Re: [texasems-L]seizure disorder

[Guest guest]

I wonder if anyone out there can answer a question that has been nagging

my mother-in-law for about 2 years. My 22 year old sister-in-law has a

seizure disorder and has two or three seizures everyday. These are

grand-mal seizures of which the best neurologists in the state can't seem

to stop. She is also on a very special diet which is very exact on food

and liquids. If they are out somewhere in public and she has a seizure,

invariably, someone calls 911 and an ambulance shows up. Upon arrival,

she is generally in a post-ictal state and sometimes unconcious. How

does she stop overzealous medics from forcing treatment and transport to

the hospital under implied consent, when starting an IV and giving extra

fluid makes her situation worse, and the fact that there is nothing that

can be done at the hospital for her disorder. She informs them that she

is her mother, but not her gaurdian, and the problem that she has, but

the medics force the issue and transport against her wishes, (the

mother's wishes).

any insight into this matter would be greatly appreciated.

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[Guest guest]

Sounds like you have a difficult problem.

I would suggest the following; create an advance directive type document in

conjunction with the patient's personal physician to be presented at the

time of incident by the relative. It should include a description of the

patient's condition, what the physician believes should be done for the

patient including a check to make sure the patient has not been injured

during the seizure or if this seizure is significantly different in some

way. Have the document signed by the personal physician and the patient and

have it reviewed by a lawyer. Then have the document reviewed and signed off

by the medical director of the local EMS. Hopefully this will reduce the

number of unnecessary transports. It probably should include a section for

when the patient travels outside of the local service area. Outside EMS

agencies would then be advised to contact their medical control for

direction concerning this nonroutine situation. Good luck to your family.

MBA, EMT-P

Re: seizure disorder

I wonder if anyone out there can answer a question that has been nagging

my mother-in-law for about 2 years. My 22 year old sister-in-law has a

seizure disorder and has two or three seizures everyday. These are

grand-mal seizures of which the best neurologists in the state can't seem

to stop. She is also on a very special diet which is very exact on food

and liquids. If they are out somewhere in public and she has a seizure,

invariably, someone calls 911 and an ambulance shows up. Upon arrival,

she is generally in a post-ictal state and sometimes unconcious. How

does she stop overzealous medics from forcing treatment and transport to

the hospital under implied consent, when starting an IV and giving extra

fluid makes her situation worse, and the fact that there is nothing that

can be done at the hospital for her disorder. She informs them that she

is her mother, but not her gaurdian, and the problem that she has, but

the medics force the issue and transport against her wishes, (the

mother's wishes).

any insight into this matter would be greatly appreciated.

________________________________________________________________

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[Guest guest]

Bruce. Along with the Advanced Directives, your mother-in-law might also

consider a Power of Attorny. Jerry

Re: seizure disorder

>I wonder if anyone out there can answer a question that has been nagging

>my mother-in-law for about 2 years. My 22 year old sister-in-law has a

>seizure disorder and has two or three seizures everyday. These are

>grand-mal seizures of which the best neurologists in the state can't seem

>to stop. She is also on a very special diet which is very exact on food

>and liquids. If they are out somewhere in public and she has a seizure,

>invariably, someone calls 911 and an ambulance shows up. Upon arrival,

>she is generally in a post-ictal state and sometimes unconcious. How

>does she stop overzealous medics from forcing treatment and transport to

>the hospital under implied consent, when starting an IV and giving extra

>fluid makes her situation worse, and the fact that there is nothing that

>can be done at the hospital for her disorder. She informs them that she

>is her mother, but not her gaurdian, and the problem that she has, but

>the medics force the issue and transport against her wishes, (the

>mother's wishes).

> any insight into this matter would be greatly appreciated.

>________________________________________________________________

>YOU'RE PAYING TOO MUCH FOR THE INTERNET!

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>------------------------------------------------------------------------

>

>

>

[Guest guest]

Please understand that the medics are trying to make a bad situation better.

The first thing I'd suggest is a medic-alert bracelet and card that fully

explains her condition and what treatments make it worse.

The IV is being started to create a drug route for anti-convulsants such as

Valium, and to draw lab work for the hospital.

As for " over-zealous " medics, they're required to treat a patient, and when

nobody is around that can properly give or withhold consent for that

patient, they MUST begin performing that care necessary to the patient under

implied consent.

