# Sensing danger?



## RedAirplane (Jun 3, 2015)

Scene safety is always taught as a priority, but determining whether you're safe is not always clear. What would you do in this situation?

You are called to a scene by police for an altered 65 year old male. The patient is alert but not really oriented, and is sitting upright but unable to stand without assistance. Clues suggest he has been drinking. The patient is pink, warm, and dry. The pt insists he will not be taken anywhere, but PD says "you have to go with these guys" and hands the pt over to us and vanishes.

Sensing no apparent danger, you begin transport. You ask the patient if he takes any medications, and he produces a few Walgreen's Rx bottles, some of which have pills, others have weed. He then becomes agitated and implies that you stole his drugs, and that if by the time he counts down from 10 you don't release him, he will... (unspecified).

He begins counting...
9... 10... 11... 10... 9... 6... 7... 8... 10...

Thankfully at this point we arrived and quickly turned over the patient to the nurse/security. If you were alone during this bizarre countdown, what would you do? Is it just an altered person rambling, or is there any danger?


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## luke_31 (Jun 3, 2015)

I always take threats seriously and would move out of his reach. Informing your partner that there may be a problem and finding out eta to the er would be good. Also if it worsens get your partner to stop, get out, and regroup getting PD involved if the patient is getting violent. Elderly altered patients can be surprisingly strong


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## medicaltransient (Jun 3, 2015)

I like 5 of midazolam IN. I prefer to sedate or restrain a pt and transport myself than let PD transport. In the past I rode in the front of a police car with a bvm and a o2 can with the box following us because I felt the pt was legitimately ill and too violent to attempt moving from the cruiser to the box.


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## Medic Tim (Jun 3, 2015)

Wouldn't happen where I am. If police request transport they have to accompany.

For the sake of the argument I would back off and if he wants to leave he is free to leave. I am not putting myself at risk by trying to keep the idiot in the truck.


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## gotbeerz001 (Jun 3, 2015)

If police say "you have to go", then he is on a green sheet. 
If he is on a green sheet and I suspect any actual instability in his mental state then he gets 2-point restraints.


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## Ewok Jerky (Jun 3, 2015)

I would hand his pill bottles back.

I always keep my eyes open with altered patients, they are altered after all.  Keep a safe distance, don't provoke or agitate them, use seat-belts AND shoulder straps (should do that anyways).  We have a radio code to request PD Code 3 to our location, had to use that once while on scene not during transport. When all else fails pull over and get out and let the Pt hang out in the back all alone or get up an walk away if that's their prerogative.  I'm not putting my health in jeopordy.


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## COmedic17 (Jun 3, 2015)

Lmao. 

I kinda like the crazy people. It keeps it fun.


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## Carlos Danger (Jun 3, 2015)

medicaltransient said:


> I like 5 of midazolam IN. I prefer to sedate or restrain a pt and transport myself than let PD transport.



To each his own, I guess, but I'm not forcing anyone to go anywhere.

If they are a danger to themselves or others, the cops can take them. If the cops won't do their job and take them and they don't want to go, well, it's just outta my hands....I'm a paramedic, not a cop or a prison guard. I'm certainly not wrestling anyone so that I can get them into restraints or force a syringe up their nose. How do I know what kind of weapon they have in their pocket, or what kind of kung-fu they've mastered?

I don't know what kind of bad-a** training you got on that stuff, but it wasn't part of my paramedic training, and I never made nearly enough to risk my life forcing someone to do something they didn't want to do.


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## medicaltransient (Jun 4, 2015)

Remi said:


> To each his own, I guess, but I'm not forcing anyone to go anywhere.
> 
> If they are a danger to themselves or others, the cops can take them. If the cops won't do their job and take them and they don't want to go, well, it's just outta my hands....I'm a paramedic, not a cop or a prison guard. I'm certainly not wrestling anyone so that I can get them into restraints or force a syringe up their nose. How do I know what kind of weapon they have in their pocket, or what kind of kung-fu they've mastered?
> 
> I don't know what kind of bad-a** training you got on that stuff, but it wasn't part of my paramedic training, and I never made nearly enough to risk my life forcing someone to do something they didn't want to do.


The pt is in altered mental status. I worry about the pt being transported by PD and dyeing of positional asphyxiation, I think there is some liability in a PD transport. Not as much as a refusal but still some.


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## RocketMedic (Jun 5, 2015)

Dyeing? As in coloration of fabric?


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## medicaltransient (Jun 5, 2015)

RocketMedic said:


> Dyeing? As in coloration of fabric?


Ok I wasn't a spelling bee champion like you were.


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## RocketMedic (Jun 6, 2015)

It's that fancy college book-learnin'. Helps with the words and such.

Also, arrogance. It helps to know I have mastered the English language.


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## Rialaigh (Jun 6, 2015)

Have my partner pull in a parking lot, help the patient undue the straps on the stretcher, hand him his pill bottles, and assist him down the side steps of the ambulance, have a nice day sir....call pd and pull around the corner and wait. Patient can either go in law enforcement custody with handcuffs on at this point or they have every right to refuse.


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