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Clinical sites are all extremely different on what they allow students to do. If you found a place that is proactive with teaching students, and likes having you there, take full advantage of all the clinicals you can do there! Unfortunately some sites don't like having students (more so hospitals having EMS students) and it makes it much more difficult to have a good clinical experience.

Back in the day.. ha ha.. when I first began, which was a mere 14yrs ago.. we covered a truly massive area. Went to the edge of our 1st due, more than 30 miles out and picked up a chest pain patient. An ALS Squad unit assisted, did an EKG didn't find anything...and released care. Sent us on our way to the ER, which by patient choice, was over 45min away. Pain came in waves, so I called a different paramedic unit to intercept. Just because. I went head to toe, b/c that's what I was taught. Felt something strange, it was like a balloon rapidly inflating and deflating, a balloon within a balloon. The vitals, as I recall, were relatively normal. Then the patient had a sudden onset of pressure in the abdomen, with pale skin, diaphoresis and hypotension. Medic got on, did the EKG, said, probably an MI, stop at the nearest ER. I suggested it was something more, which he sort of ignored b/c I was fresh out of the box. Described it. He felt. Met a chopper along the road. Patient survived his ruptured AAA. I've had several AAA patients, and I always thought - should I palpate or shouldn't I? Will it cause it to rupture? Usually, they were already ruptured.

Well considering I am trained in crisis mitigation I would talk the suspect down. This type of situation doesn't really scare me. I doubt he has intention to harm me or my partner. He does have other underlying that he wants addressed and he feels this is the only way to get them addressed. As long as no one plays hero you and your partner will be going home. Make slow, methodical movements. Explain what you are doing or going to do. Talk to him professionally and non-judgmentally and more than likely you will have a positive outcome. Take your time, its going to take a few hours so be patient. When its over, bitch slap your partner for being the "studly medic" and tell him next time he does such a moronic move you will put your foot so far up his ass that he will be spitting leather for a week.

I think it is important to note that there is a difference between combative (drugs/ETOH) and suicidal/mental illness. They should be treated as two different issues. Drug and disorderly is much different than suicidal and hopeless.

I'm going to step on a soap box for a minute here. Dealing with these sort of situations is where EMS (and medicine honestly) falls short. We are not taught how to deescalate at situation unless you seek out such a course (although I think they are becoming more popular). I can't tell you how many times I have seen crews bring in agitated/drunk/high/violent pts and they just continue to poke the bear. They feel they have to be superior and one up the pt. This does nothing to help the situation and most time makes it worse (I am guilty of it too). I had an eye opening experince once that totally changed my methods. PD brings in a combative guy who is just a general asshole which isn't help by the alcohol in his system. He's kicking, screaming and spitting. EMS is yelling at him, the nurses are doing the same and I start to also. PD makes there way into the room and we step out. The officer looks at the guy and says to him, "Hey, these people are here to help. They don't want to hurt you and don't want to get hurt. Your problem isn't with them so cut them some slack and cooperate. OK?" The pt stops yelling and fighting and says, "OK." We all go back in the room with some apprehension but the pt is as calm and cooperative as could be and there is no more trouble. He even says sorry and thanks on the way out. Ever since that day I have tried the same type of approach and 9 times out of 10 it helps. Poking the bear and fighting with the pt over who has the bigger figurative penis will only get people hurt. I think this needs to be taught more.

Open body gestures can be helpful. If they are shouting the best technique I have found is to really whisper. It throws them off and has been very helpful in calming a shouting patient down. Lower your voice and almost switch to a monotone, slow cadence. If they are creepy and calm, then I find making them think is helpful. Get them thinking about what happens if they don't succeed in killing themselves. Unless you have had specific training in disarming someone with a firearm or knife, then your chances are very slim you will do this successfully. I would have tried to chuck the jump bag/o2 cylinder at the guy and bolt for the door while he's recovering, or throw a chair at him to knock him off and get out of there. This situation is likely not going to end well for anyone involved.