# Restraining Psyche Patient



## WashboardSlim (Jan 31, 2009)

In my EMS class we've been running a lot of scenarios; it's gotten to the point where our primary goal for the time being is to restrain a "psyche patient" acted out by a fellow student. 

I really have no idea if the most recent ones are realistic or not - basically we're supposed to assume any sort of LE has dropped off the face of the Earth, so it's just us (usually 4 members to a team) and the patient, who is apt to swinging, pulling hair/clothing, biting, etc.

The next scenario involves taking down the biggest guy in class - he's probably 6'3 and weighs over 200 pounds easy. So this got me thinking.

We're going to have to use a lot of force to bring him down and the instructor loves to make these as difficult as possible (giving the patient a "knife" for example). I'd really love to get some advice from real EMS personnel on what you guys would do in this situation and what my team and I can expect.

If you need any more info I'd be happy to provide it. Thanks!


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## downunderwunda (Jan 31, 2009)

Proper restrain is determined by patient size & the type of restraint you will use. Proper restraint will require up to 8 people.

I would suggest you talk to a proper psych ward to learn hoe to do it properly.


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## marineman (Feb 1, 2009)

psych patient with a knife? Believe me I have plenty of time until a new class of cops get trained and put on the road. There is not a chance in hell I would step foot in that house. If the teacher says no law enforcement are available I would say that I'll be staging down the street at the diner with a cup of coffee until they become available and sit down. 

Yes learning how to handle these patients while keeping everyone safe is good but it could also lead to people thinking they know what to do and not really ensuring scene safety. 

As far as restraining I prefer almost a straight jacket type position if possible where arms are crossed and secured to opposite sides of the cot. If you do it right you can still get a set of vitals and an IV if you really need one but they can't generate as much force pulling that way. Really DT4EMS would be the best at telling you how to bring the guy down, I have a method that works for me but that's what he does for a living so I'll stand by.


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## DT4EMS (Feb 1, 2009)

Hmmm............

The name of the school you are attending is what?

There is NO reason anyone should be teaching EMS how to restrain a person with any weapon much less a knife.

I normally stay away from saying anything negative but if this type of training is actually taking place it is WRONG. Trust me....... when your motive is "care and medical restraint" and the other person is intent on hurting you......... game over. You lose.

I have spent the last 12 plus years studying and teaching EMS scene safety tactics. At no point would we ever have you try and restrain a person holding a weapon (by choice).

Even when I train officers in knife use and defense........ we train them to flee the knife. It never jams and it never runs out of ammo. Look at my bio......... I train in Kali-Silat. I am a student of the blade arts. Even semi-trained blade practitioners like myself get cut....  a lot....... in training learning to escape a blade attack.

Before restraints are taught they may want to look into the "position" the NAEMSP took on patient restraint. According to their paper it takes 5 people to medically restrain a patient.

Now, with this I disagree because how often do you have 5 similarly trained personnel on scene to help with restraint.

Look into it.......... a person who is intent on causing you harm........... and has the capability to do so............. doesn't really need you.............. at the moment.


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## Aidey (Feb 1, 2009)

*once staged an hour and a 1/2 at 4am for police to become available to clear a suicide scene* 

I'm guessing your teacher isn't going to accept you guys sitting in the diner drinking coffee (although I personally would do that) so here's what I've got. 

Ascertain why the patient has a knife, is he violent, thinking you are KGB agents coming to steal the chip implanted in his head? Or is he depressed and threatening to cut himself? It's going to be easier to get the knife in the second scenario than in the first. For me, it's always just been talking to the patient and figuring out the right way to get them to the hospital safely. The only time I have not been able to talk down a patient is when it was a guy high on PCP. In his case, I didn't even try. I also want to mention I have never tried to talk down a patient without police support either right there, or within shouting distance.


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## JPINFV (Feb 1, 2009)

The key to dealing with any armed and violent patient is to simple be able to run faster than your partner.


