dealing with verbal abuse

[nick72]

I have had to deal with too many patients who are both physically and verbally abusive; if they are physically violent, then they get tied down to my cot in restraints. But even then, most combative patients continue to be loudly verbally abusive even when strapped down, yelling and cursing at me, saying things like they're going to kill me, they're going to lay my wife, etc. etc. I had one colleague tell me to just gag them with duct tape, but i know that was obviously a joke. Another recommendation was to sedate them, but I doubt Medical Con would allow me to sedate a person for just being verbally abusive.

How do you handle these situations? Is there anything you can do or say to the patient to calm things down?

[Just Plain Ruff]

Ok, Nick, sounds like you are at your wits end with this and maybe you need to discuss some outlets on how to deal with these types of patients. How often do you have violent patients that require them being tied down to your cot with restraints? Is there some reason why they are becoming physically violant and verbally abusive with you?

Im not busting your balls brother (to take a note from Dwayne) but seriously, I have treated thousands of patients and I can count on probably mine and my partners hands the numbers of times I've had to physically restrain someone to my cot.

Many of these patients can be talked to and transported without having to resort to restraining them but then again some cannot.

There are classes out there, your local hospital if they run a psych ward or similar department can probably point you to the right class.

Violent patients most often go with the police depending on how violent they are. I tell the police that they can either transport them or they have to send one of their officers with the patient in the ambulance and the decision is usually to put them in the back of the cop car to the ER but I will never put a patient in a cop car that I believe needs a ambulance. EVER. A police officer will go with me.

And yes I will get a sedation order from Medical control if my safety is in jeopardy and the patient needs to go by ambulance. But the police will always go with me, sometimes it's pulling teeth to get them to go with us but I tell them that my safety is tantamount and sometimes I pull the "if you want me to take care of you when you get hurt you will do this for me buddy" in a joking way! thank goodness for a great working relationship with local LEO's.

But call the local psych facility you transport patients to and ask them about what classes they have to defuse situations like these, and they probably have them available for EMS providers.

One other thing, it says you are a student in your occupation, you will get better over time at defusing these types of patients and until you do, always keep an eye out for escalating signs such as clenching fists, rapid talking, pacing, cursing, glaring at you and just hairs standing up on the back of your neck. See any of those and you know the issue is escalating to a possible unsafe level. There is nothing wrong with you leaving the area to wait for help to get there.

[ERDoc]

Why do you let the verbally abusive pts get to you? They are just words. The best thing to do is to ignore their tirades and just transport. As juvenile as it sounds, "Stick and stones may break my bones but words will never hurt me." Don't be that guy that feels he needs to one up the pt. That will never end well and usually leads to burnout. Try not to laugh when they are carrying on either. That tends to make them even more mad (yup, personal learning moment).

[island emt]

are you working in an urban jungle environment by chance?

This is what we in EMS do on a regular basis.

We cannot just "tie them down to my cot with restraints" as you put it without reason. That constitutes assault, unless medically necessary.

I'd be surprised if your state protocols allow that to happen.

You need to talk with someone other than your partner who may be on the edge also based on the duct tape comment. Even said jokingly that is just wrong.

Follow ruffs advice and get some training.

Like him , I can only think of a few instances were restraints were required and they were mostly for Pt's who had done angel dust or bath salts types of illegal drugs.

I have had the police put a Pt in handcuffs who is actively trying to commit suicide by any means possible. Don't want them jumping out of the back of my ambulance while driving down the road.

Edited May 28, 2014 by island emt

[nick72]

Island Emt, maybe you missed the part when I said that PHYSICALLY VIOLENT patients get restrained, not "without reason," as you say. And yes, my state protocols DO allow restraint of violent patients. Maybe you should read posts more thoroughly before you make disparaging remarks.

Edited May 28, 2014 by nick72

[Just Plain Ruff]

Nick, being that violent patients get restrained, that's a given. but why are you letting verbally abusive patients get to you. You didn't respond to my post at all. You focused on Island's post and no-one elses.

