# Teen jumps from ambulance, dies



## bstone (Mar 1, 2010)

> Greenville County coroner Mike Ellis told News 4 that Ryan Emory, 16, was restrained on a gurney in the back of an ambulance when he loosened his restraints, got past the EMT with him, opened the door and jumped out the moving vehicle. He landed in the road, tumbled several times and went into cardiac arrest, Ellis said.



http://www.wyff4.com/news/22700850/detail.html?hpt=T2


I doubt they had on 4 point restraints. Most likely just the seatbelts on the cot.


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## FLEMTP (Mar 1, 2010)

Im curious how the EMT or medic missed this going on...?  

I'd also like to know more of the circumstances surrounding the reason for transport.. whether it was a psych patient, or just some kid who didnt want to go to the ER... either way, IMHO the EMT or Medic in back was negligent... and breached their duty to act... but that is based on the facts at hand as of right now. That opinion may change should more information come to light


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## reaper (Mar 1, 2010)

Lets see. This was a Psych transport. The teen was rather large for his age. Maybe the EMT was not able to control him. Four points do not keep anyone on a stretcher.

The fault here lies with the Dr that sent this transport, with no sedation, for and 1.5 hour trip!


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## EMSLaw (Mar 1, 2010)

reaper said:


> Lets see. This was a Psych transport. The teen was rather large for his age. Maybe the EMT was not able to control him. Four points do not keep anyone on a stretcher.
> 
> The fault here lies with the Dr that sent this transport, with no sedation, for and 1.5 hour trip!



Not sure where the blame lies, but an EMT in the back of an ambulance is not exactly well-positioned to stop a patient from jumping out the back of the rig.  For one thing, people don't usually want to jump out the back of a moving ambulance, so it's not the sort of thing the designers planned to stop!  

Sitting to the side or behind the patient, in a moving ambulance (a confined space), if the patient suddenly gets free of the restraints and wants to get out, it's going to be difficult to stop, unless you want to clobber them with an O2 bottle.  And even if you managed to struggle with the patient, all they have to do is get away from the EMT for a few seconds and they can be out the door.  

Without knowing more, I wouldn't be so quick to blame the EMT or medic.


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## Veneficus (Mar 1, 2010)

Why would you want to try and stop them?

I have wrestled with a couple of psych patients by myself in the back of a moving squad. I have even ran a couple down on foot.

In hind sight I think it was extremely foolish. 

There are needles and scissors and scalpels and all manner of improvised weapons. Not to mention getting pushed or pulled out by/with the patient.

The best part is they can hurt you, but you cannot hurt them. Go ahead and punch somebody down or take a swat at them with an O2 tank and take a gamble on how that plays out.

Let him jump then work it as a trauma. Scene is unsafe, you may not have the ability to leave, (moving vehicle and all) but if the patient is willing to leave, why stop him?

I agree with the idea this person should have been chemically restrained.

Prolong QT be damned, Mag Sulfate for all.


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## mississippimedic (Mar 1, 2010)

I'm not going to fight anyboby that's trying to get out the back door, better them than me going splat on the road.


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## DT4EMS (Mar 1, 2010)

According to the story..... the teen was brought in after he assaulted his grandmother.......

There is a claim he was Autistic. 


If he wanted out......he gets out.....period. What training does the "average" EMS provider have to physically restrain someone.......alone.........in the back of a moving ambulance.

I will stand with the EMT on this one. I bet he was doing the best he could during this "Oh Sh**! " moment.

This happens quite a bit. I just finished an interview where something very similar happened here.........where according to admin.........this type of thing never happens.

*Note* Whacking someone with an O2 Bottle is bad ju-ju for restraints..............


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## TransportJockey (Mar 1, 2010)

I'm gonna have to agree wtih everyone. What says he didn't yell up to his partner to stop the rig but the pt got out before that could happen?


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## Veneficus (Mar 1, 2010)

DT4EMS said:


> *Note* Whacking someone with an O2 Bottle is bad ju-ju for restraints..............



And your freedom, job, and license...


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## FLEMTP (Mar 2, 2010)

reaper said:


> Lets see. This was a Psych transport. The teen was rather large for his age. Maybe the EMT was not able to control him. Four points do not keep anyone on a stretcher.
> 
> The fault here lies with the Dr that sent this transport, with no sedation, for and 1.5 hour trip!



