What would you do?...

[emtfarva]

My partner and I (Sharon) responded to a call for injurys after the assualt a couple of months ago. When we got there we find about 7 police crusiers. We found a very drunk Pt sitting in the back seat. PD was telling this guy he had to go to the hosp. We got him out of the crusier and started to try to get him on our stretcher.

At this point the Pt became very uncoop. and started to swing wildly. He even hit me in the face a couple of times. Not hard but he hit all the same. It took about 5 of us to get him straped down. We didn't restrain him due to the fact he wasn't try to really hurt anybody, just swinging really. We were hoping PD was going to cuff him but that didn't happen. My partner is a medic and I am a basic. I am a male and my partner is a female. When we finnaly got the guy into the back of the truck I asked Sharon, "Are you going to do anything for him?" She replied No and I told her to drive us to the hosp. Now what would you do in that situtation? Would you let the medic tech? would you tech? Would you take PD along? Would you go solo?

The drive to the hosp was about 3 mins long. In that short amount of time the Pt's condition didn't change. We took PD with us. We didn't have any problems and we also had Hosp security meet us at the door. we got him to a rooma nd security took over. No problem there either. Another question is what should we have done if the transport would have been 30 mins to an hour or longer?

We didn't even know the guy's history he wouldn't even really talk to us. PD told us that his friends told them that they were at a party and they had the same amount to drink. PD said they were fine. I think he took something else and his friends just ditched him. I haven't really found out what happened either. I think we made the right choice what do you think?
Oh, PD also doesn't think he was assaulted either.

 

[Sasha]

I would have restrained him or allowed the police to restrain him. I don't care how much it isn't their fault that they are being combative or if they're not really trying to hurt someone, if you're going to try and hit me, I'm going to make it where you can't.

I eventually learned my lesson after getting hurt by patients I didn't restrain because "Oh, he's just confused! It's not his fault!"

I also would have let the medic have the call because alcohol is great at masking and mimicking other problems that I, as a basic, cannot effectively treat like a medic can.

 

[emtfarva]

I would have restrained him or allowed the police to restrain him. I don't care how much it isn't their fault that they are being combative or if they're not really trying to hurt someone, if you're going to try and hit me, I'm going to make it where you can't.

I eventually learned my lesson after getting hurt by patients I didn't restrain because "Oh, he's just confused! It's not his fault!"

I also would have let the medic have the call because alcohol is great at masking and mimicking other problems that I, as a basic, cannot effectively treat like a medic can.

I can't restrain a Pt unless they trying to hurt themself or others. If his punches had more power behind them I would have. I should have asked PD to do this but I didn't. Also after my c-med report the only thing I could do for the pt was to hold his hands down from swinging all about the ambulance. I couldn't even get a b/p because he wouldn't stop moving. anything else I should have done?

 

[Sasha]

I can't restrain a Pt unless they trying to hurt themself or others.

Most people take swinging fists as trying to hurt others!

 

[emtfarva]

Most people take swinging fists as trying to hurt others!

I know that. but in my opinon he didn't need to be restrained I really can't remember why at the moment. He prob needed to be restrained.

 

[spisco85]

If I had that patient I would have either restrained him myself or had a cop cuff him to the stretcher and ride with us.

It is easier to explain restraints than it is why your patient came in unconcious because they got the jump on you and you had to knock him out for your safety.

On a side note: Picking up drunks is a common occurence and we all know that hypoglycemia can look like alcohol intoxication. This is another reason why I am for EMT-Basics to have glucometers (my local hospitals don't think we need them). If the patient refused to give you a history and didn't have a med bracelet on then you do not know if he/she is a diabetic. Granted getting the combative patient to allow you to check his/her blood sugar might not be the easiest in the world.

 

[BEorP]

At this point the Pt became very uncoop. and started to swing wildly. He even hit me in the face a couple of times. Not hard but he hit all the same.

But...

We didn't restrain him due to the fact he wasn't try to really hurt anybody

?

 

[Sasha]

but in my opinon he didn't need to be restrained

He prob needed to be restrained

Which is it? You don't think he needed to be restrained, or you do think he needed to be restrained?

 

[emtfarva]

I can't remember why we didn't restrain him. in hindsight he should have been. but that is not the question I was asking.