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## medic417 (Feb 1, 2009)

JPINFV said:


> The key to dealing with any armed and violent patient is to simple be able to run faster than your partner.




Exactly I don't have to be faster than the attacker I just have to be faster than the slowest of the team.

Now if you are in a situation where there is no choice but to fight to get out the O2 tank is pretty hefty should knock them out if you swing it.  But your goal is to make hole you can run through not to get control of patient.  Your instructor may be trying to get you to think scene safety.  I would do something like above and run.


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## BossyCow (Feb 1, 2009)

I hope your instructor was seeing if you had the common sense to determine that a pt with a knife is not a safe scene and you wait for Law Enforcement. 

You need a minimum of 5 people for restraint and more is better. There's another thread where techniques are described  which you might want to take a look at.


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## BLSBoy (Feb 3, 2009)

Aidey said:


> *once staged an hour and a 1/2 at 4am for police to become available to clear a suicide scene*
> 
> I'm guessing your teacher isn't going to accept you guys sitting in the diner drinking coffee (although I personally would do that) so here's what I've got.
> 
> Ascertain why the patient has a knife, is he violent, thinking you are KGB agents coming to steal the chip implanted in his head? Or is he depressed and threatening to cut himself? It's going to be easier to get the knife in the second scenario than in the first. For me, it's always just been talking to the patient and figuring out the right way to get them to the hospital safely. The only time I have not been able to talk down a patient is when it was a guy high on PCP. In his case, I didn't even try. I also want to mention I have never tried to talk down a patient without police support either right there, or within shouting distance.



Bro, I have some one the most compassion and understanding for psych pts. 

That being said, I will NOT attempt, unless my gut instinct, and situational awareness fails me, and I am in a bad situation, to attempt to talk down someone that is armed, especially with a knife. 

As it was said, it never runs outta ammo, or jams. 

There is a LEO video that is very applicable to EMS. Its called battling edged weapons, or something to that effect. 

Gives you a whole new perspective.


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## emtfarva (Feb 3, 2009)

*what?*

I was taught that we are not police. WE DO NOT TAKE PEOPLE DOWN THAT IS WHAT THE COPS ARE FOR.


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## Aidey (Feb 4, 2009)

No, we don't. If an EMS person is *taking *someone down, something has gone very wrong somewhere and there is going to be a lot of paperwork involved. However, *talking* someone down with appropriate police support isn't always out of the question (and I think should be utilized more).


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## Sasha (Feb 4, 2009)

Aidey said:


> No, we don't. If an EMS person is *taking *someone down, something has gone very wrong somewhere and there is going to be a lot of paperwork involved. However, *talking* someone down with appropriate police support isn't always out of the question (and I think should be utilized more).



Dude, if I have a psych patient who has a weapon and wants to use it against me, I'm waiting far away with the O2 cylinder within arms reach to bop him upside the head with if he decides to come and find us. Unless you are properly trained to talk someone down, it just doesn't seem like a good idea.


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## 281mustang (Feb 4, 2009)

BossyCow said:


> I hope your instructor was seeing if you had the common sense to determine that a pt with a knife is not a safe scene and you wait for Law Enforcement.


 x2, I can't imagine an instructor telling students to knowing go into a situation like that and attempt to take him down yourself.


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## JPINFV (Feb 4, 2009)

emtfarva said:


> I was taught that we are not police. WE DO NOT TAKE PEOPLE DOWN THAT IS WHAT THE COPS ARE FOR.



You haven't been in emergency medicine long, have you?


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## Aidey (Feb 4, 2009)

Sasha said:


> Dude, if I have a psych patient who has a weapon and wants to use it against me, I'm waiting far away with the O2 cylinder within arms reach to bop him upside the head with if he decides to come and find us. Unless you are properly trained to talk someone down, it just doesn't seem like a good idea.



It's totally situational dependent, it's hard to accurately describe here.


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## emtfarva (Feb 4, 2009)

JPINFV said:


> You haven't been in emergency medicine long, have you?



Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.


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## Griff (Feb 4, 2009)

When I went through LE Academy, we were taught to avoid close contact with anyone brandishing a weapon, period. The only exception being that the suspect pulled a weapon after you let him/her get to close to you (i.e. inadequate scene safety); you have no choice then, obviously. 

I have not had any EMS training aside from BLS, so I may very well be mistaken, but I know that our medical personnel always stage well away from a scene involving known weapons. Even with less-lethals, controlling a suspect's weapon (and the suspect as well) without harm can often be quite tricky. 

I personally would never intentionally _approach_ an armed and hostile person, period, unless it was my specific job and I had the appropriate resources (i.e. backup, OC/Taser, etc). From a LE standpoint, officer safety is a higher priority than the medical needs of a hostile individual (then again, I am not EMS). Is this true within prehospital medicine, as well?


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## JPINFV (Feb 4, 2009)

emtfarva said:


> Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.



While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down unarmed patients. If this scenario was the same sans knife, then I see no reason why EMS shouldn't take down the patient provided there is enough people on scene to assist.


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## Sasha (Feb 4, 2009)

> While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down* unarmed *patients.



Keyword, unarmed.


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## BossyCow (Feb 4, 2009)

JPINFV said:


> While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down unarmed patients. If this scenario was the same sans knife, then I see no reason why EMS shouldn't take down the patient provided there is enough people on scene to assist.



Absolutely, the diabetic pt who goes combative on you, the sweet little old lady who wigs out, the drunk, anyone who just had the narcan take hold, and any one of a dozen or more examples where the pt who was compliant is suddently combative. 

I'm just saying if a pt has a knife, they are not yet my patient. I don't treat the armed. LEO can make the scene nice and safe first. Every scenario starts with "BSI and scene safe" this particular scenario didn't pass that test. I have to believe, as an instructor that this had to be a test on the ability of the responders to determine that the scene was not safe and not to enter.... I have to..... it couldn't have been otherwise because that would be.. well.. just crazy talk.


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## JPINFV (Feb 4, 2009)

BossyCow said:


> I'm just saying if a pt has a knife, they are not yet my patient.




Oh, I'm not arguing that. My issue was with Farva's blanket 'not taking patients down' post.


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## BossyCow (Feb 4, 2009)

JPINFV said:


> Oh, I'm not arguing that. My issue was with Farva's blanket 'not taking patients down' post.



That's why  the first word in my post.... the 'absolutely' was me agreeing with you.


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## JPINFV (Feb 4, 2009)

/me fails.




Sasha said:


> Keyword, unarmed.



...but it's only a flesh wound.


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## Sasha (Feb 4, 2009)

Sweetie, that's a t-shirt on a tree.


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## Veneficus (Feb 4, 2009)

WashboardSlim said:


> In my EMS class we've been running a lot of scenarios; it's gotten to the point where our primary goal for the time being is to restrain a "psyche patient" acted out by a fellow student.
> 
> I really have no idea if the most recent ones are realistic or not - basically we're supposed to assume any sort of LE has dropped off the face of the Earth, so it's just us (usually 4 members to a team) and the patient, who is apt to swinging, pulling hair/clothing, biting, etc.
> 
> ...



Your instructor should be fired for this kind of BS. At least reported to the state.

First there is more than enough to learn in class than how to fight (a guy with a knife or otherwise)

Second since you should never be engaging somebody with a weapon, why practice it?

Third, martial arts schools are better than EMS schools for learning how to attack or defend against a knife. It will also take longer than medic class to learn to be good at this.

But if you really want to know the best way to take down a guy with a knife:

Shoot him with a gun.

If he threatens to harm himself, let him, much easier to subdue an unconcious bleeding person.

Did your instructor bother to tell you the legal ramifications of wrestling with patients? It boils down to you are not allowed to harm them. They have no such limitation regarding you. 

If you find yourself suddenly confronted with a weapon run away and hide. (If you want to make this action sound heroic call it retreating and taking cover) If you cannot, forget medical help for this person, you are fighting for your life.