So the tribe has spoken, why do you allow verbally abusive patients get to you?

I've been in EMS for 20+ years and I've had patients tell me that they wanted to kill me, to kill my family and to do all sorts of nasty things to me. Did it bother me, sure but I never took it personally because it's part of the job.

Sure in my first year or so, I had a unlisted phone number because I was worried someone would search me out but you know what, it never happened.

But your response to Islands post leads me to believe that you really get defensive at just the little things that are thrown your way and you really need to work on that. The question is "how can we help you?"

[paramedicmike]

There is just so much going on here.

I have had to deal with too many patients who are both physically and verbally abusive; if they are physically violent, then they get tied down to my cot in restraints.

In my entire career I can count on one hand the number of patients I've had to physically restrain because they were being violent. My questions for you are what are you doing differently that leaves you with so many violent patients? Is it the area in which you're working? Is it your approach to patients? Is it your lack of ability to talk to them, talk them down and keep them calm?

Or, are you engaging them? Talking back at them? Antagonizing them? Getting them ramped up with stuff like, "...keep it up and we'll tie you to that stretcher..."?

But even then, most combative patients continue to be loudly verbally abusive even when strapped down, yelling and cursing at me, saying things like they're going to kill me, they're going to lay my wife, etc. etc.

Have you ever been tied down to a stretcher? Ever been restrained against your will? How would you feel? How did you feel? What would you say to the people who tied you down?

I had one colleague tell me to just gag them with duct tape, but i know that was obviously a joke.

Are you sure? Sounds like your partner is another one who needs a break from EMS for a while.

Yes. We in EMS tend to have a warped sense of humour. However, comments like the duct tape comment can be a symptom of a much larger problem.

Another recommendation was to sedate them, but I doubt Medical Con would allow me to sedate a person for just being verbally abusive.

There would also be an awful lot of questions if you started to request sedating what sounds to be a good number of your patients.

How do you handle these situations? Is there anything you can do or say to the patient to calm things down?

First, I don't let their words bother me. I don't know them. They don't know me. It's not personal.

Second, I remain calm. I try to talk them down. I don't let my voice show excitement or anger or exasperation. I keep an easy, even, calm tone and I talk to them like human beings. It takes practice. But it's one of the best skills I've learned over the years.

Island Emt, maybe you missed the part when I said that PHYSICALLY VIOLENT patients get restrained, not "without reason," as you say. And yes, my state protocols DO allow restraint of violent patients. Maybe you should read posts more thoroughly before you make disparaging remarks.

Hmm. Based on this I'm starting to wonder more if you are the problem and not the patients.

I've asked you this before and you've yet to answer. Your occupation is listed as "student". Are you a student? What are you studying? Are you in EMT school? Paramedic school? You make it sound like you're working in EMS but as you haven't addressed your listed occupation I can't tell if you're really working as an employee or if these are clinical ride alongs for school.

If you're an employee working as an EMT you have a lot to learn before you should consider moving up. If you're a student and these are school mandated ride alongs you may do well to consider another line of work if you're so easily bothered by what patients are saying to you.

[Just Plain Ruff]

He's only replied once and that was to go on the defensive.

nothing more. I'd like answers to the questions posted so far.

[island emt]

I seem to bring out the sunny side of newbies.

[island emt]

Island Emt, maybe you missed the part when I said that PHYSICALLY VIOLENT patients get restrained, not "without reason," as you say. And yes, my state protocols DO allow restraint of violent patients. Maybe you should read posts more thoroughly before you make disparaging remarks.

No I didn't miss that statement. Thats why I asked if you were working in the urban jungle with lots of homeless folks or outdoor adventurers as one group called themselves.

The fact that you are regularly tying patients down worries me .

As several of us have said, we can count one a hand or two the number of Patients / customers that we needed to restrain. These cases were usually drug induced or stupid drunks wanting to do harm to themselves.

Those that have responded to you so far in this thread have decades of experience in the EMS field, dating back into the early 1970's , so take our word for it there IS something wrong with the need to tie folks down on your cot.