Downed Power Line, a Hypoglycaemic Driver and a Minor Passenger
At 22:40 on a rainy November night (4 °C) you are driving home after a shift when you come upon a sedan that has left a rural two-lane road and struck a utility pole. The pole is leaning over the ditch and a power line lies across the road shoulder, sparking intermittently. The driver, a 71-year-old man, is standing beside the car. He is alert and oriented to person and place but not to time, smells of alcohol, and his own glucose meter reads 3.1 mmol/L. He has a 4 cm scalp laceration that is not bleeding heavily and insists he will walk home, 2 km away. His 16-year-old grandson, the only passenger, has a 6 cm forearm laceration with bleeding controlled by a bystander's scarf; he is frightened and wants his mother. Rain is increasing, your phone shows one bar, ambulance ETA is 25 minutes, police ETA 10 minutes. You carry gloves, a basic first aid kit and an AED.
1. Before touching anyone, how do you manage the downed line and the leaning pole, and what do you tell the occupants? Justify each action.
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Priority: do not become a second casualty. A downed conductor may still be energised, and a leaning pole can fall.
- Stop at least one span away; treat all lines as live and set an exclusion zone of about 10 m (more if the line is high-voltage or arcing).
- Call dispatch, request the utility and police, and state that lines are down at a vehicle scene.
- Keep bystanders back and keep the occupants in the car unless it is on fire. The vehicle is the safest place if they are not touching metal and the ground at the same time.
- If they must exit, tell them to open the door, jump clear without touching the vehicle and the ground simultaneously, land with feet together and shuffle away.
- Put on gloves, park upwind/upstream, and do not approach until the utility confirms isolation. This controls the electrical hazard before patient contact, which is the practical prerequisite for any rescue and the basis of a defensible scene-safety decision.
2. The driver refuses assessment and transport. Analyse whether his refusal is valid and describe your actions.
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Capacity requires four elements: the patient must communicate a choice, understand the information, appreciate the consequences and reason about alternatives. This man fails at least the first two: glucose 3.1 mmol/L plus alcohol produces reversible impairment, and he is disoriented to time.
- If he can swallow and protect his airway, give 15–20 g oral glucose and reassess in 10–15 minutes. Do not give oral fluids if swallowing is unsafe.
- Do not accept a refusal while he is hypoglycaemic; treat first.
- If he recovers capacity and still refuses, explain the diagnosis, risks, alternatives (ambulance, own transport, follow-up) and document his words, a witness and your advice; contact medical control if uncertain.
- If he deteriorates, implied consent applies and you treat.
- Police cannot force treatment without a specific legal authority; your role is to make the refusal informed and documented, not to override a capable adult.
3. The grandson wants treatment but his mother is 30 minutes away. What consent authority applies and how do you document and transfer care?
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Minors and consent.
- Life-threatening conditions: the emergency doctrine allows treatment without parental consent; document the necessity.
- Non-urgent care: obtain consent from the mother by phone if possible. Record her name, the time and what was agreed.
- Many jurisdictions allow a 16-year-old to consent to minor treatment; check local statute, but do not withhold first aid for a controlled laceration while sorting this out.
- Treat the wound, confirm tetanus status, and hand over to the ambulance crew with a written record: mechanism, findings, treatment, consent attempts and the name of the receiving clinician.
- Report the crash through the normal police channel; the grandson's wishes are relevant but not decisive for a non-emergency procedure.