Violent Patients

[NYCEMS9115]

™Scene safety. Safety in numbers. Call for Police and additional resources. Safe distance. If you have determine that the patient is a danger to self and/or others. You've determine that there are no weapons (even though it is tough to determine); your gut tells you otherwise. There is no clear cut way to handle any situation; especially violate ones. You have to go with experience, gut instinct, peer experience, & readings/media. I can't tell you what you should really do other than what the textbook says and what your protocol dictates. Neither can others.

I can give you a event which happened to my partner and I. We were sitting 89 (NYC EMS lingo for at our assigned cross street location) at St Mark's Place & 2nd Ave: we were just sitting and viewing the passerbys. We witnessed a person; acting bizarre, walking against oncoming traffic, going up 2nd Ave. He was yelling and smacking himself; he was shirtless with shorts. He walked in front of cars. We called for PD backup and we followed him up 2nd Ave. I was driving and went alongside him; I notice no weapons on his waist; I saw no bulges in his pockets; he had sandals on: he was a mid-age white male. I asked him if he could stop so we could talk. He iterated that they're trying to get him. He kept smacking himself. He pounded on cars. He appeared to be under the influence. I following him for several blocks. He almost was hit by cars. In NYC, drivers don't care about lights & sirens. He barked and lunged at passerbys. In NYC, bystanders are always so nosey. We waited for PD and asked for an ETA (estimated time of arrival); no one came. I looked at my partner and we knew what we were about to do without saying anything. I drove up ahead of him; we exited the vehicle and asked him to stop; so we could talk. He passed me by: my partner was ahead and facing him. I went behind him & grabbed the waistline of his shorts and tripped him backwards over my body and braced his head; I held his body to the ground until PD came. My partner held one arm down; while I held the other. PD rushed to the scene and cuffed him. We took him to a Psych ER. He remained restrained. Hours later I checked up on him; he had taken a cocktail of illegal and legal drugs; too much, I can't remember. I'm not saying; this was the right move. My background in Martial Arts and Wrestling helped me subdue him and get him help. Yes, my partner and I could have been injuried or killed. It was our decision; luckily it was the right one at the time.

I hope this helped; not to confuse you. All the best...

[DwayneEMTP]

NYCEMS9115, I would respectfully disagree.

Because a situation worked out in the end does not then verify that it was a correct and intelligent decision. I used heroin a few times when I was growing up, and it worked out alright, but I'm guessing that most would be hard pressed to argue that it was an intelligent, healthy decision for me and/or my family.

Saying that your 'partner just knew what you were going to do' seems to imply that you allow yourself into these situations on a regular basis. Again, if allowing yourself to be involved in those situations feeds a need that you have, then that's certainly your right as a human being, but it also sets a very dangerous example for those that come behind you as well as puts your partners in a danger not necessarily of their choosing.

Safety first. Always.

The only reason I'm getting so preachy is that you posted... "™Scene safety. Safety in numbers. Call for Police and additional resources. Safe distance. If you have determine that the patient is a danger to self and/or others..." Followed by.. " I went behind him & grabbed the waistline of his shorts and tripped him backwards over my body and braced his head; I held his body to the ground until PD came." in the same post, and in no logical intelligent place do they really belong together.

I spent much of my younger life in wrestling and martial arts so you'll have a hard time convincing me that while taking down a violent pt that you could guarantee that you could 'cushion his head' while doing so or guarantee that no part of your or his body would accidentally strike hard surfaces.

Not busting your balls brother. But this is a learning forum and I believe that your post was a bit braggy, and that you allowed that to override your lesson.

Thanks for participating. I look forward to your thoughts..

Dwayne

[Chief1C]

™Scene safety

Trademark?

[Happiness]

Scene Safty is a very important part of our job, not only for ourselves but also for our pts. It is also the one thing that we tend to forget when we are in a high stress situation, or like myself compliant. I do a saftey check all the time but I do have to admit that it is not always the best as since Im in a small community and everyone knows me, so I think I'm safe.

My New years day call made me really realize how my actions have actually rubbed off on others. Call person suicidal with a knife, the RCMP waited for us. Now in reality we are to wait until the officer comes out of the scene to let us know that it is safe (its good to have cops that also know this), My partner saw the cop go in and was going to rush in after him. I did stop her before she entered the home and after we had a good discussion about scene saftey.

Like others have stated but in my little bubble "After me you come first" its very hard to watch someone in need and not be able to help right away but if you become the one in need you also become useless in the end.

Happy

[Richard B the EMT]

...interesting how the Kobayashi Maru is always introduced in class and what peoples solutions are in a hypothetically situation.

