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TABBOMA Doc Couldn't resist :-}

We must paint the ER staff a very clear picture of the how, why and why not of mechanism of the injuries sustained. We also have to clearly explain that we followed the spinal protocol to rule out the need to collar and board this pt and show that the Pt did NOT need to be immobilized by our protocols. Many hospital staff have no clue that there is plenty of evidence based medicine studies to show that when done properly following the NEXUS protocol EMS can safely rule out the need to immobilize a pt that passes the clearance protocol.

When I first started as a wayward student I learned from some really good ones and some really bad ones. One bad one that stands out in my mind was a preceptor that restrained a patient, was so viciously nasty to the guy that the patient broke the kerlex restraints and began to whoop the medics ass. This was after the medic had hit him with a mag light three times causing a couple of small lacerations. This patient, after the ambulance was stopped, opened the back doors and ran off into the darkness. The medic then closed up the doors, put us out of service and we drove to headquarters where he just up and said F it and he quit. I learned that everyone has their breaking point and this psych patient was my preceptors breaking point. It was really a eye opening time for me when I was able to see someone get to rock bottom and snap. He did eventually get the help he needed and he's working in another state doing I don't know what. On the flip side, I have watched another group of medics/care givers talk jumpers off ledges and patients who we did not at the time know had guns, put them down. The compassion that those providers is how I have built my ems career. Long story but short point. I have transported maybe a handful of psyche or suicidal patients restrained. I have initiated most of all the restraints. In my earlier newbie days, I used restraints not out of an abundance of caution but as a new guy with the EMTP patch, and with the protocols to back me. After a few months of experience in the field, I realized that many times, albeit most if not all the time, a soothing voice and calm demeanor would most always do more for a suicidal patient or psyche patient than brute force ever does. You learn that after a time, you really do because most psyche patients, that are really ramped up, are definately stronger than you and your partner if you are alone or if you are with one or two police officers. Yes, I worked in an area where we often had NO backup for that crucial time where we had to decide with patient contact time whether to restrain or talk. (one deputy for 800 square miles). After a year or so on the job, i became astutely aware of who would be one to have to get restrained and I got pretty good at it. Of course there were the ones who blind side you but those were few and far between. Like I said, a calm voice and no fast moves or moves that could be considered threatening to the patient often would do wonders. If restraints were needed, telling the patient what was going to happen would often defuse the situation as well. You learn after a while unless you enjoy restraining patients, that the act of NOT having to restrain is an ART and it's much more preferable to the act of restraining. Less paper work, less monitoring and often times, less time with the police having to write incident reports when you have an injury. Why do I write this? Because with practice and continuing education, there are ways to defuse situations that may end up as restraint situations down into situations where you and the psych patient get along fine and you can transport them to the ER without incident. Self defense courses only go so far, verbal and mental defense courses are also important. knowing the signs of impending violence is very very important. Knowing when to walk away and wait for assistance is tantamount to keeping your ass safe and realizing that if the patient does something to themselves in that period of time between you waiting on backup and you getting that assistance is not your fault, and getting to go home to your family IS your responsibility and to me that's worth it. If you can find the book "When violence erupts" Is a great book to get. You can purchase it from Barnes and noble http://www.barnesandnoble.com/w/when-violence-erupts-dennis-r-krebs/1101795118?ean=9780801661952 it ranges in price from 1.99 to nearly 200bucks. Don't be stupid and pay 200 bucks for it. It's a used book as it's not in print anymore, it's version 1 and published in 2002 but the info in the book is priceless. It's not an EBOOK though. Buy it and read it, then share it with your colleagues. Ruff.

I'm not sure if this will help at the level that you're talking, but I was convinced by someone once that the best way to learn and retain more complex information is by reducing it. In medic school I would read a paragraph, highlight then only the sentences in the paragraph that completed the thought it meant to convey, and then reduce those to the fewest possible words for flashcards. I ended up doing that through the rest of my college classes (the more complex the material, the better it seems to work for me) and now do it for everything. What seems to happen is that to force a word out of my mental process I have to really understand it first. And I try really hard to eliminate every possible word. Anyway, for what it's worth, it might be worth a try for a few paragraphs. But for it to work you have to be committed to eliminating every, single, possible word... I'd be interested in your thoughts..as I can always use a new way to study...