PDA

View Full Version : Question about emergency room procedures



Tornadoboy
12-22-2006, 08:12 AM
As I've got things figured right now for my WIP my male protag rescues my female protag from an attempted suicide by drowning, putting his own life in danger while doing so, and since they are both total strangers I was wondering what kind of info if any the hospital would be willing to share with him about her?
For the timeframe he will be in the hospital she won't be in any kind of shape for the staff to ask for her consent, so without it would they be willing to give him any basic info such as her name and condition? I don't think he'll press the issue TOO hard but all considering he's going to be just as curious and concerned as most people would.
Also I think later this will all catch up with him again because another character will find out his name from the police report, which if I'm correct is a public record anyone can access, so is that also plausible?

greglondon
12-22-2006, 08:26 AM
I'd think they'd be pretty tight-lipped. He won't be coming in with her when she's brought into the hospital, so he's just some random guy off the street as far as they're concerned.

"Yeah, I'm the guy who rescued her. I was wondering if you could tell me her name? Where she lives? Date of birth? Social Security Number?"

KCH
12-22-2006, 03:20 PM
Would the hospital even know her name? Was she ablle to communicate that to them? Unless she carried a purse during the suicide attempt, they'd have no ID for her.

The laws are pretty stringent about who can be told what. So technically, your protag should be out of luck. But if you'd like him to be able to know who she is, it wouldn't be hard. Hospitals are bureacracies, and bureacracies always have enormous chinks in the armor--especially when so many of the people with direct patient contact are not themselves bureaucrats. They're good-hearted people for whom skepticism/cynicism is not the default mode. Easily exploited.

Actually, you don't even need inside help unless your hospital is huge. Ever visited someone in the hospital? Floor nurses have no idea if you actually know the person into whose room you're entering. Act like you know what you're doing and you can wander the floors with impunity. Most of the hospitals have the patient's name on the door. If not, most of the doors are left open and you can easily window shop. Once in the room, you'll see the patient's name on a dry erase board. Exceptions, of course, but for your purposes, you can make the setup whatever you'd like.

Tornadoboy
12-22-2006, 05:12 PM
To the ER staff It'll be readily apparent that he is the one that rescued her because he is brought in from the same scene suffering from hypothermia, he had to fish her out of an ice cold river after seeing her jump off a bridge. She had to be resuscitated by him and is extremely drunk so she may be coherient enough to give out her name but not much else, so given the context I doubt the staff would even try to ask her consent or take stock in it if she did, I just don't want her to simply give him the brush off since he just saved her life.
At this point for the sake of the story I don't want him really getting involved with her, he's of a mindset that he already has enough problems of his own without dealing with her's so he won't press the issue too hard, but he's a decent albeit troubled person so he would want to know if she is going to be ok. He leaves there thinking that will be the end of it but their paths soon cross again when someone tracks him down by getting his name from the police report, I'm assuming there would be one since they would have been called along with the fire department and ambulance, and I figure one would take his statement at the hospital once he's in good enough shape to give it.
My male protag can be a bit of a charmer when he wants to be so I'll probably have him finesse her first name, general condition and what is usually done with attempted suicides out of a nurse, but that's about it.

Steve W
12-22-2006, 11:41 PM
Hi,

In England he wouldn't get any info unless he could prove he had some form of relationship with the woman - partner, relative, etc. I don't imagine it's so different in the US. Why not just pop into your local ER and ask? As long as you don't take up too much of their time, I doubt they'll mind - they might even think it's fun helping out a writer.

Cheers,
Steve

WackAMole
12-22-2006, 11:48 PM
The new HIPPA laws in the US make it very difficult for anyone, even FAMILY members, to get info about a patient if the patient is over the age of 18.

We once had a guy try to commit suicide by taking an overdose of pills. His mother came to the hospital and the hospital would not release his condition to her. Not only that, but they hesitated to even tell her he was there. She was outside crying, fearing that he would die without her having a chance to see him or say goodbye. All this, because he was over the age of 18.

HIPPA laws are very strict and result in huge fines if hospitals break the rules. Even if he did come into the ER in an ambulance at the same time as the victim, the victims status would not be released to him at all without the patients consent. he would have to rely solely on a sympathetic nurse or ambulance driver who might share the info with him in the strictest of confidence. Even then, it is still a rule breaker and the workers could lose their jobs.

HIPPA was the worst thing that ever happened to medicine. It took a problem and gave it the most extreme solution thus rendering it as bad or worse than the original problem, which of course is, patient confidentiality.

KCH
12-23-2006, 04:19 AM
Yes, Hipaa laws are very stringent, and in theory, they're good. Like all bureaucratic good-intentions, they're riddled with unintended conseqences that screw up as often as they serve the original intent.

