrs then the door going in

  8. I was the neighbour a while ago, the emergency services (police) were called when the community nurse came around for an appointment with our elderly neighbour an there was no answer: Because we insisted that he was always in at this time the door got smashed to smithereens only for him to come back from visiting freinds having forgotten about the appointment and wondering where his front door was!

    I still think they made the right decision though; it’s better to lose a door than to die alone on the floor in my books.

  9. I’d be tempted to get the big red key and put a window in.

    To force entry = 1/2Cost x Risk(squared)

    where cost is damage to property and risk is mortality

    That’s my equation anyway

    Great topic (again)

  10. I’d have forced entry.

    Here in Canada, we get called multiple times a month to assist EHS and Fire to check on the well being of people. It all comes down to risk assessment, and if there was no issue with the person being checked on, our department will usually pay for a new door/window.

    Again, we’re talking about someone’s wellbeing, and as far as we are concerned, replacing a window/door is no issue.

    Great blog, by the way. I’ve just stumbled across it, and even though I’m not in the medical field, it’s very interesting.


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