EMS Patient Care Report - 11/18/95
|Date:||November 18, 1995|
PINELLAS C0UNTY EMS PATIENT CARE REPORT
Call Received: 1755
Patient: 01 of 01
Pat Depart: 1830
En Route: 1755
Unit Depart: 1830
Arrive Loc: 1755
Arrive Dest: 1838
Pat Contact: 1756
Nature of Call: Behavioral
Call Status: _X_ To Scene _X_ From Scene
Call Level: ALS
Type of Transport: Ground
Incident Location: 515 Belleview Bl
Last Name: McPherson
First Name: Lisa
Street Address: 2324 Jonesboro Av
Date of Birth: 2/10/59
Pupils: _X_ WNL _X_ WNL
Glasgow Coma Scale:
Resp Rate: 18
BP Systolic: 160
BP Diastolic: 102
PINELLAS COUNTY EMS SUPPLEMENTAL SHEET
Patient Name, Last, First: McPherson, Lisa
Skin w/n, * PMS y4, ABP S & NT, Pt stated she's having a difficult time & / t doing bad things in her mind & doing wrong things that she didn't know were wrong. One example "I took my eyes off the object" VP, 10, 20, EKG, GSC trans ALS -> MPH s incident pt states she needs to rest.
REFUSAL OF CARE ALGORITHM
[This is the back of the EMS Patient Care Report. It includes an ECG Strip marked:]
18:13 18 NOV 95 LEAD II XI 0_HR=127
RELEASE OF MEDICAL ASSISTANCE
A Release of Medical Assistance form, signed by Lisa McPherson.
I (or my guardian) have been informed of the reason I should go to a hospital for further emergency care.
I (or my guardian) have been informed of the evaluation and/or treatment that will/may occur when I get to the hospital.
I (or my guardian) have been informed of the potential consequences and/or complications that may result in my (or my guardian's) refusal to go to a hospital for further emergency care.
As a competent adult, I (or my guardian) fully understand all of the above, and am/is capable of determining a rational decision on my behalf.
I (or my guardian), the undersigned, have been advised that emergency medical care on my/the patient's behalf is necessary, and that refusal of recommended care and transport to a hospital facility may result in death, or imperil my/the patient's health by increasing the opportunity for consequences or complications. Nevertheless, and understanding all of the above, I (or my guardian), refuse to accept emergency medical care or transport to a hospital facility, assume all risks and consequences resulting from my (or my guardian's) decision, and release Pinellas County EMS from any and all liability resulting from my (or my guardian's) refusal. I have had the opportunity to ask all of the questions I feel necessary to provide this informed refusal.
Lisa only signed her name, checked the Patient box (rather than Guardian), and wrote her phone number, 559-9886. She did not fill in an address.
There are notes written on the reverse side that have bled through; they are very hard to read, but appear to include the comments: "PT states she needs to talk ... people think she was crazy. Pt has agitated state ... Pt states she is Scientologist. ... Cont to ask me ... "
This is probably the Refusal form mentioned in the police interview with paramedic Bonnie Portolano<.
continuation of the PINELLAS C0UNTY EMS PATIENT CARE REPORT
There are no items marked in the following sections of the form:
- Airway Interventions
- Breathing Interventions
- Circulation Interventions
- Secondary Interventions
There are no items checked under (medical) History.
Current Meds: None
Allerlgies: None Known
Chief Complaint: "I need help, I need to talk to someone"
Narrative: 36 y/o WF involved in minor MVA. No injuries pt signed refusal. As we were leaving pt came walking down the road naked. We guided pt in unit. Pt stated she needs to talk, that she didn't need a body to live, stated she's an O.T., stated she took her clothes off to make people think she was crazy. Pt has a fixed stare, speak in a programmed & formal manner. Pt stated she is a scientologist, is clear, +=, EKG ST, pupils WNC, O JVD, pt switches topics as she speaks unable to stay focused on one topic. Cont to ask me to repeat the question. R/O behavioral disorder
Lead Crew Signature: Bonita Portolano
Destination Address: MPH (Morton Plant Hospital)
Hospital Selection: Nearest Facility
Response Code: ALS
Moved to Ambulance: Stretcher
Transport Position: Head Elevated
Oxygen Supplied: N
Patient: 901 Oceola #205 Clwr FL 34616
Patient Phone: 559-9886
Patient SS #: 461-94-2009
Guarantor Name, Last, First: McPherson, Lisa
Guarantor Address: SAA
Worker's Comp: N
Employer Company Name: AMC Publishing<
Employer Phone #: 446-1100
Employer Company Address: XXXX Lakeview 34616