And the EMT has no fault in this for not asking that the patient be sedated appropriately? 

nothing says you have to put an IFT patient in your rig if you're not comfortable with the transport. 

You must be a patient advocate... and an advocate for you and your crew.


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## reaper (Mar 2, 2010)

FLEMTP said:


> And the EMT has no fault in this for not asking that the patient be sedated appropriately?
> 
> nothing says you have to put an IFT patient in your rig if you're not comfortable with the transport.
> 
> You must be a patient advocate... and an advocate for you and your crew.



This shows no experience with psych Pt's. You don't always know that a pt plans on flipping out on you, prior to the event. They can be the sweetest person in the world, till it happens. We cannot request that every psych pt be sedated, just in case.

The medic did everything they could in this case, including trying to stop it from happening. They were over powered. Nothing that could be done. If the Dr knew that the pt had violent tendencies, then that is where it needed to start.


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## Sasha (Mar 2, 2010)

FLEMTP said:


> And the EMT has no fault in this for not asking that the patient be sedated appropriately?
> 
> nothing says you have to put an IFT patient in your rig if you're not comfortable with the transport.
> 
> You must be a patient advocate... and an advocate for you and your crew.



You must have only had to deal with nice, predictable psychs! Not the ones who go from normal to crazy in five seconds! Sometimes you only realize you need sedation when it is too late. And sometimes sedation just doesn't work. I have seen a psych "fight" ativan.


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## Dreadnought (Mar 2, 2010)

That's a fine example of natural selection


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## AnthonyM83 (Mar 3, 2010)

FLEMTP said:


> Im curious how the EMT or medic missed this going on...?


 Oh, that's the simplest answer, yet. Do you realize how long this "going on" takes? Patient can be totally kicked back and relaxed on second. Have both seatbelts off in 2 seconds, out the door by the 3rd second.

Provided you're wearing your seatbelt, too, and have a 1 second reaction time, to just dive tackle him (which would be stupid if patient is larger than you...last one who got rowdy in my rig was over 6 feet and thick), then MAYBE there's a chance you'd have time to pull over before he got out. Plus, think of the safety risk of grabbing at someone who's in process of opening doors...very likely you'll be falling out with him/her.

And realistically, we don't have those perfect reaction times and aren't always built to fight every patient type.

You said finding out more information might change your stance...but how about finding out more information FIRST, THEN determining your stance.


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## zmedic (Mar 3, 2010)

Two things we used to do with psych transports that may have helped. One was locking the door once we were in. The second is when you put the seatbelts on, put the release side on upside down, so the button is towards the patients body. Having the button down makes it take an extra couple of seconds to access the button, and the patient also has to figure out how to unlock the door. Those ten seconds or so should be enough time to yell to your partner to stop and for them to quickly pull over and stop. Again, not fool proof but why wouldn't you at least lock the door?


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## reaper (Mar 3, 2010)

I learned a long time ago that the seatbelt trick does not slow anyone down.

I never lock the doors with a pt in the back. Not only for safety reasons in a wreck, But I dont want a pt trapped in the back with me, if they flip out. I would rather they jump and hope we can get slowed down enough, in time!


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## rhan101277 (Mar 3, 2010)

Paramedics over here can give Haldol 5mg IM to patients who we see as a danger to themselves or others without med control contact.

I guess they thought he was under control.


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## FLEMTP (Mar 3, 2010)

Sorry some of you don't agree with me.. I also have a somewhat different perspective of things.. coming also from a law enforcement background.. and I've had training in restraint techniques and defensive tactics so I don't shy away from putting a patient back on the stretcher when they try and hop up. I also make it a point to sit next to them on the bench seat and not behind them in the jump seat.. so they know I am watching.. and I can use distraction techniques to prevent them from becoming preoccupied with the idea of bailing out. I also have a code word with my partner so if they do attempt to get up or if its my partner in back, we yell out the special code word which tells the person driving to slam on the brakes as hard as they can so the patient is thrown off balance. 

Lots of little things you can do to prevent a psych patient from bailing. Using the excuse that they are too fast or too big for you, etc etc isn't an excuse for protecting you and your patient. 