Something else she could do is legally give her mother power-of-attorney for

medical decisions, and have her mother always carry around that

power-of-attorney. But I'd be hesitant to do that for the following reason

(story follows):

Last year, I made a relatively routine call to a 21 year old female, 5

months pregnant, having a seizure. We arrive to find a very, very scared,

post-ictal patient. Family helps us calm her down, this is her first

seizure ever, so we advise transport, and they accept. I never thought

about that call again until last week, when we made a dog bite just down the

street from there. After we were through with first aid, and as the

paramedic was getting the necessary information for an informed refusal of

transport, my seizure pt's mother walked up to me and re-introduced herself.

She gave me the background on the call, and I remembered. She told me that

her daughter went four months without another seizure, and that the ER had

put her on Dilantin. Well, in her ninth month of pregnancy, she started

having frequent seizures. A CT was done and revealed multiple brain

aneurisms. This sort of changed the risk-level of her pregnancy... and to

make a long story short, one day after her 22nd birthday they induced labor,

trying to reduce the need for a cesaerian section. After delivery, the 22

year old mother died due to complications of delivery and the aneurisms and

grandmother now has the baby to raise, and no daughter.

Moral of the story? Seizures don't happen in " normal " patterns. While some

may be controlled through medicines, others have strikingly different

origins. As a field medic, you can never, ever assume that this is just

someone " who needs their levels checked " or " isn't compliant with their

meds. " Every seizure patient must be give protective care, including IV

access, o2, monitor, possibly anti-convulsants (as always, check your

protocols!) and last, but certainly not least, evaluation by a physician.

Mike

Re: seizure disorder

I wonder if anyone out there can answer a question that has been nagging

my mother-in-law for about 2 years. My 22 year old sister-in-law has a

seizure disorder and has two or three seizures everyday. These are

grand-mal seizures of which the best neurologists in the state can't seem

to stop. She is also on a very special diet which is very exact on food

and liquids. If they are out somewhere in public and she has a seizure,

invariably, someone calls 911 and an ambulance shows up. Upon arrival,

she is generally in a post-ictal state and sometimes unconcious. How

does she stop overzealous medics from forcing treatment and transport to

the hospital under implied consent, when starting an IV and giving extra

fluid makes her situation worse, and the fact that there is nothing that

can be done at the hospital for her disorder. She informs them that she

is her mother, but not her gaurdian, and the problem that she has, but

the medics force the issue and transport against her wishes, (the

mother's wishes).

any insight into this matter would be greatly appreciated.

________________________________________________________________

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[Guest guest]

Bruce, I would agree with Jerry. Your mother-in-law needs to be

named the agent in a Medical Power of Attorney, but your

sister-in-law

must be able to sign it to make this designation. Without more

information, you will need to consider whether her designation of her

mother as this agent would be supportable within the legal perameters

of " Informed Consent. " In other words, if your sister in law is

mentally handicapped, this option may not work, and another legal

route needs to be explored.

Just as an aside, the OOH-DNR will not be the sole answer here

either because what you described doesn't fit the arrest criteria.

But a Medical Power of Attorney is the most desirable since it allows

for an agent to legally say no to any and all EMS/medical

intervention. You can get a Medical Power of Attorney document, at no

charge, from hospitals, hospices, long term care facilities, Texas

Hospital Association, and persons involved in clinical case

management

or hospital social work.

Be aware though, that a lawyer will charge BIG BUCK$$$$ to get a

blank copy to your family, so avoid that route. Hope this helps.

Janene Jeffery, RN, MSN, CDE

Associate Degree Nursing Program

Austin Community College

> Bruce. Along with the Advanced Directives, your mother-in-law

might also

> consider a Power of Attorny. Jerry

> Re: seizure disorder

>

>

> >I wonder if anyone out there can answer a question that has been

nagging

> >my mother-in-law for about 2 years. My 22 year old sister-in-law

has a

> >seizure disorder and has two or three seizures everyday. These are

> >grand-mal seizures of which the best neurologists in the state

can't seem

> >to stop. She is also on a very special diet which is very exact

on

food

> >and liquids. If they are out somewhere in public and she has a

seizure,

> >invariably, someone calls 911 and an ambulance shows up. Upon

arrival,

> >she is generally in a post-ictal state and sometimes unconcious.

How

> >does she stop overzealous medics from forcing treatment and

transport to

> >the hospital under implied consent, when starting an IV and giving

extra

> >fluid makes her situation worse, and the fact that there is

nothing

that

> >can be done at the hospital for her disorder. She informs them

that she

> >is her mother, but not her gaurdian, and the problem that she has,

but

> >the medics force the issue and transport against her wishes, (the

> >mother's wishes).

