Management of Violent Patients Page 64-1
MANAGEMENT OF VIOLENT PATIENTS
INTRODUCTION
Never transport these patients without police presence. When transporting these patients without police presence use of the following protocol is permitted. Patients often present with bizarre and unpredictable signs and symptoms. These patients must be handled with extreme care. One moment calm and serene, suddenly violent and out of control, or worse, sorrowful and weeping. Occasionally these patients change form from human to extraterrestrial. Note that these patients may be at risk of mutating, shape shifting or morphing into creatures of the night.
RECOGNITION
Patients whose color changes rapidly, grow fangs or claws or simply disappear fit into this category. Do not rule out drooling, leaking or other bodily emissions as potential weapons. Occasionally, these patients rip seat belts from stretcher and flop on floor of rescue vehicle. Some levitate. Some attack.
TREATMENT
1. Perform a primary survey. Handle patients gently, sudden movement may provoke them.
1.1 Tie combative patients to stretcher using whatever means available, preferably face down. If one of these patients breaks loose, use of a sheet as a safety net is permitted. Throw sheet over escaping patient, temporarily confusing them. Beat them with a loaded clipboard if necessary. Gently resecure patient to gurney.
1.2 Use of retrievable portable radio may be used to stun escaping patient. Hold microphone section of radio and use body as a projectile. Aim for the back if running away, between the eyes if approaching. Repeat as necessary.
1.3 Teamwork is recommended when volatile patient attempts to elope from rescue. Driver must monitor progress as is prudent. If patient manages to escape from restraints, quick starts and stops should incapacitate patient. Team member in rear of truck may utilize safety net (see 1.1) Planting foot behind subdued patients neck and firmly pressing to floor should alleviate the situation.
1.4 Consider abandoning vehicle.
2. Obtain Vital Signs
2.1 From safe distance see if patient is breathing. If so, no further treatment is necessary. Transport immediately to appropriate medical facility
2.2 If Patient is not breathing follow all appropriate protocols
2.3 If patient remains conscious, repeat above until desired effect is attained
3. Document all incident information, except for all of the above, by completing the RI EMS Ambulance Run Report
Posts like this make me so glad I’m an accountant….
“Never transport these patients without police presence. When transporting these patients without police presence use of the following protocol is permitted.”
Uh, isn’t this statement contradictory? First you are NEVER to transport with out the police present. Then the next sentence tells you what protocol to follow if you do transport without the police present.
Wait, I’m reading the rest of this post and the only logical conclusion is that you meant for this to be an April Fool’s Day post but forgot to use the WP scheduling function. Right?
I’m going to pretend that this is a real protocol, although I can’t imagine any medical director agreeing to this. You do have a medical director, right? He’s a doctor, not a fire chief, right?
1. This is a patient, not a bottle of Nitroglycerin explosives.
1.1 Face down restraint has been out of everyone’s protocols for ten or more years. It’s an invitation to a lawsuit for wrongful death. Look up “Positional Asphyxia”. Gently resecure patient after beating them with a clipboard. Aluminum clipboard, right? See my comment on 1.2.
1.2 Assault and Battery with a Dangerous Weapon. I know a few EMTs that were fired for hitting violent patients with a portable radio.
1.3 I’m speechless.
1.4 Don’t forget to take the keys and lock the cab on the way out.
2. If the patient is that violent, VS are the last thing you are going to want to try. Gets you way too close to the patient.
2.1 Contradicts 2. If you can get close enough to do VS, you can get close enough to determine breathing. Which is THE VS we most worry about.
2.2 If patient is not breathing, call your attorney, you are in deep doo doo.
2.3 If by some chance you didn’t do something that will cost you your job, your pension, your paramedic ticket, your house, and all your favorite pastimes, repeat until something you do DOES cost you…
3. Sure, the patients or patients estate’s attorney will love thorough documentation of how you murdered his patient. The DA might like it too and the Grand Jury will love it.
Really Michael, tell me you meant this to be an April Fools Day post and forgot to schedule it properly. Please?
Ok, now that I’ve reread it a few times, I’m convinced it’s an April Fools Day post that went up prematurely.
Got me!
HAHAHAHAHAHAHAHA!!!!!
DDD
Ha! Didn’t mean to trick anybody, that was just me at 32 hrs and 30 runs waiting for the next lunatic to enter my domain. Just goofing around, but I should have waited till April Fools Day! Wish I had thought of that.
That’s a relief, sort of. You really had me worried for a minute.
I’m going to pretend that this is a real protocol, although I can’t imagine any medical director agreeing to this. You do have a medical director, right? He’s a doctor, not a fire chief, right?
Wouldn’t even matter, because our medical directors (assuming the agency has one, because they don’t have to last I checked) have no say over our protocols. Only the DOH/OEMS does. An agency medical director can’t add or subtract from any statewide protocol.
ALS systems in RI don’t have to have a medical director? Wow.
Like I said, I could be wrong, but I know that was true for a while.
With a few exceptions I an think of, most medical directors are just signatures on medication and supply orders.
Wish it was a joke about six months ago. Patient was violent from the moment we arrived on-scene. Restraint worked for a short while, till the verbal and physical abuse got to the EMT-P onboard. We stopped the box, yelled for the police, and held tight. Police handcuffed patient to the stretcher, and almost had to taser the patient. Patient still managed to break several bones in one of the officer’s hands.
One modification. Add Step 1.15:
Attempt to affix “Magic Ginzu Neck Reliever (TM)” to patient.
RI has an EMS medical director and every EMT in the state works directly under his license.
No fun, mrmacs, I lost my partner for two months last month what an Afghanistan war vet attacked us.
Wish I had the Magic Ginzu Neck Reliever, Monique!
jeez, wish I had known this 10 MONTHS ago! Still out. Glad your partner is doing well! It was funny, I appreciate that.It doesn’t hurt to make fun of the horror we put up with everyday. Not that we would do any of that…………..