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## Explorer127 (Feb 4, 2009)

I have a question-

When would you use leather restraints instead of cravats to restrain someone? Which type of restraint is used more often? Why?

Also, do you prefer one over the other? Why?


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## JPINFV (Feb 4, 2009)

Personally, I'd take a commercial restraint (leather or nylon) over cravats any day of the week, especially since you can preattach commercial restraints to the gurney.


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## Veneficus (Feb 4, 2009)

Explorer127 said:


> I have a question-
> 
> When would you use leather restraints instead of cravats to restrain someone? Which type of restraint is used more often? Why?
> 
> Also, do you prefer one over the other? Why?




On the truck i like lots and lots of kling.

Leathers are great for extremely agitated patients. But usually a soft restraint will work for most. In my home state EMS persons are not permitted to use any nonhumane restraints.(aka handcuffs or anything else the pt can injure themselves on like zip ties)  So it is a soft restraint or leathers.(or Kerlex) 

When you engage leathers you have to wrap them with kerlex anyway and tape it. That makes it extremely difficult to work with prehospital. In addition there are straps as well as key locks on most of them. It could take the better part of 1/2 hour and 6-8 people to put somebody properly in leathers. Then when you get to the hospital you get to repaet the process because they have to come off your stretcher or board.

I also like to put diapers over their hands like boxing gloves to keep them from grabbing with their fingers.


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## emtfarva (Feb 5, 2009)

Ok, ok I understand there is a point that you may have to hold down a Pt that has a medical situation. I am talking a about a true psych call. not hypoglycemia or postdictal combative pt or s/p head injury. I am talking about a person who truly wants to kill himself or others. we should not be messing with these types of persons without police and the pt restrained. I understand that we may get a person that is just plain old combative because he forgot to eat after taking his insulin. in that case we may have to hold down the pt. I have never seen a diabetic pt (in my short time in ems) come after me with a knife and threating to kill me. I could be wrong. just throwing it ou there.


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## Jon (Feb 5, 2009)

If we REALLY need to take someone down, as Kip already alluded to, it takes 5 or more people - 1 to protect the head, and 1 for each limb. This requires practice, and prior knowledge - not "gee... figure it out".

It sounds like you are at the BLS level - How can your instructor find time to spend time to run multiple scenerios on this?


If the patient has a knife - they aren't a patient anymore - they are a potentially violent subject with a lethal weapon. You need to LEAVE. BEFORE THIS HAPPENS. If the knife comes out, you probably missed a bunch of warning signs... and you need to remove yourself from the situation and retreat to your truck to await LEO arrivial / scene secured.

When a former patient starts waving a lethal weapon - that's when the BIG RED BUTTON on your radio becomes your friend... put the call out... get help.


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## DT4EMS (Feb 5, 2009)

emtfarva said:


> Ok, ok I understand there is a point that you may have to hold down a Pt that has a medical situation. I am talking a about a true psych call. not hypoglycemia or postdictal combative pt or s/p head injury. I am talking about a person who truly wants to kill himself or others. we should not be messing with these types of persons without police and the pt restrained. I understand that we may get a person that is just plain old combative because he forgot to eat after taking his insulin. in that case we may have to hold down the pt. I have never seen a diabetic pt (in my short time in ems) come after me with a knife and threating to kill me. I could be wrong. just throwing it ou there.



I had one holding a knife in one hand and a grapefruit in the other years ago. He had already destroyed his house prior to our arrival. Threw a TV out of a window. It was due to hypoglycemia. 

Once officers had restrained him, a little D50 later he was golden.


Diabetics, especially younger ones have thought I was an "alien" or a monster when starting the medical treatment. 

This is why the Diabetic is listed in our section called "The 5 D's".

They are the Diabetic, Deranged, Domestic, Drugged, Drunk. We spend several hours on these during a Defensive Tactics 4 EMS course.