But for purposes of the novel, it's been my experience--and I've had a lot in the past two years with parents and in-laws in at least 4 separate hospitals in 3 cities for extended periods--that supposedly off-limits info is readily shared more often than you'd imagine. While I was in the hospital, I'd always chat with patients doing their laps with their I.V. poles. Some seemed all alone, and I'd ask the nurses about them. You'd be surprised how much info I got that technically, I shouldn't have. Sometimes I'd even call the nurses station and ask how someone was doing. I had a .50 batting average with that one.

So yes, Tornado, I think you can safely have your hero finesse the situation. I think a simple "Is she going to be OK?" would get the response you need. No details though.

I missed the part that they were still in the emergency room. You can maybe use that to your advantage. He could overhear medical personnel talking--either among themselves or to the woman. Since she's kind of out of it, they'll have their voices raised anyway to get her attention and keep her focused, i.e. "Miss Peterson? Miss Peterson. Can you tell us what happened? MISS PETERSON. Come on, Angie, stay with us here, hon..."

And don't forget the "hon". They always call you "hon." Or sweetie.

Cat Scratch
12-23-2006, 04:24 AM
I've been to the emergency room on 4 separate occasions in the past year (unfortunately). In the hospitals I've been to, treatment takes place in open rooms with nothing but curtains separating patients, unless there is need for surgery, etc. I would imagine that your characters would be set up near enough to one another that your protagonist would be able to tell, reasonably, what is going on with her.

Additionally, I see it as reasonable that the nurses in question would assume the two people are together, and may volunteer information based on that alone. If they think it's his girlfriend, etc, and if he seems concerned they may say things like "She's doing better, don't worry" or things like that. He may not bother to correct them, or may not be in a physical state to do so. If they locate her name because of ID or something similar, he could hear them referring to her by name and learn that way.

Not all hospitals are single-room private facilities. Last time I was in the hospital I was chatting away with a kid with a broken arm and a solider with kidney stones, both on beds nearby.

uina
12-23-2006, 08:36 AM
I have been to the emergency countless times in my life (4 times in a year. i feel ur pain.)

But i have no say on the subject. :)

greatfish
12-24-2006, 01:21 PM
Not only do I think they would give him the information, but I'm almost certain they would be asking him questions about what happened. They won't know it was an attempted suicide, so they'll probably want to know how the two of them ended up in the water.

tenpenynail
12-24-2006, 08:40 PM
I've worked in ER's and its hectic, open, and assumptions are made.

But even BEFORE that---is there a paramedic team that works on her? An ambulance that picks them up? Because girl could have a suicide note around her neck [permanent ink, of course]. "Tell my parents I'm sorry. Emily" Then he'd know her 1st name and could act like he knew her to hospital personal.

Or the paramedics could find her driver's license in her jean pocket and say aloud, "Emily Perkins. 22 years old. Donating her organs." [Well, let's hope she doesn't have to do the last.] Then Hero would know her name and could trade on it.

Also, as the very wet engaging Hero, he'd be a soft-spot for admitting personal. I actually heard one clerk say to a boyfriend "I'm sorry because of HIPPA laws, I'm not allowed to tell you that your girlfriend is responding to treatment and being transfered to 322 within the hour." Then she smiled and winked.

Tornadoboy
12-25-2006, 06:49 AM
I've worked in ER's and its hectic, open, and assumptions are made.

But even BEFORE that---is there a paramedic team that works on her? An ambulance that picks them up? Because girl could have a suicide note around her neck [permanent ink, of course]. "Tell my parents I'm sorry. Emily" Then he'd know her 1st name and could act like he knew her to hospital personal.

Well here's the timeline from the standpoint of the rescue personnel:

911 gets a call from a store clerk that someone has just told him that another person had jumped off a nearby bridge, it's late and he doesn't trust the situation enough to leave the store, so he can't give them any further info as the scene is not visible from his vantage point. I'm assuming that what would be deployed is one or two police cars, the fire department and one ambulance, with the police probably being the first ones the scene.
What they find when they get there is an extremely hypothermic (and very drunk) female whom is at best semi-conscious and a male whom is quite confused and hypothermic himself, both slumped together against the chainlink fence bordering a parking lot.
When they arrive at the emergency room they are taken to separate stalls to be worked on. He get's placed under one of those forced-warm air "Bear Hugger" warming blankets and has his core temp watched closely while she, being in more serious condition, is given oxygen, warmed intravenious fluids and placed under a warmer as well.
Eventually when they are stabilized they are taken to rooms, he is released by noon the next day after giving a statement to police. She on the other hand is kept for a 72 hour evaluation, eventually being released after making a commitment to see a local psychiatrist and being deemed not to be an immediate threat to herself, although I doubt I'll cover any of this in the story.
I'm not sure about her having any actual ID, I would like to show the reader that she is not in such terrible shape that when she tries to return to work a little over week later (she's a work-aholic type) that it isn't credible, and having her talk at least a little to the hospital staff by giving her name might be a good way to show that. She doesn't leave a note as it was a very spur of the moment, alcoholic lubricated-kind of act, and in any case with her being very introverted leaving a note wouldn't be her style.
He never makes any bones about the fact that he doesn't know her and is not desperate enough to find out as to lie or try to manipulate anyone, he's just completely stunned by the whole situation. But still he might probe a little while he's there and maybe charm some basic info out of people, he 's got some personal history that makes this situation rather ironic and naturally he's curious to know what she's all about.
When all is said and done all he walks away with is her first name, that fact that she was very drunk, that she will physically be ok and is going to be kept for a while to make sure she is not a danger to herself.