 

[emtfarva]

On a side note: Picking up drunks is a common occurence and we all know that hypoglycemia can look like alcohol intoxication. This is another reason why I am for EMT-Basics to have glucometers (my local hospitals don't think we need them). If the patient refused to give you a history and didn't have a med bracelet on then you do not know if he/she is a diabetic. Granted getting the combative patient to allow you to check his/her blood sugar might not be the easiest in the world.

I work with a medic so getting a chem bg isn't a big deal. I use my partners all the time to check a bg on pt i tech going to the ER. But she could have pushed other drugs, like narcan. And theres was know way to even get to sit still for B/P. I wouldn't be able to get BG.

 

[Sasha]

I can't remember why we didn't restrain him. in hindsight he should have been. but that is not the question I was asking.

Considering it is a "What would you do?" thread, I kinda thought it was the question you were asking.

 

[emtfarva]

Considering it is a "What would you do?" thread, I kinda thought it was the question you were asking.

No you answered the question about the medic teching the call

 

[Veneficus]

I work with a medic so getting a chem bg isn't a big deal. I use my partners all the time to check a bg on pt i tech going to the ER. But she could have pushed other drugs, like narcan. And theres was know way to even get to sit still for B/P. I wouldn't be able to get BG.

What is the purpose of pushing narcan on an agitated patient? It competes for opioid receptors. Opioids depress patients. This is quite the opposite effect described here. If by some chance he was on an opioid in addition to his other issues he would have been more awake and more agitated. Maybe with some acute pulmonary edema to boot.

A patient swinging at me buys some physical and possibly chemical restraints dependng on what I think is wrong. If I am in house they just bought a foley cath as well as one of those tape on colostomy bags too. Not because I am malicious, because I don't want myself or anyone else getting hurt. The punches don't hurt till he lands one in your eye and we start calling you "patch" or knocks the tip of your xiphoid into your liver and you wind up in the ICU with the providers there wondering if they have to take a section of your liver out.

Scene safety!!! Be selfish you are the most important person there.
Next to me of course (you get the idea though)

 

[emtfarva]

What is the purpose of pushing narcan on an agitated patient? It competes for opioid receptors. Opioids depress patients. This is quite the opposite effect described here. If by some chance he was on an opioid in addition to his other issues he would have been more awake and more agitated. Maybe with some acute pulmonary edema to boot.

A patient swinging at me buys some physical and possibly chemical restraints dependng on what I think is wrong. If I am in house they just bought a foley cath as well as one of those tape on colostomy bags too. Not because I am malicious, because I don't want myself or anyone else getting hurt. The punches don't hurt till he lands one in your eye and we start calling you "patch" or knocks the tip of your xiphoid into your liver and you wind up in the ICU with the providers there wondering if they have to take a section of your liver out.

Scene safety!!! Be selfish you are the most important person there.
Next to me of course (you get the idea though)

Medics in Mass can push Narcan in a situtation like that. On the chance that he was on a drug other than etoh.

 

[Sasha]

Did he have any s/s associated with narcotics?

 

[Arkymedic]

In your state, if a medic is present are they required to "tech"? I understand the arguement you make for wanting to be in the back since she was female, but is it allowed? In AR, a paramedic is required to take the call regardless of circumstances if they are present and the unit is ALS (which almost every EMS service is). In OK, I have seen the opposite where services can be BLS, ILS, or ALS and some medics put the basic or intermediate in the back on most every call.
One of the services I used to work at a crew responded to a call for an intoxicated subject that had been kicked in the head by a horse in the middle of night. When the unit got there SO was on scene and ultimately the medic (also a female) "feared for her life" and put her male basic in the back. The pt had a severe head injury and required being sent to another facility by helicopter and his BAC was over 3x the legal limit and DOH was called later and it turned into a very very big deal and a political situation due to other circumstances.
Again, I understand the desire to protect a partner, but I would most definately have restrained him and once he swung at us PD would go too. I do not care if he meant to hurt you or not, he swung and struck you (regardless of how hard you think it was) and that compromises your safety, your partner's safety, and that of others on scene. At that time why did PD not cuff the patient? I also would have checked a CBG on this patient because as spisco mentioned, hypoglycemia can often mimic intoxication but I would not have given narcan. Thiamine could be given, but with unknown history, I would be cautious throwing drugs at him. Also, just remember that everyone reacts to substances in different ways so the statement "PD told us that his friends told them that they were at a party and they had the same amount to drink" is highly unreliable.This is in no means suggesting females are unable to take care of themselves or to handle a patient nor do they need rescuing.

