Violent Patients

[ColinW]

Hi there,

I was in class tonight and we were going over legal stuff and i started to wonder what should be done when a patient becomes violent. Heres the sanario I was thinking about:

You respond to a single car crash when you arrive on scene the subject (male in his 30's) is out of the car sitting near the wreck and is very intoxicated. You go up to him and do a basic examantion and conclude he has suffered a neck injury during the crash and you and your partner deduct that in his current state he is not compent to refuse your services. When you tell the patient that you are now going to transport him to the hospital he refuses, you and your partner try to presuade him to go willingly but the man becomes increasingly agitated and after awhile becomes phycally violent toward you and your partner.

What do you do at this point? This man needs medical attention and is too drunk to make his own dicessions about his well being but will fight to not go to the hospital. And phyically restaining him could possibly cause more harm to his potentially broken neck and you cant get close to him to give him a seditive. Also, in my part of the world especially, the police officer may not arrive for awhile since when I live has so few people cops ae few and far between. This really stumped me and i didnt ask the instructor since the class is so fast paced i wouldnt have been able to get a word in edgewise anyways but its been bugging me since i thought of it.

What you do in this situation?

[Chief1C]

Wait for the police to arrive... If you fight him, and he injures himself; you've 1: Not accomplished anything; and 2: Opened a legal can of worms. Suggest he sit down and relax, and you do the same. If he were to become unconscious.. Treat him. If not, you're safety always comes first.

I'm in a rural area too, we don't have police on duty at night. They're all "State Police", but they have to respond from home, like us; "On Call". But I'm not going to injure myself, or help someone to premature disability, just b/c they made a bad choice. I'm usually pretty good at convincing people they need to go. But I've been hit, spat upon and kicked a few times; and it's just not worth the fuss. Tell the cops to step it up, just try to convince the person to sit still, and chill.

[Bieber]

I agree with 4c6. Remember, the first rule of medicine is primum non nocere--first do no harm. There may not be any way to prevent that man from exacerbating his injury (even after the police have wrangled him in he's still gonna be squirming until the sedative takes effect), but you don't have to be the ones to get him riled up, and you definitely don't have to be the ones to get a bloody nose or worse when that patient starts fighting. Our job is to treat, not to get into scuffles with patients, and as a general rule I'd leave as much of the rough housing to the police as possible.

[HERBIE1]

Do the best you can. If you cannot safely subdue this person-without causing injury to yourselves or further the patient's problems, let him go. If you are in the boonies, where is he going to go? If someone else picks him up from the scene- fine, and advise them to get the person help.

I've had violent patients who I simply let go. In my younger days I would have no problem going toe to toe, but it's a stupid idea. Try to convince the guy to allow transport- even for just a ride, even if it means no treatment. Undertreatment is better than no treatment at all. Of course you need to properly document all this to CYA.

m lucky- in an urban area, police are usually just a few minutes away, although even 3 minutes, while you are dealing with a combative patient, can seem like an eternity. I cannot imagine having to wait for a cop to come from home.

[uglyEMT]

Call PD, wait in the rig with the doors locked.

Remember priority ONE is you and your partners safety!!

Yea it sucks to see an injuried party and you being in a position to help but the patient is too violent for you to render assistance.

As you go deeper into your course some of these scenarios will come up and the instructors will delve into them a little. It is important to remember that you want to go home after your shift, uninjured. Wait for the PD, let them do the restraining, documnet document document, then finally treat. You will have a long healthy time as an EMT if you remember scene safety.

There is a thread on these boards with a training video showing a police officer not taking scene safety into account. I suggest you watch it and learn from it as a student.

[DwayneEMTP]

...This man needs medical attention and is too drunk to make his own dicessions about his well being but will fight to not go to the hospital. And phyically restaining him could possibly cause more harm to his potentially broken neck and you cant get close to him to give him a seditive.

Done deal brother. I'm going to call the cops and walk the street to try and keep him from getting hit by a car until they get there. If he's as injured as you state, he will be manageable pretty soon, just bide your time until he tips over. If it's really hot, or really cold outside, the same applies. Wait for him to tip over and then do your deal.

