You arrive on the scene for a slip and fall/minor injury call/something happend and your patient doesnt wanna go to the hospital. The call was generated and a report will need to be written and a refusal secured for him. The catch is hes been drinking.

How much is too much?

Sure, if the guy is falling over, slurring (doing the "yabba dabbas"), wobbling like Bambi on the frozen pond, your choice is pretty clear. This aint the case though.

The patient is alert, oriented x3, isnt the greatest at field sobriety tests though. Is he sober enough legally to sign his name?

Do you except signed refusal-of-service forms from people who have had 1 beer? Or more than one beer? Is a patient capable of signing off AMA while you or your medics know that the patient had been consuming ETOH?

The floor is open....

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When in doubt, we contact our Medical Director. The MD talks with the patient and tries to convince him/her to go to the hospital. When the MD ok's the refusal AMA, the "monkey" comes off your back, but document the hell out of it. Include times the MD was contacted and every "ya she ossifer", "I'm not so think as you drunk I am". Get law enforcement or a responsible third party to witness the refusal. If the patient is alert and oriented to time, place, self, and event, even if they appear to have been consuming an "alcoholic beverage", still have rights. Unless they are placed in "protective custody" by law enforcement, we can't kidnap them.
As oldman stated, have law enforcement involved. They are on scene usually anyway, and if the person is ETOH, your better having them there to secure the scene as well. Having the law enforcement officer there to concur with your report will take the "monkey off your back." Unless the patient doesn't have the ability to communicate properly and is of sound mind, they have the right to request and sign a refusal. Always keep the CYA theory onhand though. (Cover Your Ass!)
Put me down for "implied consent".
That is; were the drinky drunk not in an impaired state, he/she would otherwise consent to treatment.
Yep; definitely put me down for implied consent and someone please hand me the puke tray.
Stumbling drunk is a given. In this case Im asking about the guy who has had more than 1 but less than, say, blotto. 1 beer gets a trip to the ER regardless under complied consent?

I dig the CYA and am all about it. Callin the doc and putting the legal load on him is very wise. Getting the patient to understand that despite his adament, attempted arguements to not go to the hospital is a whole other story. Especially after the doc has said he should go. Therefore having Johnny Law around is a very good idea too.
Oldman said it best...'When in doubt, call medical control." Stay safe!

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