1) Kobayashi Maru scenario is to find out how potential command candidates handle failure.

2) James Tiberius Kirk is the only candidate to take the Maru scenario twice, and the only one in academy history to beat the scenario. He cheated, you know!

2) Peace and long life. Live long and prosper, my "Trek" fan breathren!

[tniuqs]

2) James Tiberius Kirk aka "William Shatner"(A Canadian)is the only candidate to take the Maru scenario twice, and the only one in academy history to beat the scenario. He cheated, you know!

Define cheat.

***********************************************************************************************

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DAMN Kanukistan and all the stupid goofy rules, you can dart a moose in a city, but oh no .. the 2 legged Neanderthals you have to be politically correct and invite them for bloody tea and crumpet's.

yet another retirement plan .... buzz killed.

[NYCEMS9115]

I was just sharing. There's nothing I can say to defend it. Your right... I shared an experience. It was something that had to be done. I could have continued to follow until PD came. Hindsight is 20/20. Thank you DwayneEMTP.... All the best...

[Richard B the EMT]

Shatner is, indeed a Canadian, but he portrayed Kirk, an American from the "Midwest".

As for the cheating, Kirk broke into the computers, and reprogrammed them so, on hearing who he was, his name so "frightened" the computerized Klingons, they decided not to engage in battle, so Kirk was able to "rescue" the passengers and crew of the Kobayashi Maru (Original version, not the new movie with Nimoy's "Spock" meeting his younger self (Zachary Quinto) after a time traveller destroys planet Vulcan.)

On a real subject, the 6 PM news reported on a social worker on a home visit, attacked by the client with a knife, in New Jersey. The client/perp is under arrest as I write this.

[croaker260]

Someone made the comment about "tricks" for this situation.

Sadly there are no"tricks" that are common accross the majority of the patients.

There are, however, "pitfalls" that will land you in a world of trouble. It is probably more useful to you to consider the pitfalls and avoid them. Then, of the options that do not fall afoul of the pitfalls...chose the best ones that the situation allows.

I dont know if that approach makes sense, but sometimes its hard to explain things in this format.

NOW...what are the pitfalls?

1- For most EMTs/Medics, we do not (unless we are LEO/CO's) empowered by law to seize, apprehend, or otherwise detain a subject. To do so is a volation of the 4th ammendment. It is a civil liberties /constitutional issue, so before you lay hands on some one you must be absolutely sure you have the right standing and that you must act immediately. "Implied Consent" is unsteady ground at best if an adverse result occurs....

2- There is a clear difference between restraining someone for their own safety and defending yourself. Therefore techniques that are perfectly OK if you are DEFENDING yourself are NOT OK if you are restraining someone for their own safety. Be sure you are in the right "mode" at the right time.

3- When determining if someone is competent to refuse care, remember that there is much more to determine mental status than simply Alert and orinented x4. If you are simply using A/Ox4 to determine if you can lay hands on someone , or that is all you are documenting....you are setting yourself up for trouble.

4- As someone mentioned, what ever we do we should make every effort to avoid harming the patient. It is important to remember that when restraining a patient, even if you are doing it perfectly, can still result in harm and even death. There has been much written about Excited/Agitated delerium just to name one cultrpit....restraining someone ....should not be taken likley.

5- and most important....Gordan Grahmn says that High Risk low frequency descisions like what we face in EMS (and Law enforcement) can be furhter broken down into descretionary time and non-descretionary time ... in otherwords, do you have to ACT NOW, or can you de-escelate and wait for the problem to either resolve it self or be resolved with the expertese of Med Control or a supervisor. Frankly, half the problems in this situations are because EMS providers JUMP IN before they have to.

Remember that slow is fast....

I hope this helps. Sorry for any TYPOS...Sinus Medication is killing me.

Edited January 20, 2011 by croaker260

[NYCEMS9115]

Abosultely right. Its well in the pass; I can't change that. We never hit him just held him but no excuse. However, maybe our intentions were good but not waiting for PD was a mistake, it only took then 10 minutes. I can't assume but maybe something bad was going to happen. I don't know; him banging on cars, screaming, lunging at people wasn't illegal (I don't think). I can't justify it. I can only relay the story. I never said I was right. It was a decision we made at the time. It was a long time ago; would I do this now; NO.... Unless it was to defend myself. But we see so many times; where people say, "Why didn't anyone do anything?" Maybe that wasn't the time; not yet. It hadn't developed...

I can go on and on but I am wrong. I got no thrill out of it. I wanted to help him and others from being hurt by him. I didn't have to share it; I'm not proud of it but I wanted to share it; so others can see all sides. Thanks. All the best...