violent psych patients

[NREMT-Basic]

So far in about two years, I have had two patients grab me. My order of operations is the same as Dust's: 1. retreat 2. let the patient retreat 3. go hands on. The one thing you dont want is a street fight in your rig. There are ways to physically defend yourself that will leave no lasting harm to the patient and will give you that moment of pause to escape. The first thing is to holler to your partner to pull then hell over. Otherwise its like trying to defend yourself on an out of control roller coaster. If you end up on the floor, you are going to be in a world of hurt. Cover your face and trunk and use your legs. Kip Teitsort who is a LEO/Medic teaches DT4EMS and is really a pioneer in the field of EMS self-defense. Anyone who says they are going to use a defib or a slug to the head with an oxy tank is full of it. Learn some ways to defend yourself that are not likely to kill your patient.

[AnthonyM83]

Current national standard taught in law enforcement is that, to subdue a violent psych, an officer must be available for each limb. That's what the physical restraint tactics instructor from the local academy is going to show up in court and testify is the current state of the art for them. Why should it be different for them when the guy is in my ambulance? I want them to take at least as much concern for my safety as they would take for their own. If not, screw them. That's what they have a cage for.

I very much agree with the four limbs, plus chest/head restraint tactics, but that's when transporting a patient handcuffed to the mainframe of the gurney, I don't see how a patient's going to get out of that with enough time to harm you, whether there's one or four officers. Anyway, in LA if there's a serious threat they'll handcuff then just have one officer with a taser ride in the cab.

[AnthonyM83]

Anyone who says they are going to use a defib or a slug to the head with an oxy tank is full of it. Learn some ways to defend yourself that are not likely to kill your patient.

But at the same time, learn some ways to defend yourself that ARE likely to kill your patient, as well. If your 280lb muscular male patient who was unconscious comes to and decides to try to harm you or pulls a deadly weapon at freeway speeds, know what you're going to do...and then what you're going to do if plan A fails.

[iMac]

Psych emergencies can and a lot of the time require medical assistance. If you are in an ALS service depending on the situation chemical restraint is the way to go, if not get an officer to climb aboard, you would be surprised to see how much easier they suddenly become to treat.

[Don1977]

I believe EMS should not transport psych patients period! Unless they slashed there wrists and are bleeding out or overdosed and are unconscious, in otehr words we should not transport unless its a medical problem!

Violent psyche, hmmm, sounds like a police matter, what the hell am I going to do as an EMT, Im not armed. A medic can push drugs, but really, not an EMS matter, sorry.

If your a voluntary commit and want to open the backdoors and run, I am not stopping you, run Forest run! I cant stop you legally and even if you are a involuntary, I still am not stopping you! im not a cop, not my problem.

[reaper]

A psych pt is a medical problem! :roll:

[JPINFV]

Violent psyche, hmmm, sounds like a police matter, what the hell am I going to do as an EMT, Im not armed.

Yea, and the security guards at the hospital aren't armed either. This is not to say, though, that police involvement on scene is not an option. Strike 1.

Medics can use chemical restraints if needed. Strike 2.

As stated before, psychiatric issues are medical, that is why they are treated by physicians in a hospital or clinic setting. Strike 3.

If the patient is a flight risk, then that should be an indication for restraints. Strike err...4.

[Eydawn]

Since when did mental illness become something EMS shouldn't have to deal with because it's difficult, dangerous and uncomfortable? Psychiatric patients are just that: PATIENTS.

One thing I think we should differentiate between here is the interfacility transfer of a psychiatric patient who has already been evaluated and the emergency response to a behavioral episode somewhere in the community.

Looking at Case A, the interfacility transfer: If this individual is not suffering any other medical complications and does not have meds on board with a high likelihood of sick-making side effects, it should be acceptable for someone other than EMS to transfer them. If they're suffering any other sort of medical complication and/or the meds are very powerful with a high likelihood of side effects, then one of our old favorite EMS transfer units and adequate resources should be utilized. Emphasis on the adequate resources.

Looking at Case B, the emergent behavioral episode occurring in the community: How do we know for sure there isn't some underlying medical factor eliciting this behavior? How do we know that our favorite frequent flyer schizophrenic isn't having a delerious episode brought on by a high fever? How can we be sure it isn't a BGL issue?

I guess the big question is, how do you know this person is ONLY suffering complications from their mental illness? Is that mental illness known to you and bystanders and DOCUMENTED? And regardless, they are going to need to be evaluated by a doctor upon their arrival to... the ED... so how could it not be safer for the patient and the responders to have them four or six pointed on a cot?

Seems to me that taking away someone's power base by having them restrained horizontally lessens the chance that they're going to work loose or be able to injure me, my partner and any LEO's I have with me.

And remember... even though someone may be having a severe, violent behavioral episode due to medication imbalance, blood sugar levels, mental illness etc., they are still a human being deserving the best care we can give them. There is a distinct difference between the individual who is intentionally violent or uses illegal drugs causing such a reaction, and the individual who is having an episode of mental illness.

But we still care for everyone who is in need of our care, no? As long as you can find a way to safely do so...

Wendy

CO EMT-B

[steph1030]

i agree wendy

they shouldnt be treated in any other manner no matter what is going on

they are still patients and above all else human beings

[spenac]

i agree wendy

they shouldnt be treated in any other manner no matter what is going on

they are still patients and above all else human beings

You are so wrong, sometimes they are GOD, his son Jesus, or the arch enemy Satan. I have had all 3 on my ambulance more than once. I hate when Jesus calls me God. That just freaks me out.

Mental patients deserve proper treatment. Proper treatment can and does require protecting them from themselves and protecting ourselves from them.