A&Ox4 doesn’t mean shit

When dealing with patients with a slightly altered level of consciousness who are either not cooperative or straight-up refusing care, I’m so tired of hearing medics say, “Well, if she’s A&Ox4, we can’t do anything…” or, “We can’t kidnap her…” or, “We can’t force her to go to the hospital…”

“Yeah, but she’s DRUNK OFF HER ASS with her face firmly planted on the toilet seat and glued to it with dried puke, you idiot.”

No one is saying this is always going to be easy, but since we’re getting paid to make responsible decisions… or did you miss that day they explained this?

I also see medics trying to coach patients into answering the 4 questions just so they can abdicate their responsibilities. C’mon – I can get a toddler to answer the 4 questions properly.

If you really want to weasel out of transporting patients that badly, perhaps there is another question you should ask yourself.

Now, A&Ox4* (alert and oriented times 4 – name, time, place, event) doesn’t mean shit if patients are not OBVIOUSLY MENTALLY COMPETENT ENOUGH TO MAKE RELIABLE DECISIONS. Many patients can answer these 4 stupid questions while having an altered level of consciousness. As far as I’m concerned, A&Ox4 is more like being able to appropriately answer something like 25 questions** while demonstrating the ability to carry on a coherent conversation with me during the assessment. And with no reason for me to believe that there are a lot of drugs and/or alcohol involved.

I once equated, in a legal setting, A&Ox4 with being able to sign loan documents. Of course, that was in the middle of the subprime fiasco, which sort of undercut my statement. I guess my timing sucks. I’m not good at a lot of things.

Anyway, this is yet another example of our non-thinking protocol/checklist mentality. I have no problems with standard protocols or checklists, but they are tools, not the be-all and end-all.

*In EMS, it’s A&Ox4. In nursing, it’s usually A&Ox3; they don’t include event. So when a paramedic tells a nurse that a patient is altered because he’s only A&Ox3, hilarity ensues.
**Random number I pulled out of my butt. Could ask fewer questions if patient is a butthole and you don’t really want to talk to him/her. Just don’t stop after the 4th question and make the 5th one something about wanting to go to the hospital. And definitely don’t ask about hospitals before the 4th question.

2 thoughts on “A&Ox4 doesn’t mean shit”

  1. Amen, It just isn’t as simple as AO. The one thing I often ask myself, Does this pt have the ability to make an informed decision about their medical care. If the answer is no…..Get the f@#$ on my gurney. If they want to argue…. Medic XYZ we need police, assuming they aren’t already on scene.

  2. Interesting…. Someone just recently asked me what the heck “A&O x 4” meant? As a Critical Care/ICU Nurse of 18 years, A/O x 3 was what we always used, but somewhere in the deep recessess of this old military medic’s mind, I was sure I had heard of A/O x 4 some where before. Thanks for reminding me! 🙂

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