Please remember............ sometimes your internal drive to help someone else puts your safety at risk. You have to be vigilant in your personal safety.


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## WashboardSlim (Feb 5, 2009)

Holy cow! Has this turned into a discussion haha

First off I feel I should clarify some things. I wasn't very clear in my first post, but in no way, shape or form has our instructor's goal been to teach us how to suplex the mentally ill. 

The scenario which involved the knife I mentioned went like this:

Our team ran on a 17 y/o pt who was apparently very depressed and generally not feeling well. When we "arrived", she was sitting in the middle of the room and barely paid attention to us when we approached her. 

One student knelt down beside her to initiate a conversation and try to get some information while another started to get her blood pressure. She wouldn't really talk to either of them, she just kept asking "What are you going to do for me?" "Who are you?", etc. She waited until all FIVE (something I messed up on in my original post - there were five of us, not just four) members were within reach, then made her move.

Beneath her left thigh she was hiding a "knife" (red marker). She drew it without warning and went absolutely berserk, trying to "stab" anyone she could. 

So it wasn't so much sending in a group of EMT's to do actual LE work, but to get us to a point where we had no choice _but_ to try and restrain the pt for our own safety. The point of the exercises was to kind of hammer into our heads how quick a situation can go South and how far it can go. 

For instance, one time our instructor was in the back of an ambulance with a psyche pt when he suddenly decided to try and get out while they were going 55 down the freeway. 

Thank you guys so much for all the input! I understand a lot of you have been in real life situations like these and I'm pretty blown away.


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## Sapphyre (Feb 5, 2009)

Um, Yeah, Washboard.  That's why, here, calls that come in involving the pt being "depressed" usually have LE dispatched first.   Usually....  And, if the parents are telling me that their daughter is depressed, and LE's not there, and they're acting like that, I don't approach until we have extra resources, and have spoken about how we're going to handle it.


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## emtfarva (Feb 5, 2009)

WashboardSlim said:


> Beneath her left thigh she was hiding a "knife" (red marker). She drew it without warning and went absolutely berserk, trying to "stab" anyone she could.
> 
> So it wasn't so much sending in a group of EMT's to do actual LE work, but to get us to a point where we had no choice _but_ to try and restrain the pt for our own safety. The point of the exercises was to kind of hammer into our heads how quick a situation can go South and how far it can go.
> 
> ...



At that I would have left the area with all my crew and wait for PD. Only restrained the Pt to escape.


At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.


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## ffemt8978 (Feb 6, 2009)

emtfarva said:


> At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.



You may want to rethink that...if your patient is up and trying to get out of the ambulance, just what do you think will happen to them with the "dog stop"?

And what do you think the ramifications of that will be after you get done with your new trauma alert?


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## emtfarva (Feb 6, 2009)

ffemt8978 said:


> You may want to rethink that...if your patient is up and trying to get out of the ambulance, just what do you think will happen to them with the "dog stop"?
> 
> And what do you think the ramifications of that will be after you get done with your new trauma alert?



first of all I would prob only use a dog stop for a pt that is about to get up not up out of the stretcher. and if the pt was standing I would also be standing. I work in a van. not enough room. I should have worded that statment a little better. In the case you mentioned I would tell my partner to stop the truck when possible and let the pt get out if he wishes and again let PD deal with it. I would only really use a dog stop if the pt is trying to unbuckle his seatbelts and saying he wants to get up or out. I have never really used it. Most of my sections have been very coop. or I have orders to restrain them.


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## Sasha (Feb 6, 2009)

> At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.



I can totally see not chasing a psych patient after they have escaped, but to let them escape? Not even try and stop them? Really?


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## emtfarva (Feb 6, 2009)

Sasha said:


> I can totally see not chasing a psych patient after they have escaped, but to let them escape? Not even try and stop them? Really?



yep I am an emt not a poilce officer. I have not been trained to take down Pts. That is what law enforcement is for. I am not going to get killed. let PD, they get paid more than me. + they have guns and tasers, mace etc...
I have a clipboard and maybe an O2 tank which I am not really able to get at quickly.
I tell him that he can't do that but I will not stop him physically.


