Protecting yourself from patients or bystanders...

[beckoncall62]

Should also add that I meant on my 1st post do I have the right to beat the crap outta the person to defend myself, not do I have to, sorry wrong wording.

JENN

I'll tell you an experience I had on one of the first calls I went on as an EMT- we were called to a residence on a female with some sort of medical difficulty. This woman was a frequent flyer and had a boyfriend who could behave "erratically" at times. The place they lived had a latch and padlock on the OUTSIDE of the door. 2 of the more experienced EMTs went in and I stayed outside with him, due to limited space in the living room. Right after they went into the house, the boyfriend latched the door-as if locking them in! I walked over to him from the ambulance and asked him to unlatch it. He had placed the padlock on and acted as if he was going to lock it. He replied with "I don't want it getting cold in there." After calmly talking with him and asking him again, but actually walking over and unlatching it myself, he didn't argue anymore. Immediately after that call, after I told them what this guy had done, they red-flagged this residence. 2 days later we were called there again. This time, law enforcement was sent there first to secure the scene, while we staged. Law enforcement called us in, but as we were arriving the guy grabbed a chain saw and went after the deputy with it, then the EMTs that had already gotten out of the ambulance. Fortunately we were able to get away from him without being injured. The man was eventually subdued. You brought up a good question and it reminded me of this incident. What can you do when a patient or someone else attacks you on a scene? Personally, I would try talking with or reasoning with them first. If that didn't work, I'd take whatever steps necessary to defend myself and prevent them from injuring me. :naka: Situations are different. Sometimes people can be reasoned with and sometimes they can't.

[emsbrian]

To start with to say I am not aware that the ED and EMS is dangerous would be a joke. Belittling my experience and knowledge is not appreciated and I will not tolerate comments such as that. I feel you are a reasonable and intelligent person, with a vast base of useful knowledge, but in this case I feel your advice is dangerous to impressionable and new medics in our field. If you read my post you will find that I distinguish between those who are altered and those who are not. I fear for those who take solely your advice from this thread.

Either you want to make a strong point or your callase. I'm not sure. While I'm in no way advocating letting them off for something, yes it is our job to take drunken rants, sure it is. We do no choose who we care for, they choose to be cared for. Never do we have any right to judge those who come to us. ED's over flow with idiot and pointless cases, while those who are scared stay at home. Where was security when this nurse was beaten, perhaps problems lie else where. Policies are needed to protect us. The average drunk will not consider the consequences of his actions even if "you have a reputation." I would beg the lawyers to tell me how in the world you could legally throw a combative drunk out. As far as I can tell you are not counting them as AMS.

Now if an assault does happen sure file charges, but both hospital security and medics around here all expect to take a punch from an idiot now and then. Should I sue the driver of the car that hit me when I was working a wreck? No, there was no intention in their action, as there is none in a drunks. As to a Alert person choosing to be violent, what provoked them. You have no right to keep them in the hospital so let them go and likely no violence will befall any employee.

As far as pressing charges, in no event would I recommend if you feel the need not to. If you feel significantly violated as to press charges, please do. But be judicious in your decisions as the job you choose does indeed require you to face violence and drunks and other altered mental patients, and if this is the root of your patients problems then why are you keeping them? If they are in police custody then the police should be with you, it is your right to have them with the patient at all times. Do not think a "reputation" or retribution for action will prevent someone who has little or no thoughts in there head to begin with (altered or not) from taking the action which you fear. To say we do not have to take is both true and false. If you feel that your management is attempting to keep you from damaging their image when you talk to them about the incident, contact your insurance advocate, they will lead you down a safe path.

