Versed fail, I need a trainquIlizer gun

[island emt]

Not faulting you at all for your actions.

But it is not our job to have to wrestle with a combative patient. Have the LEO's bring the pt to you , or restrain him enough to get him well secured to a backboard with extra straps and when under control, then we do our magic.

If the LEO's need to use the TASER to do their job, so be it.

And yes in my younger days I've wrestled a few violent patients into submission. But then I got smarter with age and learned to let the LEO's do their job.

[mobey]

I am not a fan of armchair quarterbacking, so I will just say this.

With 3 small kids at home, personal safety has become a HUGE focus of mine these past few years.

You won't find me without a seatbelt on in the back of the rig very often, everything is always secured down... and even on the sweet old lady long distance transfers - gloves are a must.

These days, some combative person whether drunk, hypoglycemic, or psycosis, is not getting any physical restraint from me. Our local cops love to help out in these situations, and heck... they are trained for it.

Someone else tackle him, and I will administer IM Versed, Haldol, Glucagon, whatever.

BTW: OP, you mention up to 30min for IM Versed to take effect. Do you have much experience with that? I have used 10mg Versed IM a few times with much quicker response times.

[stcommodore]

Dose were allowed is 0.05 mg/kg every 5min to max of 0.1 mg/kg. So we might max at 10mg on a 100kg patient right? On some cases police or fire help and are on scene but I also have to transport and give the hospital these patients. So if fighting in the back and a maniac at the ED can be avoided I'd try to do so.

[HERBIE1]

Just for my curiosity...why fight tasing him? I've seen a few combative patients tased and it seems like a real attitude changer to me. Though I've only seen a few I understand that tasing rarely results in any detriment to the patient???

Tasers usually work well, but not always. I saw a guy get tased 3 times and he was STILL fighting well enough to injure 2 cops.

Stunning them momentarily usually allows just enough time to at least cuff ,hog tie the perp, and gain control of him/her before they fully come to their senses.

[fakingpatience]

Our protocols don't allow for sedation of combative patients. If it is a head injury we can restrain them and once I called medical control for sedation options and was approved to give Valium. My question is why are you sedating a 200lb drunk? Where I work if the drunk is able to put up a good fight then they are stable enought to go to the ER in a patrol car. Ive also had OD's that have been extremely combative but in that case the Sheriff deputy accompanies us to the ER and the restraining is done with handcuffs. Maybe its just a difference of where we work but I dont plan on fighting a drunk to sedate him. Im not saying its wrong just asking why endanger yourself or your partner?

In my system, we transport pretty much all psychiatric, and a good number of drunk patients to the ER, and PD follows behind in their car, if at all. We are not allowed to out and out refuse a request from PD to transport the pt, even if we feel the pt is very violent. We can request that they ride along, but we cannot refuse. Oh, and all we have are soft restraints, no hard restraints or chemical restraints . Also, PD can cuff a patient, and then only follow in their car behind the ambulance, not ride along. To me, if the patient is handcuffed, I would want a police officer in the ambulance with me incase the patient a. uses their handcuffs as a weapon, or b. deteriorates, and I need better access then what I can get with the handcuffs on. Unfortunately, my company will not support us if we say we don't feel safe with the patient...

[medicgirl05]

Wow. That sounds very unfortunate. Make me think I've got things pretty good. We have complete support from the deputies. If we feel unsafe they do everything in their power to change the situation.

[DwayneEMTP]

In my system, we transport pretty much all psychiatric, and a good number of drunk patients to the ER, and PD follows behind in their car, if at all. We are not allowed to out and out refuse a request from PD to transport the pt, even if we feel the pt is very violent. We can request that they ride along, but we cannot refuse. Oh, and all we have are soft restraints, no hard restraints or chemical restraints . Also, PD can cuff a patient, and then only follow in their car behind the ambulance, not ride along. To me, if the patient is handcuffed, I would want a police officer in the ambulance with me incase the patient a. uses their handcuffs as a weapon, or b. deteriorates, and I need better access then what I can get with the handcuffs on. Unfortunately, my company will not support us if we say we don't feel safe with the patient...

You need to get that documented with backup from your coworkers. Then when you get injured you and your lawyer can own yourself a brand new ambulance company and fire the idiots that take such a moronic stance...

But as Mobey said, you need priorities. If you don't have a mate and kids yet, perhaps your priorities are unclear for you at this point. When you do, you'll find it much easier to tell these folks to go and piss up a rope.

And I don't think anyone is suggesting that they would refuse these patients, just that they would find a way to resolve the situation that doesn't include risking their safety. You truly must, must, must get good with the fact that if you work rural and you have an altered pt capable of injuring you that you have to wait for additional support. While you're waiting should s/he further injure themselves? I'm sorry for that, but they are not going to injure me. That has absolutely got to be your drop dead, no compromise, 'aint even interested in talking about it point of view going into each call. Other points of view lead to pain and sadness.

Dwayne

Edited to syntax. No significant contextual changes made.

Edited December 18, 2010 by DwayneEMTP

[CBEMT]

Where I work if the drunk is able to put up a good fight then they are stable enought to go to the ER in a patrol car.

Absolutely, in the world where common sense is common.

In the litigious swamp that is medicine, on the other hand, once we make contact with this idiot, we own him (or her). If they stop breathing in the back of the police car 10 minutes from now, we're going to have to explain why we "let" that happen.

Edited December 19, 2010 by CBEMT

[Alex Woo]

Its unfortunate Prehospital Sedation doesn't allow the Medic to really give Medications for sedatory purposes. In NYC for the most part; the Sedation Protocol is the same as the EDP Protocol and the Sedation Protocol doesn't provide enough Benzodiazapines and the does are sub-theraputic.

[uglyEMT]

Also, PD can cuff a patient, and then only follow in their car behind the ambulance, not ride along. To me, if the patient is handcuffed, I would want a police officer in the ambulance with me incase the patient a. uses their handcuffs as a weapon, or b. deteriorates, and I need better access then what I can get with the handcuffs on.

Faking this statment jumped out at me. If the patient will be cuffed or restrained you must tell the PD how you want your patient. If hard restraints will be used make sure the arms are in correct positions to gain IV acess without having to unrestrain the person. Never transport one with their arms behind their backs and never face down on the cot.

Im not saying you ever would! Just commenting on the above statement. I have read a number of articles where a drunk was rerstrained and asperated due to improper position, one where a patient went into cardiac arrest after being Tased and due to the arms being behind them and cuffed and time was wasted trying to get the arms moved to begin CPR. Its a nasty situation to have a patient restrained in the back of a rig without PD envolvment. If you do DOCUMENT DOCUMENT DOCUMENT. Poistion of restraints, type used, position of the patient, how long the restraints were on, any visable injury caused by the restraints, ect. CYA with these patients.

I work rural EMS and on occasion we have restrained patients. I have a LEO ride with us, I want witnesses as to what transpires during transport. Especially when transit time can be over 1hr in certain cases. BTW Spider Straps work excellent even when used just on the cot.