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## XxBigBrotherxX (Feb 6, 2009)

in my EMT-B class we were told that is is never our job to restrain patients..you have to remember that the safety of you and your crew members come before the pts safety. But personally if i was in a position where there was a hostile pt and i was being attacked...i would have to kick their ***...im sorry but im from the Bronx, NY. over here you learn and see how easily it is for a life to be lost, even if that was the intentions involved. Your life comes first..


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## BLSBoy (Feb 6, 2009)

XxBigBrotherxX said:


> in my EMT-B class we were told that is is never our job to restrain patients..you have to remember that the safety of you and your crew members come before the pts safety. But personally if i was in a position where there was a hostile pt and i was being attacked...i would have to kick their ***...im sorry but im from the Bronx, NY. over here you learn and see how easily it is for a life to be lost, even if that was the intentions involved. Your life comes first..



So you are gonna wait for PD to come out to restrain that diabetic with a BGL of 42, but is acting quite irrationally?

And yes, if you "kicked their ***", you WOULD be sorry. 

You use the _minimum_ amount of force necessary to escape the situation. 

I live and work in Atlantic City. 
Are we stating where we live/work now?
I thought that was to go in our info?<_<


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## Veneficus (Feb 6, 2009)

Sasha said:


> I can totally see not chasing a psych patient after they have escaped, but to let them escape? Not even try and stop them? Really?



cheer for the underdog. 

Run Forest!!! Run!!!


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## rescuepoppy (Feb 6, 2009)

You use the minimum amount of force necessary to escape the situation.
  BLSBoy I like that response. Minimum amount of force and escape the key points. If the patient comes out with a weapon after I get to them then whatever gear I brought in and layed in the floor will just stay there until the LEOs can get there to clear the scene.  My partner(s) and I will be somewher away from the patient until then. I made myself a promise a long time ago that I would not do anything on purpose to hurt myself,and I like me too well to take on someone who is armed.


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## ttoude (Feb 12, 2009)

My state (NM) offers a "CPI" training class on proper and safer ways to handle that. 

The problem is its such an obscure optional state training class that unless I worked here (Living support for the developmentally challenged) I NEVER would have known. Wonder if I could get CEU's for that........

Anyway, track down an company in your town that helps Challenged people to live on there own in private residences. There called group homes in NM, But in my home state a "group home" is for recent jail prisoner releases. So the names will vary state to state.

It might take some doing to find out what the companies/fields are called where you are but the training is uniform nation wide.

Try googleing Crisis Prevention institute. 

V.S. varies WIDELY in this particular community, as well

And just a tip, they use the back of their head as a last resort weapon, so NEVER stand directly behind a challenged individual. You WILL lose teeth when they swing their head back to defend themselves.


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## DT4EMS (Feb 12, 2009)

I can speak with a high level of certainty ( I have an intimate knowledge of NVCI/CPI) that CPI is NOT for use with a violent patient. 

(Read my other post with the letter I received)

CPI has great verbal de-escalation techniques. But the restrain techniques taught are things like "Children's Control Position" and the Team approach. 

CPI is great for dealing with small children, or people significantly smaller than the person applying the technique.

I would love to be on the stand to testify on behalf of a provider INJURED because they attempted to use a skill taught in CPI on a person trying to injure the provider.


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## ttoude (Feb 12, 2009)

Again this will vary by state, so dig deep. CPI in one state may be something different in another state.

In one house I work in is a 19 y/o autistic, a 23 y/o Bi-polar manic, and a 20 y/o severe MR. All with some level of independance and all really good guys. But in no way are they children and when a 260 lb man comes running at u full bore you quickly realize that psych restraint is REALLY important. 

Interestly after its all over, they appologize for the attack. I say no prob and we continue with our activity.

