# A EMTLIFE-Mythbreakers scenario



## mycrofft (Sep 16, 2008)

A disturbed pt is loaded into the ambulance with you. (S)He suddenly pulls a strip of cloth out of a pocket, whips it around your throat, and slips the loop shut and the knot tight. C'mon, it's only a rolled up one inch strip of t-shirt...or is it serious? (Potentially could have happened to me last weekend).
HINT: any of you had to cut down a hanger with rope once, and cloth another time? How did they compare?


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## reaper (Sep 17, 2008)

Cloth can be hell to cut through. That's why I keep my handy razor sharp pocket knife, just for these occasions!


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## Short Bus (Sep 17, 2008)

Um, first I would say, don't let that happen.  Second, I would say, you now have the right to defend yourself however you need to.  Then restrain them.  Then you can fix them.


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## traumateam1 (Sep 17, 2008)

Pull out my taser and just give er! ^_^


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## imurphy (Sep 17, 2008)

"Drop" the oxygen bottle you were "carrying" ....


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## mikie (Sep 17, 2008)

imurphy said:


> "Drop" the oxygen bottle you were "carrying" ....



and by drop, you mean use it as a battering ram against the pt?  ^_^


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## jrm818 (Sep 17, 2008)

going to be hard to cut...you're in deep doo doo.  Knife is great for getting to the pt., but i'm not sure i'd want that razor sharp knife anywhere near my throat.  worse comes to worse though i guess....

Personally I'd do whatever is necessary to get myself out of the situation (obviously).  But I'd expect that if the pt. was inured in the process (by a knife, O2 bottle, fingers gouging his eyes out, whatever) than the EMS crew is also going to have some 'splaining to do.  If the pt. was that disturbed, the crew maybe should have known and had additional hands around to control him.  

Then again this could happen out of the blue too....seemingly stable patient goes nuts.  Not much you can do about that but do what you need to do to get away, and then keep getting away.  Even still, an injured pt. is sure to = loads of paperwork, if not time in court.  No fun.


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## stephenrb81 (Sep 17, 2008)

I hardly ever take my attention away from a suspected psych, and all mental alarms go off if said psych pt reaches in his pocket.

Now for the sake of the scenario: I am being strangled by a psych patient, he has locked his grip and the noose is unwavering, My life is DEFINITELY in jeopardy, (no doubt about it) so a swift punch to the throat will shift the tables in most circumstances....Harsh? maybe, but a kidney punch or a blow to the head may not phase said individual if he is drugged up and would only add fuel to his rage.  My life on the other hand is now being measured in seconds


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## reaper (Sep 17, 2008)

In a situation like this, I could care less how much I injure the Pt. I am in a fight for my life. I will deal with the aftermath later.


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## traumateam1 (Sep 17, 2008)

I agree with steph and reaper.
What is the first rule of EMS? Our safety. If our life is in serious jeoprady than you play for keeps. Punch in the throat, or "the family jewls". This should hopefully work. Hopefully this never happens to any of us out there.
Stay safe everyone!


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## jrm818 (Sep 17, 2008)

Don't get me wrong, I have no intention of dying to avoid a court case.  In such a situation I'd do whatever I need to.  As I said in another thread, better to be judged by 12 than carried by 6.  But if my knife did need to come out (I carry one too - hopefully never to be used as anything but a tool) I fully expect to be judged by 12 afterwords.

The important thing, from what I've read about the legalities of the situation, is to try to escape - not attack.  Do what you need to get out of the situation - and then keep getting away.  

As a side note - how easy is it to get to your knife?  Can you open it one handed?  A lot of pocket knives or leatherman type tools can't be opened quickly or without two hands and a set of nails.  What else is around to use?

I haven't seen DTEMS on here recently...wonder if he's still around.


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## mycrofft (Sep 17, 2008)

*Here's the COMEBACK:*

The hint would be: "Ever see one of those old movis where the kids are skinny dipping and some meanies tie their clothes into knots? And they walk home in a barrel or a newspaper?". (a'la "Our Gang" comdey shorts).

The answer is this: cotton or other complex structured "natural" cloth is virtually impossible to untie once it has been tightened while stretching, and especially if wet. The fibers run in too many directions and the stretch cinches the knot. Also, since it is extremely hard to apply a uniform circumferential constriction to the neck to occlude the carotids, you have instead occluded the jugulars which acts like a phlebotomy tourniquet...your face and neck almost instantly start to swell, overlayering the cord.