The situation that you describe above is not possible to solve in a morally/ethically/professionally sound manner. This is one of those time when you say, "It's not my emergency. I didn't cause it. He's made it impossible for me to solve it. So until one of the above conditions changes, I'm going to wait."

... Also, in my part of the world especially, the police officer may not arrive for awhile since when I live has so few people cops ae few and far between...

You have to accept this as a limitation of your treatment options, right? Again, accept that sometimes in this situation not only will you have to stand by and wait for the situation to change, sometimes you may have to run away and leave him to fend for himself!

If he suddenly reaches into his car and comes out with a knife or a gun..or even a broken whiskey bottle...I'm leaving his dumb ass there. I will run down the road and sext with Babs until the cops come and never lose a moments sleep over it.

I know you want to help him because he's hurt, but tell me this; if he was on fire and running around would you stand still and wait for him to come to you under the thinking that, "If I can hug him, then I can roll us both around on the ground and put the fire out. That is what's best for the patient." And it would be best for him, right?

...This really stumped me and i didnt ask the instructor since the class is so fast paced i wouldnt have been able to get a word in edgewise anyways but its been bugging me since i thought of it.

I think you already knew the answer brother, you just aren't comfortable with 'do nothing' as an answer. And I really get that. But in this job you must ALWAYS have that as one of your scene options, always. Ok?

Excellent question!

Also, use your spell check and proof read your posts, ok? You're way too smart to spell like that..

Dwayne

[ColinW]

Thanks for the replies everyone thought i should ask just in case EMS veterans had a trick for dealing with this

I think you already knew the answer brother, you just aren't comfortable with 'do nothing' as an answer. And I really get that. But in this job you must ALWAYS have that as one of your scene options, always. Ok?

Excellent question!

Also, use your spell check and proof read your posts, ok? You're way too smart to spell like that..

Dwayne

You hit the nail on the head Dwayne, even though Ive only been a EMS student for one day now already I feel like i need to do everything within my power (and scope of practice) to help the patient so doing nothing would be kinda of tough for me. But in this case I can understand doing nothing until the cops show up.

[tniuqs]

Hi there,

I was in class tonight and we were going over legal stuff and i started to wonder what should be done when a patient becomes violent. Heres the sanario I was thinking about:

You respond to a single car crash when you arrive on scene the subject (male in his 30's) is out of the car sitting near the wreck and is very intoxicated. You go up to him and do a basic examantion and conclude he has suffered a neck injury during the crash and you and your partner deduct that in his current state he is not compent to refuse your services. When you tell the patient that you are now going to transport him to the hospital he refuses, you and your partner try to presuade him to go willingly but the man becomes increasingly agitated and after awhile becomes phycally violent toward you and your partner.

What do you do at this point? This man needs medical attention and is too drunk to make his own dicessions about his well being but will fight to not go to the hospital. And phyically restaining him could possibly cause more harm to his potentially broken neck and you cant get close to him to give him a seditive. Also, in my part of the world especially, the police officer may not arrive for awhile since when I live has so few people cops ae few and far between. This really stumped me and i didnt ask the instructor since the class is so fast paced i wouldnt have been able to get a word in edgewise anyways but its been bugging me since i thought of it.

What you do in this situation?

This is the exact situation for purchasing one of my (soon to be patented) Pigmy Blow Dart EMS delivery system devices that doubles as rape me whistle (hah I bet Dwayne getting sex into the thread !)

nah nothing to add but interesting how the Kobayashi Maru is always introduced in class and what peoples solutions are in a hypothetically situation.

cheers

[DwayneEMTP]

This is the exact situation for purchasing one of my (soon to be patented) Pigmy Blow Dart EMS delivery system devices that doubles as rape me whistle...

LMFDO!!

Are you accepting advanced orders? I'll need several...

Dwayne

[Chief1C]

Oh... and Document. Document. Document.