All this brings up a couple of other good questions, like would they try to take them both in one ambulance or would they take the time with the male to call another for him? He blacks out about the time they arrive so while he never needs CPR they certainly wouldn't want to waste time getting him to the hospital either.
Also when it comes to soaking wet, dangerously hypothermic people is it standard practice for paramedics to just cut off their clothes or would they try to work them off intact? And if they do have to destroy their clothes, what would they give such individuals to wear upon their release assuming they had nobody to bring them new clothes? That wouldn't be an issue for my female protag but it would be for him since he doesn't know anyone in that area.
I don't plan to give a blow-by-blow description of what happens to them on the way to the hospital or their treatment, in fact I don't think either he or the reader will hear from the female again until this episode is at least a week or two old, but still I want to know the details just in case I need to work some of them in.

Oh and by the way, MERRY CHRISTMAS!!

tenpenynail
12-26-2006, 07:24 AM
Well, timing is everything in the ER world. The 'golden hour' is reverently honored.

If she was out drinking wouldn't she have her ID? I mean, they won't serve even a 40 year old unless they see prove...oh, but maybe she had a purse, huh? As for me, I'd stick my bills and driver's license in my jean pocket.

"...would they try to take them both in one ambulance or would they take the time with the male to call another for him?"

They'd use the same ambulance, unless there was two there waiting. Time is of the essence. Golden hour. Hero might over hear her name in there or think he hears it.

Also, I'm pretty sure paramedics and ER room would 'assume' they knew each other or were together.

"Also when it comes to soaking wet, dangerously hypothermic people is it standard practice for paramedics to just cut off their clothes or would they try to work them off intact?"
ER and paramedics always cut the clothes off in emergency situations. Always. It's the most efficient way.

"what would they give such individuals to wear upon their release assuming they had nobody to bring them new clothes?"
I've seen ER patients walk out in scrub-shirts and bottoms. Not new ones from the laundry, but older ones, abandoned and hanging about in the doctor's lounge. Nurses usually know where to get them.

Hope that helps!!! Keep us posted on how it is coming along.
Blessings

;)

Tornadoboy
12-27-2006, 08:28 AM
If she was out drinking wouldn't she have her ID? I mean, they won't serve even a 40 year old unless they see prove...oh, but maybe she had a purse, huh? As for me, I'd stick my bills and driver's license in my jean pocket.

Actually she wouldn't need one because she had been drinking at home alone, she keeps her own private stash of booze and doesn't like to go to bars. The bridge is nearby, she had been entertaining fantasies of killing herself from it for quite some time but given what had happened to her that day it was enough to push her over the edge.
I haven't made up my mind on the whole issue of her ID yet, I may just have her leave a purse on the bridge for the cops to find but realistically I don't know if she would have bothered to bring it, but either way I can work the story around it so it's not critical


ER and paramedics always cut the clothes off in emergency situations. Always. It's the most efficient way.

That's what I figured because why worry about something as trivial as clothes when someone's life is in danger? But still I wanted to check with the experts, I guess I'll send my male protag home in scrubs, his original jacket and sneakers, which would no doubt be embarassing as hell but hey life is tough!
Actually the way he is he'd probably turn it into a big joke with the cabbie that drives him home, but I don't think that'll make it into the story! :D

Thanks for your help!

Dixie
01-01-2007, 05:07 AM
They dont always cut clothes unless they deem it necessary.

If it was a Code 3 yeah theyd cut her naked :D

I dont think you're so much as to looking into ER procedures but more pre-hospital care AKA ambulance chuffuer to the ER with a $$600 price tag. Oh yeah they itemize vitals - they even charge for O2 as well.

Now heres what Ive got based on my patient-

a 40-ish female - ETOH - unconscious - her resps are < 12, pulse < 60, BP < 100 - yeah this is an oh shit case. You aim for the golden hour and pray hard for a platinum 10.

As for your knight in shining armor - unless he is listed as a contact in her contact info they aint sharing nuffin'. HIPAA Act of 1996 says docs/nurses/Medics/EMTs/FRs/LEOs cant share any medical info - even if there is a family member present unless on the pt records there is an emergency contact. Its Law.

Also if it is a suicide attempt they usually admit the person directly to a state hospital for a in-patient counseling and therapy boot session.

If she's LOC - and cant consent - they'll do whatever for the circumstances unless she has a DNR.

IF you have any questions concerns about what happens on the ambulance or in the ER - PM me I can give you some details. Im a former EMT.