These guys are in a constant state of emotional disturbance and verbal redirection is always tried. Some times it comes down to protecting your resident (PT), housemates, staff and yourself. 

CPI, in my state

So how does all this tie into the topic? People who have made a career in this field deal on a constant daily basis what an average emt might see once a month.

I've been attacked up to 10 times in one day. So far no injuries to my guy or myself.

I feel very confident that when I get out of the bus and the AMS PT begins to behave poorly that I'll have a good idea what to do.


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## BossyCow (Feb 13, 2009)

For some reason pysch pts like me. Do they see me as a kindred spirit or just a few bad days away from where they are????


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## DT4EMS (Feb 13, 2009)

ttoude said:


> CPI, in my state
> 
> So how does all this tie into the topic? People who have made a career in this field deal on a constant daily basis what an average emt might see once a month.
> 
> ...



You make a good point with dealing with it daily. It is like the difference between a prison guard and a patrolman on the street. The prison guard KNOWs who he has to work with where the patrolman on the street may go from stopping a 90 y/o grandmother on the street to being in a all out fight for his life the next minute.

Those are the similar differences between working in an emergency setting like the ambulance or the ER vs. working a long term care situation where you know your pateint.

I still stand behind CPI when dealing with a person who has a decreased metal capacity due to MR or a child. But I will also see a person from a cross the witness stand when a patient or provider is assaulted by a person certified by CPI.

I commend you for doing what you do. Dealing with and caring for people who have disabilities takes a person with  strong moral character and a desire to help others.

Please don't take offense because none is meant. I have trained hundreds of people who have had CPI in the past and they will tell you it has no place in the emergency setting as a course for self-defense. 

Restraining a psych patient in the ER or in the field due to an spontaneous occurrence is a very, very dangerous thing. Agian, I am not talking about a MR person or a child with a behavioral disorder  like ADD or ADHD. The techniques taught in CPI/NVCI work well for them.


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## ttoude (Feb 13, 2009)

No offense taken. But I gotta stand by it. 

A 260 lb man that is fine one minute and has your hand in his mouth the next can happen in a living room or as you make the mistake of reaching across the PT to get a gause pack out of the bin. 

The CPI training I recived had one page for children and 49 pages on safe management of an adult having a "Behaviour" or what we call being violent. 

It's far more complex than I ever imagined. One excerise was targeted toward the pt grabing a handfull of a females hair and how to get a "release" without harm.

Another had me (5"11 220lbs) between to 5ft females bent at the waist in a way I could not grab, hit or bite & did not compromise the airway and the could "walk" me in any direction. maby I could post a pic of it.....

BUT, even the instructor said when it comes down to it "Defend yourself with as little force as possible" 

-Horror Story-
Our local PD has a special trained crisis team. A new employee called PD and they just came out tazed, cuffed, and arrested a 22 y/o non-vocal autistic.

When AMS PT's attack yes its bad but there ARE ways out there to "restrain" them till the cavalry gets there or till they agree to stop. 

My wish is that ALL EMS somehow could get what I've found out in the last 3 months. My guys are very lucky. They are in a SSi funded warm house. 

But NM has a 48 to 72 hr catch and release policy that puts guys like mine out on the street for EMS and Police to stumble across when the E.D.'s  prn's where off and they get violent.

Restraint was one of my biggest questions in class beside ped VS. Its tricky/sticky but please seek out these companies and find out what u can. AMS attacks actually deserve more consideration than they get


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## medic417 (Feb 13, 2009)

BossyCow said:


> just a few bad days away from where they are????



I think that applys to most of us long time EMS people.  If our elevators lose one more floor we are done.


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## ttoude (Feb 13, 2009)

BTW make no mistake my "guys" are 100% psych patients and routinely get violent.


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## firecoins (Feb 13, 2009)

I has a psych patient escape once after just leaving an ER for IFT to a psych hospital. I had the rig pull over before they jumped out. I talked them back into the rig but they would only sit in the front passenger seat.  I let them sit there for the ride back to the ER where they were chemically restrained before transfering them successfully to their final destination.