[NREMT-Basic]

Actually Brian, assualt is not verbal, at least not solely. If I threaten, at the top of my lungs to beat someone or to shoot or stab them, this is called disorderly conduct, breech of peace, or whatever other turn of phrase your state may have chosen to define the term. Technically, and under the laws of every state, to be legally charged with an act in furtherance. For example, if I say in a very loud voice "I am going to shoot you" I have just committed disorderly conduct or possibly terroristic threatening, though that usually involves another step, say me calling you on the phone or sending you an email that says I am going kill you. For the act to be considered assault, there must be an act in furtherance...IE: I say in a very loud voice "I am going to shoot you" and then I produce a gun. That is assault. The legal definition of assault is "Conducting such action or actions as may induce a reasonable person to be placed in fear of receiving a battery." So assault in not solely verbal. There is also sexual assault, assault with a deadly weapon, etc, but those are not what we are discussing here. Battery on the other hand is usually defined as "unwanted or unlawful touching." A very broad term. Spitting on someone who has not asked you to is battery. Grabbing someones arm is battery. Shoving someone is battery. You get the idea. Battery then becomes aggravated when a weapon becomes involved, when the person is a LEO, a teacher, etc.

Police Officers have a force continuum of course which involves everything from restraining a person, to less lethal options, to deadly force. The so called "civilian" self defense laws are much more complex and indeed civilian self defense is much harder to prove. So called "self-defense" is defined as "the use of such force as is necessary to mitigate an immediate threat to person or property." Mitigate...to alleviate. If a person comes at you with a pool cue, and you sock him on the jaw and he falls to the ground, you now have the oppurtunity to run, to retreat. Any further physical force used by you in the civilian world would be considered battery and would likely find you placed in jail as well, if not insted of your attacker.

EMS personnel, especially if they belong to a private agency, fall into a legal grey area. The medic/LEO who has developed DT4EMS has addressed this in great length both in his courses, his videos and my personal conversations with him. If you watch his videos, you will notice that most of his work involves a double tap, a shove and most prominently, a retreat in almost all cases. This becomes dicey in the back of a moving ambulance with an EDP or otherwise combative person. I have been on the brunt end of an attack by a patient twice so far. One of the first things one should do, is tell your driving partner to pull over. It is not wise to put the patient out the ambulance as has been previously suggested, since to do so would hold you open to the civil tort action of neglect in that you have taken over medical care for this patient and then ceased that care by removing them from the environment of treatment (in this case, your rig). It is a far far better idea, to remove yourself from the rig, have your partner do the same, and call for police back up at that point. While I agree that the immediately safest option in many cases would be to put the patient out the back of the rig, this will almost certainly open up a legal can of worms, the result of which can very depending on the whim and opinion of the court. The fact is that very few states have written laws regarding how EMS personnel are to defend themselves. In one of my situations, I used Kips double take push off maneuver from DT4EMS. Our protocols in Illinois do not allow for so called "chemical restraint" without prior authorization from medical direction.

To answer the "beat the crap out of the patient" question, you only have a right in terms of self defense to use as much force as will stop the attack and allow you to remove yourself from the situation. So if a patient grabs you, and a push off maneuver allows you the time and space to restrain the patient, that is reasonable force. If it requires you to strike the patient because there was no other way for you to protect yourself, you are likely to be called into court, but you are also likely to do fairly well, as long as you can clearly explain the scenario, the patients actions, your response and the outcome. If at any point, it appears that you used one ounce more force than was necessary to immediately mitigate the threat, you may well have legal trouble. Remember, the least amount of force necessary is always the benchmark. For police, EMS personnel and "civlians."

Hope this helps

Steven KinCannon, NREMT-B/D, Paralegal, Medical Legal Consultant

PS- as for Rids theory that alot depends on what has caused the patient to react this way is irrelevant. If you are the victim of an attack, you have the legal right to defend yourself using the least amount of force necessary. As for Asysins suggestion, well its just illegal, he knows it and is trying to appear, like I dont know what. Anyone who indicates or holds that opinion that you can batter a patient and get away with it simply my covering it up is opening himself and anyone else who choses to follow such idiotic suggestions to huge problems with the law. Besides that, it assumes that the police, EMS and hospital personnel with either A)Always close ranks and stick together or that a nurse or police officer will be so stupid as to not be able to tell the difference between a person who has fallen and on who has been battered by an EMS responder. Further, it advocates the battering of patients, which I find morally reprehensible as well as just plain stupid. This may work in some situations you have found yourself in Asys, but we would all probably be best served by operating in the real world and not some fantasy realm where you batter a patient on the way to the hospital and then everyone plays dumb, even as they stare at the cuts on your knuckles.

