Violent Patients

[emt1231]

Yup scene safety covers this all. Once you see him get agitated becoming aggressive just call for the police and try to keep him calm or just wait in th rig till they secure the scene. Remeber your safety is more then theirs and their possible injuries.

[speedygodzilla]

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.

Can you please elaborate more on this point.

When it comes down to it if they are A&O4/4 and have been made aware of risk of refusing and are still refusing than my hands are legally tied.

There is a difference between refusing and not wanting to go the hospital, but that is whole other can of worms.

[crotchitymedic1986]

In the NY scenario, I am not sure I agree with waiting on PD. Look at it from this angle, what if as he was slow rolling behind this guy, someone in an upper office or apartment was filming the whole thing (maybe they were awoken by the chaos). We watch this ambulance follow this guy for 10 minutes, and then boooommmmm, he is hit by a truck and killed. When that video hits You-tube, do you think the public would say you did your job ? Do you think your employer would keep you on as an employee ?

I often found myself in situations where I should have waited on the experts (fire, pd, rope rescue), but if I had, the patient would have died, so I risked my life a little; I think any of us who have been in the business atleast 10 years have probably done the same. Letting this guy walk into traffic and die is not the answer.

[queensland paramedic]

The SAFE program introduced by the Queensland Ambulance Service has reduced the amount of assults on paramedics dramatically, great program if anyone is lookin at implementing a similar program.

Cheers

[croaker260]

Can you please elaborate more on this point.

When it comes down to it if they are A&O4/4 and have been made aware of risk of refusing and are still refusing than my hands are legally tied.

There is a difference between refusing and not wanting to go the hospital, but that is whole other can of worms.

Perhaps you misunderstand my point, what I am saying is that the simple 4 question (person, place, time , and event) A/Ox4 exam is inadequate (and never was intended) to determine if someone is legally competent to refuse care. Not even close.

I have used this example before, but I promise you that on any weekend you can go into any bar outside a military post and find a completely hammered, completely and utterly altered soldier/marine/sailer/airman, and ask them the basic questions and their SSN, and they will respond clearly, LOUDLY I am sure, and quickly. Because this is a simple rote memory reflex and not a determination of cognition.

Here are links to 3 different cognitive assessment/questions in common use in medicine. All are mostly reproducible in the field and provide a better picture of cognition.

Why? Because if a patient cannot be shown to be cognitive enough to understand the refusal process, they cannot make that decision.

I am not endorsing one over the other, but I feel EVERY provider should be familiar with these questions and incorporate them seamlessly into your assessments/documentation, especially on refusals.

http://en.wikipedia.org/wiki/Mini-mental_state_examination

http://en.wikipedia.org/wiki/Abbreviated_mental_test_score

http://en.wikipedia.org/wiki/General_Practitioner_Assessment_Of_Cognition

The SAFE program introduced by the Queensland Ambulance Service has reduced the amount of assults on paramedics dramatically, great program if anyone is lookin at implementing a similar program.

Cheers

Can you provide a link or more information?

[NYCEMS9115]

There are many Programs for defusing situations; I've taken many. However, each situation is different. Its like only doing what you learned in school; no changes; its not as concrete as we think. Nothing is. Medicine is a practice & so is Prehospital Care. The decision I made years ago wasn't something to be proud of. It was wrong but at the same time it was right. No one was hurt & the patient received the help he needed. I can use that experience and my current experience with continuing education along with the Psych Nursing I'm taking right now and make better decisions. The fine line we were walking on was Duty to Act and Implied Consent. It was like seeing someone just abruptly passed out and waiting for it to developed into something else. Its a touchy subject and I am not ashamed of what I did but I'm not proud of it either. All the best.

[Richard B the EMT]

The SAFE program introduced by the Queensland Ambulance Service has reduced the amount of assults on paramedics dramatically, great program if anyone is lookin at implementing a similar program.

Cheers

For informational sake, could you provide a link, if available, for those of us in other parts of the world than your geographic location, please. I am in New York City, and might have had, or have available to me, something similar, but under a different name.