> > any insight into this matter would be greatly

appreciated.

> >________________________________________________________________

> >YOU'RE PAYING TOO MUCH FOR THE INTERNET!

> >Juno now offers FREE Internet Access!

> >Try it today - there's no risk! For your FREE software, visit:

> >http://dl.www.juno.com/get/tagj.

> >

>

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net.

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[Guest guest]

One answer might be to have the daughter wear a bracelet or medic necklace

that states she is not to be treated with fluids and transported under

certain conditions. Treatment may consist of V/S and oxygen until regaining

consciousness, and transport only if the patient doesn't come around after

about 15 minutes. I know it puts the medics in a peculiar situation in terms

of abandonment, but if maybe it is treated like a DNR where paperwork stated

specifically what can and cannot be done, it might help.

Joanna, LP

[Guest guest]

And it has to specify that it is a Power of Attorney for Medical/Health

Care from what my parents' attorney just told them. A general power of

attorney would hold more weight than none, but one that specifies leaves no

questions.

Take care, stay safe, and practice mercy, ya'll!!

Jana

FW,TX

Re: seizure disorder

>

>

> >I wonder if anyone out there can answer a question that has been nagging

> >my mother-in-law for about 2 years. My 22 year old sister-in-law has a

> >seizure disorder and has two or three seizures everyday. These are

> >grand-mal seizures of which the best neurologists in the state can't seem

> >to stop. She is also on a very special diet which is very exact on food

> >and liquids. If they are out somewhere in public and she has a seizure,

> >invariably, someone calls 911 and an ambulance shows up. Upon arrival,

> >she is generally in a post-ictal state and sometimes unconcious. How

> >does she stop overzealous medics from forcing treatment and transport to

> >the hospital under implied consent, when starting an IV and giving extra

> >fluid makes her situation worse, and the fact that there is nothing that

> >can be done at the hospital for her disorder. She informs them that she

> >is her mother, but not her gaurdian, and the problem that she has, but

> >the medics force the issue and transport against her wishes, (the

> >mother's wishes).

> > any insight into this matter would be greatly appreciated.

> >________________________________________________________________

> >YOU'RE PAYING TOO MUCH FOR THE INTERNET!

> >Juno now offers FREE Internet Access!

> >Try it today - there's no risk! For your FREE software, visit:

> >http://dl.www.juno.com/get/tagj.

> >

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> >

> >

>

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[Guest guest]

Bruce:

Two options as I see it. Your sister could award to your mom durable power

of attorney (I think that's the right term) or guardianship, which would

give her the right to consent or desent from your sister receiving medical

care. She'd probably have to carry documentation with her at all times.

Second, she could legally execute an advanced directive, something like a

DNR, that would restrict what could be done for her in the specific kind of

case you are describing. I've never heard of that being done, but it is so

similar to the DNR/living will that has already been considered legal, that

I'm fairly sure it could be. I'd suggest checking with a lawyer. Come to

think of it, a third option would be for your sister to have a conference

with the EMS service in company with her physician (if there is only one EMS

service involved) and establish some ground rules for these events and a way

they can recognize her. THAT I know has been done, because we had a couple

of patients in Arlington back in the '80s for which it was SOP.

Dave

Re: seizure disorder

> I wonder if anyone out there can answer a question that has been nagging

> my mother-in-law for about 2 years. My 22 year old sister-in-law has a

> seizure disorder and has two or three seizures everyday. These are

> grand-mal seizures of which the best neurologists in the state can't seem

> to stop. She is also on a very special diet which is very exact on food

> and liquids. If they are out somewhere in public and she has a seizure,

> invariably, someone calls 911 and an ambulance shows up. Upon arrival,

> she is generally in a post-ictal state and sometimes unconcious. How

> does she stop overzealous medics from forcing treatment and transport to

> the hospital under implied consent, when starting an IV and giving extra

> fluid makes her situation worse, and the fact that there is nothing that

> can be done at the hospital for her disorder. She informs them that she

> is her mother, but not her gaurdian, and the problem that she has, but

> the medics force the issue and transport against her wishes, (the

> mother's wishes).

> any insight into this matter would be greatly appreciated.

> ________________________________________________________________

> YOU'RE PAYING TOO MUCH FOR THE INTERNET!

> Juno now offers FREE Internet Access!

> Try it today - there's no risk! For your FREE software, visit:

> http://dl.www.juno.com/get/tagj.

>

> ------------------------------------------------------------------------

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>

>

>