EMS Crisis patient

[ERDoc]

I'm going to step on a soap box for a minute here. Dealing with these sort of situations is where EMS (and medicine honestly) falls short. We are not taught how to deescalate at situation unless you seek out such a course (although I think they are becoming more popular). I can't tell you how many times I have seen crews bring in agitated/drunk/high/violent pts and they just continue to poke the bear. They feel they have to be superior and one up the pt. This does nothing to help the situation and most time makes it worse (I am guilty of it too). I had an eye opening experince once that totally changed my methods. PD brings in a combative guy who is just a general asshole which isn't help by the alcohol in his system. He's kicking, screaming and spitting. EMS is yelling at him, the nurses are doing the same and I start to also. PD makes there way into the room and we step out. The officer looks at the guy and says to him, "Hey, these people are here to help. They don't want to hurt you and don't want to get hurt. Your problem isn't with them so cut them some slack and cooperate. OK?" The pt stops yelling and fighting and says, "OK." We all go back in the room with some apprehension but the pt is as calm and cooperative as could be and there is no more trouble. He even says sorry and thanks on the way out. Ever since that day I have tried the same type of approach and 9 times out of 10 it helps. Poking the bear and fighting with the pt over who has the bigger figurative penis will only get people hurt. I think this needs to be taught more.

[Just Plain Ruff]

I'm as guilty of that as anyone here but once I realized that it was easier to not fight than to fight the person and often times in my few poke the bear get the bear furious episodes it resulted in a lot of paperwork, I found out that you really can do a lot more with honey than with the bear stick.

Amazing how much just talking and finding common ground such as kids or hobbies or common interests can defuse a situation.

But when it really comes down to if he's going to kill me or I'm going to kill him, He's going to lose every single time if I have anything to say for it.

[Arctickat]

Yeah, all kidding aside, I've learned long ago that the best way to de-escalate a situation is to let the crazy one think he has all the control and take the dominant role. Once the Alpha Dog has his bone he's much more docile.

[scubanurse]

I think it is important to note that there is a difference between combative (drugs/ETOH) and suicidal/mental illness. They should be treated as two different issues. Drug and disorderly is much different than suicidal and hopeless.

[Jaymazing]

I'd just like to say, good luck finding the common ground with the homicidal mental case who's actively baited you into a trap, made you take off your clothes, and is pointing a .357 at your face. "Hey man, do you hate taxes? me too! Down with the man!"

I don't think anybody here is going to "challenge" him for the "alpha dog" role here. Let's be realistic. I don't know about everyone else, but if I'm in this situation, the dude with the gun is calling the shots. No pun intended.

I'm just saying.

[mikeymedic1984]

Me and my partner (male) have already decided on a "signal" and to rush the assailant at the same time, regardless of weapon. He has told you that no one is leaving alive, I have no reason to not believe him, one of us will take our chances with a single GSW versus dying at the hands of a maniac (remember that many folks are not that accurate with hand-guns). OF course, I probably would have had a different answer when I had young kids, but the world was different then.

[HellsBells]

Kate's point about the difference between a psych and drugged up pt is a really good distinction. Recently, I had a guy drunk fellow pull out a small pocket knife attached to his key chain on me, however he wasnt particularly threatening, and I just took the keys out of his hand and put them in my pocket. He then proceded to accuse me of taking his keys so that I could steal from his home. I think he overvalued the worth of his threadbare couch and 20 year old television. I have never had a gun pulled on me, nevermind Dirty Harry's peacemaker. I think it would be quite the sobering situation to stare down the barrel of a cannon like that. I have to agree that my first thought would be a fight or flight reaction. The fact that this guy set out to entrap EMS in this manner suggests he is serious and wants to go out in a blaze of glory, I doubt talking him down would have much chance of success.

[MikeEMT]

Well considering I am trained in crisis mitigation I would talk the suspect down. This type of situation doesn't really scare me. I doubt he has intention to harm me or my partner. He does have other underlying that he wants addressed and he feels this is the only way to get them addressed. As long as no one plays hero you and your partner will be going home.

Make slow, methodical movements. Explain what you are doing or going to do. Talk to him professionally and non-judgmentally and more than likely you will have a positive outcome. Take your time, its going to take a few hours so be patient.

When its over, bitch slap your partner for being the "studly medic" and tell him next time he does such a moronic move you will put your foot so far up his ass that he will be spitting leather for a week.

[MariB]

Of course im sure the tears would start flowing.

Bringing up his family may not always be a good idea of it is what brought it on, but you could make him feel like you care. Someone cares about him.

make sure he knows you are human too, with kids, family etc.

Than I pee myself and start begging.

[Just Plain Ruff]

So Mike, what if the guy is not willing to be talked down, what kind of take down's are you willing to use?

Consider this scenario-

You walk into the bedroom and then guy now is now in the doorway and you are stuck in the bedroom.