[emsbrian]

Darnit again with an actually, how rude

Texas penal code 22.01(2)

A person commits assault if they:

-intentionally or knowingly threatens another with imminent bodily injury, including the person's spouse;

Why my god, that appears to be solely a verbal act... and yes yes thats right in Texas assault can be solely verbal that the statement made indicates that bodily harm will be done to one or ones wife (my god Texas is great, love the fact I can shoot trespassers at nite)

I really don't wanna get into a fight here guys, I love the fact that you cleared up a LOT of the legalese but actually's are to be little people, and I worked my ass off to get where I am in life. I am a respected individual and I have to fight for it sometimes so if you wanna do stuff like that, be ready to be sure.

[scubanurse]

I agree with Brian...the way I learned it in my Law class was this

Assault=verbal threat of bodily harm

Battery=physical contact resulting in bodily harm

[NREMT-Basic]

I just read Texas State Penal Code 22.01 and 22.02 and do not find the word "verbal." Your state law does however have certain tests in it. Such as, what degree of threat is sufficient to create an apprehension of receiving a battery, and what exactly is a reasonable apprehension. The penal code of your state does say "threat" but threat is also defined under the law as an action, as I say, words may be there but I dont see that written and its a dangerous thing when you begin to extrapolate out from the law in terms of what you think it says. Try this, even in Texas, where, by the way, it is legal to shoot a Law Enforcement Officer who comes onto your property in the dark of night without being previously summoned or dispatched to your address, so it is safe to assume that some of Texas state law is somewhat archane. But as I say, lets try this: You get into a shouting match with a patient in a Texas ambulance and he says, if i get out of these restraints, I am going to choke you to death. Has he, under Texas law, committed assault. No he has not. Especially since your state has decided that assault and battery are inchoate or linked offenses. That is one cannot happen without the other, which shores up the concept of act in furtherance. If he doesnt carry through, he has committed niether offense. "Assault – the attempt to commit battery, or the intent to create apprehension in the victim of imminent bodily harm." Texas State Penal Code Definition of the Term Assault...I dont see the word verbal there, nor does it mention ones spouse, though in most states throughout the country the aspect of self defense includes persons and property, taking in ones house, spouse, children or dwelling (which, under Texas state Penal code can be taken to include your pickup truck. The problem with attempting to interpret law is that when you begin to read a statue, you must start at the beginning and go through to the end, en total. You cannot pick out certain phrases to suit your argument because as soon as you do, someone will come along and point out the part of the law that you didnt bother to read which qualifies and in many cases contradicts itself. You may also carry a loaded shotgun through the city streets of San Antonio and along the river walk and it may be loaded as long as the breach of the weapon is open and its presense does not create or incite a public panic. Nuff Said. Try reading the whole statute. Sometimes you will find out it doesnt say exactly what you think it does when you skim it. And since you are arguing assault as it pertains to the state of Texas, assault must have an element of will to it, that is to say that if the patient is screaming and scared and says something in what is known as an "excited utterance" and it scares you but that was not his intent, it is not classified as an assault because he had not the formed intention of placing you in apprehension of receiving bodily harm. Read the whole law. Its says alot of things you are leaving out.

And as for you distaste for legalese...get used to it. You going to hear alot of it in court during your career. I consult with attorneys, both prosecutors and defense lawyers as well as EMS agencies on these matters and have assisted in prosecuting and defending such cases hundreds of times. The fact remains, that even under your broad interpretation of 22.01-2, merely shouting at someone that you are going to hurt them is not enough. No where does your law say this. Ive just spent the last hour reading it. It does include the legal test of "sufficiency." And guess what, what is sufficient to cause you to believe that you are going to be battered will ultimately not be decided by you when you feel scared and slug someone, but rather by a judge and or jury. Your law indicates sufficent threat and while you may determine that at the time you decide to thrown a punch or shove someone, ultimately, the court decides whether that person created such a sufficient threat. And for the record, 22.01(a) defines assault directly as I have quoted it above from your own states statutes available on line. It does not include the language or intent you specify. While a law class is not really sufficient to gain a working understanding of the law, taking the information learned and putting it into practice in court does. Thats where our experience differs. And by the way, 22.01(2) as you cited it, is the portion of the law which states that assault and battery are linked offenses, not a definition of assault.