My partner and I (Sharon) responded to a call for injurys after the assualt a couple of months ago. When we got there we find about 7 police crusiers. We found a very drunk Pt sitting in the back seat. PD was telling this guy he had to go to the hosp. We got him out of the crusier and started to try to get him on our stretcher.

At this point the Pt became very uncoop. and started to swing wildly. He even hit me in the face a couple of times. Not hard but he hit all the same. It took about 5 of us to get him straped down. We didn't restrain him due to the fact he wasn't try to really hurt anybody, just swinging really. We were hoping PD was going to cuff him but that didn't happen. My partner is a medic and I am a basic. I am a male and my partner is a female. When we finnaly got the guy into the back of the truck I asked Sharon, "Are you going to do anything for him?" She replied No and I told her to drive us to the hosp. Now what would you do in that situtation? Would you let the medic tech? would you tech? Would you take PD along? Would you go solo?

The drive to the hosp was about 3 mins long. In that short amount of time the Pt's condition didn't change. We took PD with us. We didn't have any problems and we also had Hosp security meet us at the door. we got him to a rooma nd security took over. No problem there either. Another question is what should we have done if the transport would have been 30 mins to an hour or longer?

We didn't even know the guy's history he wouldn't even really talk to us. PD told us that his friends told them that they were at a party and they had the same amount to drink. PD said they were fine. I think he took something else and his friends just ditched him. I haven't really found out what happened either. I think we made the right choice what do you think?
Oh, PD also doesn't think he was assaulted either.

 

[DT4EMS]

I have a question.................

Did you pursue charges after you were punched several times?

Remember a person under the influence is not relieved of their liability when commiting a crime............

It is no different than if he was a drunk driver that ran you over............. Does the court say "Awe, he was just drunk...... he didn't know what he was doing....."

See.......... stories like this get to me a little. They happen all over the country and we are failing ourselves.

Real-World defensive training should be a part of every EMT course.

 

[Arkymedic]

amen Kip amen

I have a question.................

Did you pursue charges after you were punched several times?

Remember a person under the influence is not relieved of their liability when commiting a crime............

It is no different than if he was a drunk driver that ran you over............. Does the court say "Awe, he was just drunk...... he didn't know what he was doing....."

See.......... stories like this get to me a little. They happen all over the country and we are failing ourselves.

Real-World defensive training should be a part of every EMT course.

 

[Veneficus]

Medics in Mass can push Narcan in a situtation like that. On the chance that he was on a drug other than etoh.

I don't think it is a good idea to prophylactically push narcan on people. If they were wild to start with, if you take out their depressant, they will only get worse.

Not to mention if you push it on somebody who is physically addicted and drop them beneath their theraputic level problems have only just begun.

If they are not breathing or inadequetly breathing, narcan may be the lesser of two evils. Narcan is not benign, the side effects are rare, but can be life threatening when they present. As an anecdote the last pediatric surgery I was involved with was a nephrectomy secondary to trauma. The patient had a hypersensitive reaction to morphine and was breathing about 4 times a minute post op. It was definately more humane to retube the patient than it was to administer narcan to block the effects of the morphine.

Just being allowed to should never be the decision maker in performing a treatment. Otherwise we would have surgeons cutting people open simply because they can. One of my preceptors has a PhD in experimental surgery, what he "can" or is "allowed" to do under implied consent can be a scary thought.

Anyone giving a medication should always be practicing risk stratification. Anyone performing treatment under implied consent must act responsibly with such authority.

 

[rescuepoppy]

In my area if a patient were to take a swing at a medic with law enforcement on hand we would not have to make the decision of restraining. The officer would take care of that at least until we can get a more precise exam completed. The highest level of certification should have been attending,so that evaluation and possible treatment could be completed. Also I would probably try to get a driver so that I could be in the back with my partner and law enforcement.