ABSTRACT
A case vignette of out-of-hospital refusal of emergency care is reported with accompanying discussion. This case illustrates the challenges faced by out-of-hospital emergency care personnel in these scenarios and provides guidance to the emergency physician and emergency medical technician. Recommendations are provided for preparing the emergency medical services system to handle these cases.
Subject(s)
Decision Making , Emergency Medical Services/standards , Ethics, Medical , Treatment Refusal , Aged , Aged, 80 and over , Critical Care , Emergency Medical Services/legislation & jurisprudence , Female , Humans , Hypotension/complications , Hypotension/psychology , Informed Consent , Mental Competency/legislation & jurisprudence , Transportation of Patients/legislation & jurisprudence , Treatment Refusal/psychology , United StatesABSTRACT
TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin) in the edible portion of fish and shellfish from various U.S. waterways has been monitored since 1979. Analytical results for the period 1979-1994 are reported. Extracts obtained after column chromatographic and liquid chromatographic cleanup were examined by electron capture detection-gas chromatography (GC), and final quantitation and confirmation were performed by GC/mass spectrometry with multiple ion detection. Analyses of 1623 test samples indicated that TCDD residues in fish and shellfish were not widespread but rather were localized in areas near waste sites, chlorophenol manufacturers, and pulp and paper mills. Analytical results indicated that levels in aquatic species from these sites have been declining steadily. No TCDD (limit of detection and confirmation, 1-2 ppt) has been found in recent years in aquatic species from most Atlantic, Pacific, and Gulf of Mexico sites and Great Lakes other than Lake Ontario and Saginaw Bay (Lake Huron).
Subject(s)
Drug Residues/analysis , Fishes/metabolism , Food Contamination/analysis , Polychlorinated Dibenzodioxins/analysis , Shellfish/analysis , Animals , Chromatography, Gas , Chromatography, Liquid , Food Analysis/standards , Fresh Water , Gas Chromatography-Mass Spectrometry , Polychlorinated Dibenzodioxins/metabolism , Reference Standards , Seawater , United StatesABSTRACT
This article presents an overview of several major legal issues in contemporary prehospital health care delivery and emergency medical services. It includes review and analysis of medical-legal issues in medical control; patient consent and treatment; modern emergency medical services communications; discussion of medical-legal concerns in regard to patient destination choice, diversion, and transfer; and an analysis of theories of recovery including a review of selected case histories.