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## jamiga (Mar 26, 2009)

Just thought I would add something that an old medic told me during my clinicals...

I am not advocating this at all, but just wanted to share!


Scene: 20-something yr old female psych patient (naked) in a room, running around the room screaming. After much thought and deliberation between the EMS/Fire crew, they finally 'took her down' by using a simple sheet. I imagine they got a guy or two on each end of the sheet and ran on either side of the pt, wrapping her up like a taco.


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## ffmedic08 (Apr 19, 2009)

*Weellll....*

I'm going to assume that your instructor is giving you this scenario because 1) he wants to drill home the point of scene safety, and see if as a medic student- you can still think back to the basics, or 2) you did not know that the pt had a knife until half way through attempting to talk to the pt. 

As some have stated previously, the best form of action at this point is PD, and talking. You have got to converse with this pt long enough to get to know him, and his style. Its often not too hard to, for hte most part, figure him out and figure out what he's thinking and what he's doing. The more you talk and get to know  him- the easier it is to predict him and his potential. Even just small talk can often, eventually, get a pt to calm down. 

I understand where you are coming from with wanting info on how to prepare better for your instructors scenarios. My instructors threw a few of those at us as well - nad its hard. While you are in medic school - you automatically find yourself thinking too far into things... instaed- take a step back adn look at  the basics. 


Just a lil note from my experience... thats all.


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## ffmedic08 (Apr 19, 2009)

*ps.*

A maglight works well tucked into the lower of your back (into your pants or belt). It can serve as a pretty hefty self-defense tool, and usually the pt doesnt'  know you have it. Used this one quite frequently..


Also.. you never know when you will need a light!


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## ffmedic08 (Apr 19, 2009)

BossyCow said:


> For some reason pysch pts like me. Do they see me as a kindred spirit or just a few bad days away from where they are????



Same thoughts here! LOL!!!!


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## daedalus (May 2, 2009)

emtfarva said:


> Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.



Unfortunately, we do have to take down pysch patients. In fact, LAPD usually insists that we place our hands on the patient before they do, and if the patient resists, they than take over and do the hurting.


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## HotelCo (May 2, 2009)

daedalus said:


> Unfortunately, we do have to take down pysch patients. In fact, LAPD usually insists that we place our hands on the patient before they do, and if the patient resists, they than take over and do the hurting.



That doesn't go over well with me.

If the patient is being combative to the point where he is obviously going to swing at me, PD goes in and restrains them before I touch them. I'm not going to put myself in that situation.


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## CAOX3 (May 2, 2009)

I have to agree your instructor is an idiot.

Even if it is due to a medical condition if I or my partner is in jeopardy we dont get out.

Sorry.


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## EMTelite (May 3, 2009)

*Nman ftl  pe?*



marineman said:


> psych patient with a knife? Believe me I have plenty of time until a new class of cops get trained and put on the road. There is not a chance in hell I would step foot in that house. If the teacher says no law enforcement are available I would say that I'll be staging down the street at the diner with a cup of coffee until they become available and sit down.



Exactly lol... no point in running this scenario your scene is not safe why would you be there in the first place, the law requires that you and your partner are safe before you even enter the scene you do not have jurisdiction in dealing with combative patients if you have patient with anything that even resembles a knife you better be on the phone with PD


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## ffemt8978 (May 3, 2009)

EMTelite said:


> Exactly lol... no point in running this scenario your scene is not safe why would you be there in the first place, the law requires that you and your partner are safe before you even enter the scene you do not have jurisdiction in dealing with combative patients if you have patient with anything that even resembles a knife you better be on the phone with PD



You actually have a law in your area that states you can only enter "safe" scenes?  I would love to see that law.


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## DV_EMT (May 3, 2009)

B-52... anyone?

but in all seriousness... if the scene isnt safe... or turns into not being safe... get outta there. im pretty sure life outweighs everything else in the world. B)


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