I know some of you will disagree.. but oh well.. in a perfect world right?^_^


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## FLEMTP (Mar 3, 2010)

reaper said:


> This shows no experience with psych Pt's. You don't always know that a pt plans on flipping out on you, prior to the event. They can be the sweetest person in the world, till it happens. We cannot request that every psych pt be sedated, just in case.
> 
> The medic did everything they could in this case, including trying to stop it from happening. They were over powered. Nothing that could be done. If the Dr knew that the pt had violent tendencies, then that is where it needed to start.





Oh, and just so you don't continue to have a perception that I have no experience with psych patients, the agency I worked with in detroit did a LARGE number of psych transfers... to the point where they would run a dedicated BLS car who would spend all night (12 hours) doing nothing but psych transfers.  Even though I was a paramedic, I LOVED picking up overtime on this unit and did it frequently.. so I have extensive experience with psych patients, and in the year and a half I worked there, never had a patient successfully bail out of my ambulance on me... and ive had more than a few give it a shot...so it kind of mystifies me how people can have it happen to them.

I also was required as part of my paramedic program to do 48 hours of psychiatric rotations on a locked down psychiatric inpatient facility, where we were expected to learn the basic principles of dealing with psychiatric patients, including appropriate pharmacological restraint techniques and appropriate medication of those patients in the emergency setting.


I would make the ground rules very clear in the beginning of my transfer to the patient... 

1. you WILL stay on the stretcher at all times even if you are able to walk
2. Seatbelts remained fastened at all times.. all 5 of them (shoulder harness) 
    and if they attempt to remove or unbuckle any of them without my help, 
    they go into restraints no questions asked.
3. Let me know if you need anything to make you more comfortable, air 
    conditioning, heat, etc. 

Most importantly I treated them with respect and treated them humane while sticking to the rules. Had problems with very few of them.  As I said in another post.. i remained seated NEXT to them at all times and engaged them in conversation if they were capable of it ( not sedated or completely out of it)


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## AnthonyM83 (Mar 3, 2010)

FLEMTP said:


> Sorry some of you don't agree with me.. I also have a somewhat different perspective of things.. coming also from a law enforcement background.. and I've had training in restraint techniques and defensive tactics so I don't shy away from putting a patient back on the stretcher when they try and hop up. I also make it a point to sit next to them on the bench seat and not behind them in the jump seat.. so they know I am watching.. and I can use distraction techniques to prevent them from becoming preoccupied with the idea of bailing out. I also have a code word with my partner so if they do attempt to get up or if its my partner in back, we yell out the special code word which tells the person driving to slam on the brakes as hard as they can so the patient is thrown off balance.
> 
> Lots of little things you can do to prevent a psych patient from bailing. Using the excuse that they are too fast or too big for you, etc etc isn't an excuse for protecting you and your patient.
> 
> I know some of you will disagree.. but oh well.. in a perfect world right?^_^



Though I was not a police officer, I meet every criteria and do everything you do that you mentioned in your post above (LE type hx, code word, sit next to them, have no problem getting physical, etc). Everything. YET, I might still have a patient leap out without prior warning (like being agitated, accessory muscle flexing, fumbling with belt, etc).

And we only have a lap belt and leg belt. Provided it's a "mod"/box ambulance, I can go from reclined and seatbelted to out the door in LESS than 2 seconds. How long would it take you to go from sitting, pen and clipboard in hands, seatbelted, to physically on me provided I was completely calm with no prior signs of agitation? AND remember, you wouldn't want to tackle me once I was within arms reach of door, because if I roll out and have a grip on your, you're likely rolling out with me (depending on my size).


ADDITIONALLY, how much defensive tacts, arrest & control, and reaction type education, scenarios, and testing did you received compared to that received at EMT training?

Everything above combined answers your question of: how did the EMTs not see this going on....


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## LucidResq (Mar 3, 2010)

I personally know a medic who, while an EMT, had a properly restrained psych patient jump out of the back of her rig. 

She was thoroughly investigated and found not to be at fault. 

FLEMTP, it's funny that you mention offering to make temperature adjustments and such for your patient, because that's how this incident happened. Over a lengthy transport the patient requested several adjustments such as A/C, heat etc, and while the EMT briefly adjusted them or spoke to the medic driving to relay the requests, the patient slowly adjusted her restraints enough to permit her to bolt.


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