[whit72]

To accept abuse or assault because its part of your job. Violence is never accepted, in any field. Removing the little old lady that pinches or the assault due to injury or illness. It should never be accepted or dismissed. I am not here to be used as someones punching bag, I will and do defend myself to the extent needed to secure the safety of myself and partner.

The safety of yourself and your partner should be of the utmost importance. You are in a very vulnerable state in the ambulance, close proximity and a difficult escape route can be hazardous to your health. So if the possibility of violence is even a remote possibility the PD is called, and we wait. No exceptions, no deviations. Myself and my partner will be going home in the morning.

[NREMT-Basic]

To accept abuse or assault because its part of your job. Violence is never accepted, in any field. Removing the little old lady that pinches or the assault due to injury or illness. It should never be accepted or dismissed. I am not here to be used as someones punching bag, I will and do defend myself to the extent needed to secure the safety of myself and partner.

The safety of yourself and your partner should be of the utmost importance. You are in a very vulnerable state in the ambulance, close proximity and a difficult escape route can be hazardous to your health. So if the possibility of violence is even a remote possibility the PD is called, and we wait. No exceptions, no deviations. Myself and my partner will be going home in the morning.

Whit-

First off Im not sure who you are ranting at since we all agree, as does the DOT and the NHTSA that your safety and the safety of your partner, is your most fundamental concern. I think perhaps that if you are going to call the PD because an old lady pinches you that you may be over-reacting a touch and should probably plan on spending alot of time in court as well as being laughed at by the responding LEO. As for difficult escape routes, Im sorry to hear that you work for an ambulance company whose rigs have neither a side jump door nor back loading doors. These would certainly facilitate your hasty retreat from the amorous advances of blue haired old ladies with tummy aches. Maybe at your next job the rigs will have doors. Also, if you chose not to go home in the morning because an old lady pinches you, that sounds like a personal decision and one best kept in private. Come one here man. However much coffee you are drinking you should cut it in half. Finally, will you call the police before or after you are battered? Because honestly, laws being what they are, before would be a tad early and after may be too late. You need to find ways, such as those taught by Kip at DT4EMS to defend yourself inside the rig. I have been punched once and grabbed by the throat once and there was no available PD intervention in the back of the rig. Simple tap and escape maneuvers, and pulling over to the side of the road were what was required to regain control of the situation.

[whit72]

Ummmmm I think I stated removing the little old lady who pinches you or the assault caused by a pt with suspected injury or illness from the scenario, no other assault or attempt will be tolerated.

I will let slide you personal attack again, sighting your obvious flaws in reading comprehension.

Nremt basic wrote:

I have been punched once and grabbed by the throat once and there was no available PD intervention in the back of the rig. Simple tap and escape maneuvers, and pulling over to the side of the road were what was required to regain control of the situation.

Well you attempt your tap and escape maneuver on a 250lb mad man amped on meth. I will just wait for the the guys with the guns to arrive.

Yes I will call PD if I feel threatened before the situation escalates to the point where someones safety is in serious jeopardy. I don't take the wait and see attitude.

[emsbrian]

NREMT-BASIC has some issues with personal attacks. And to be clear my statement about legalese was to recognize an area of special knowledge you have. It was respectful, not to say I dislike it in any manner. You need to respect the knowledge of those who post in this forum. Me and Rid may argue on this one threat, for example, but there is no doubt in my mind that he has provided more then a useful amount of information numerous times. To maintain a level or professionalism we do not need to be attacking the level of others knowledge.

On that note I would like to sum up the one and only accepted infos applicable to this in EMS:

(Legal or not THIS is what is taught and accepted on the NREMT test)

Assault- Physical

Battery- Verbal (although legally apparent to have a physical action involved, but in no way taught or required as evident to MY PERSON <may not be true in all cases> experience)

Self defense- The use of minimal force to escape a situation in which emanate harm is or may befall a person

Minimal reasonable force- that which is required to remove yourself from the situation

As far as legal definition that should perhaps be the actual use of the law:

-Please refer to first NREMT basic post (ignore the "actually Brian" part though)