The *answer* is that you are screwed. To get even the "V" blade cutdown knife under that would mean lacerating the neck, quite probably into the distended jugulars, etc. Forget your K-Bar, Buck or Victorinox Swiss Officer's knife. Slipping tetrasnips in works, but takes time you don't have. And doing it yourself while alone with the pt back there? 

The *solution*, in my case, was having two officers in arm's reach and me keeping the pt beyond arm's reach and "bladed" after I did his vital signs. I was lucky, too, but luck in the long run comes from being prepared and careful. How about having patients turn out their pockets? Or refusing to transport a disturbed pt without law enforcement in there with you? 

(In my case, the pt had about ten feet of  about 3/8ths inch improvised fabric cord wound around his torso and upper legs. Not really easy to quickly whip out at that point, but he was not frisked until after I was done with him.
"Hey, nurse, come back, is this normal?...", then "yippee tie yie aye").

Play safe out there, sisteren and bretheren.


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## AnthonyM83 (Sep 18, 2008)

mycrofft said:


> A disturbed pt is loaded into the ambulance with you. (S)He suddenly pulls a strip of cloth out of a pocket, whips it around your throat, and slips the loop shut and the knot tight. C'mon, it's only a rolled up one inch strip of t-shirt...or is it serious? (Potentially could have happened to me last weekend).
> HINT: any of you had to cut down a hanger with rope once, and cloth another time? How did they compare?



Obviously even small slivers of cloth are not going to rip when knotted around your neck.

You must attempt immediate escape or violently engage the patient. Provided I had my pocket knife, I would attempt stabs to face/neck/kidneys. You're moments from losing your life. He's trying to murder you. Respond with force.

Once he disengaged, the knot shouldn't be TOO hard to escape, unless he got it real tight (which is hard to do quickly with cloth unless victim doesn't react/struggle). If you can get your fingers underneath it, you can create a gap for your carotid arteries to prevent passing out, while you cut it off or get help.


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## mycrofft (Sep 18, 2008)

*Ah, if only time and tide favored our enterprise...*

Let us take it as a given that we will physically resist if we can and for as long as we can, but unless you've seen someone attack who has it thought out and maybe rehearsed, you can't appreciate how fast it really occurs. Ditto how you will react psychologically and physiologically if your throat and jugulars are even subtantially, not 100%, occluded...near instant pounding headache, panic, SOB, visual disturbance. This is even if the attacker does not followup with some "Wa-TAH!" 's of his/her own. Prevention is your only real defense here, or maybe one of those anti-shank jackets with the real tall collar they use in prisons? (Not bloody likely). Once it goes down, unless you are accompanied by enough trained people, you have already "had it". 

By the way, when I used the term "bladed", I referred to the practice of keeping your side (flank) towards the potential attacker instead of facing him/her straight on, preferably your non-dominant side, to minimize a "first strike" debilitation and keep your dominant hand free to react. A good habit.

ALWAYS try not to fight,you are playing their game then, but be ready to go hands on fast if that fails.


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## BossyCow (Sep 18, 2008)

mycrofft said:


> Victorinox Swiss Officer's knife


.


Victoria's Secret makes knives???? Cool... I gotta get that catalog back from my husband and give it another lookover!


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## mycrofft (Sep 18, 2008)

*Oy veh!*

The only brand to buy: Victorinox (and not as good as they were thirty years ago, dag nabbit!).
NOT Wenger.


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## Jon (Sep 19, 2008)

mycrofft said:


> The only brand to buy: Victorinox (and not as good as they were thirty years ago, dag nabbit!).
> NOT Wenger.


AMEN!

My dad carries his Victorinox knife daily... and he's had it for as long as I can remember (20 years?).


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## mycrofft (Sep 19, 2008)

*I've carried them since 1966 when I could.*

I'm currently using my backup I bought for DESERT STORM at the NAS MOFFET PX. I'd never try to cut something from around my throat with it, though.


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## Bosco578 (Sep 19, 2008)

I'd rather be judged by 12 than carried by six.....my life is on the line,your's is about to end.


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