combative patient

[TysonB209]

hi first to introduce myself, my name is Tyson and i work in central california for american medical response. i have been employed with AMR for 4 years, 2.5 of them as an EMT and 1.5 as a paramedic. My partner and i were recently called out for a male cutting himself with broken glass. After staging for our local police department, we arrived on scene to find a young man lying on his bedroom floor with no injuries. Per family patient has not been acting himself lately and they wanted him transported for psychiatric evaluation. The patient was "less that cooperative" to say the least. We got the patient into the back of the ambulance and restrained his arms since he was already showing signs of being combative. While on our way to the hospital the patient became extremely combative, biting, spitting, kicking, screaming, etc. etc. etc. How do you deal with the patient? please no lectures on scene safety. if the patient was acting this way on scene law enforcement would have ridden in..

[Lisa O]

This is probably a no brainer question, but, can you request LEO's to follow you to the hospital just 'in case'?

[TysonB209]

This is probably a no brainer question, but, can you request LEO's to follow you to the hospital just 'in case'?

yes and they generally do.. however we have rather short transport times so its almost pointless to stop and have them jump in.. my question is more so "how to neutralize the situation effectively w/o hurting the patient and also keeping myself safe?"

[Lisa O]

yes and they generally do.. however we have rather short transport times so its almost pointless to stop and have them jump in.. my question is more so "how to neutralize the situation effectively w/o hurting the patient and also keeping myself safe?"

I dunno hun, but, I know you will get a lot of great answers. I am still just learning, so I tend to ask questions on other peoples threads ..

[Happiness]

If your pt is restrained and cant get out of them then step back and he will evenutally wear himself out. I would call ahead to the ER and ask for a dr to meet you with Valum or what ever before you take him out of the ambo as a squirmy pt can cause the cot to fall. If I even have a suspesition of a pt being violent (Im usually not in that position as they all know me and I have one nick name of Rocky) the RCMP are in the back with me no questions asked. This is a tough call sometimes but here goes "Always remember Saftey never takes a Holiday"

hope this helps

[fireflymedic]

It does make it tough - regardless of whether it's a medical issues (as I assume since PD did not ride in he was not under psych hold) or psych issues, if the patient is combative, I will utilize one of two options.

1. If you have a sedation protocol for behavioral emergencies, I would suggest implementing it if the patient becomes completely unmanageable and you are in danger or they are in severe danger of hurting themselves. If there isn't one - ask why and see about implementing one. For spitting, a surgical mask or O2 mask (obviously with O2 flowing which isn't going to hurt them anyway) works well.

2. As a general rule, for ANY combative pt - whatever the reason, always good to have extra hands along be it PD, extra crew, etc. Always watch your back. Short distance isn't an excuse to not have the hands there if you think they'll need them and always anticipate !

I learned the hard way recently about trusting a patient that could potentially be combative. Always look out for you and your partner's back 'cause many times nobody will do it for you. Sorry you got put in that position - Stay safe out there !

[mobey]

You say your a medic.... Why not chemically restrain him?

A second choice is to stop the ambulance and have police take over restraint. Did he really even need an ambulance? Why not pull over and have the police continue transport?

Just a thought, if he was of sound mind, didn't he have the right to refuse care?

[HERBIE1]

yes and they generally do.. however we have rather short transport times so its almost pointless to stop and have them jump in.. my question is more so "how to neutralize the situation effectively w/o hurting the patient and also keeping myself safe?"

If you or your partner are in imminent danger, get out of the rig and call for police. Let them trash the rig.

If you have a minute or 2 transport left and you are not in immediate danger, if you have the capabilities, call dispatch/telemetry/or the ER directly and let them know what you have so they can prepare.

[TysonB209]

Thank you for the replies!!!! unfortunately we have no protocols for medicinal restraints or "sedation." numerous other paramedics have called out base facility and asked for it and it was denied. looking back i should have taken a rider.. however he didnt seem like he was going to give me as many issues as he did while we were on scene. i guess i just didnt expect things to head south so quickly.. the obvious answer to this question seems to be "kick his ass!!" HOWEVER! i enjoy working as a paramedic and want to continue to do so. we did try the NRBM, but he was thrashing around so much it stayed on his face for all of 3 seconds..

[HERBIE1]

Thank you for the replies!!!! unfortunately we have no protocols for medicinal restraints or "sedation." numerous other paramedics have called out base facility and asked for it and it was denied. looking back i should have taken a rider.. however he didnt seem like he was going to give me as many issues as he did while we were on scene. i guess i just didnt expect things to head south so quickly.. the obvious answer to this question seems to be "kick his ass!!" HOWEVER! i enjoy working as a paramedic and want to continue to do so. we did try the NRBM, but he was thrashing around so much it stayed on his face for all of 3 seconds..

I don't know what type of relationship you have with local PD, but use them judiciously. Obviously if you have cause to believe a patient is a threat, and express those reasons to an officer, they should be more than happy to help, BUT...

I know a guy who has an adversarial relationship with police- he will claim he is always in danger. If a person says a cross word to him he calls for police back up. He is well known to them, has been around a long time, and is respected by NOBODY in EMS, hospitals, or police. Sad part is he is also an RN on his off days and from what I have been told(and seen) he's a lousy RN too.

Point is, be safe, protect yourself and your partner, but don't be the boy who cried wolf.