# Run of combative patients recently...



## Grady_emt (Aug 23, 2008)

For some reason I have had a run of combative patients recently. Have not had a decent trauma or cardiac patient in weeks now.  Two post-ictal siezure patients, and overdose on unkn substance, an organic brain disease pt in a nursing home...   


It all came to a head last night when we had an ETOH family member who felt the need to dictate our treatment plan to us and then try to enforce it.  He went straight from calm and cool to screaming, and posturing in a threatening manner.  Unfortunately we were in the back bedroom of the house and were in the process of packaging his mother from a GLF in the tub.  As I keyed up my radio to ask radio get PD enroute, he kept screaming and radio heard him.  The dispatcher automatically activated a "signal 63" or "UNIT NEEDS HELP" without me asking, as she thought we were in deeper trouble than we were thank goodness.  

_A signal 63 activation is only to be used when an unit is in imminent danger and does the following: Notifies all upper level management, starts both Supervisors, starts the next closest unit, two AFD engines one of which must be ALS, Atlanta Police, Fulton County Sheriff, Fulton County Marshall, and Georgia State Patrol.  If we are near the city limits, then the next municipality's PD will be requested as well.  All radio traffic on that channel is moved to our TAC channel until the call is cleared_

My partner and I attempted to exit the residence which only further irritated him and he kept attempting to block our primary exit route. I started working towards the back door when he took a swing at me. I used his momentum from the missed punch and pushed him to the ground where I managed to get both his hands behind him and keep him pinned to the ground with my partner's assistance.  Within 4 minutes of my original help request APD was onscene and all other agencys were pulling into the neighborhood.  

After being placed into custody by APD, he began resisting the officers and was OC sprayed, and then transported in custody by our 2nd due unit. Our supervisor allowed us to go home following the call if we chose to, however we both stayed and continued the shift.  

Please, Please, Please, make sure that your agency has an organized plan should you ever be in a situation where you need help quickly.  We didnt until one of our crews had a gun drawn on them by an deranged family member a few years ago.  We now have status checks after 20 minutes onscene and every 10 thereafter, as well as our "Signal 63/UNIT NEEDS HELP".

Grateful to go home in one piece, except for a few scrapes and bruises from the tussle on the floor, I'm ready for a vacation.


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## reaper (Aug 23, 2008)

We have the same thing. When you activate it, they switch all traffic to another channel. Then they send anything avalible in the area. They will send the dog catcher, if he is close!!


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## Sparky79 (Aug 24, 2008)

I live in a very small town (pop. approx 3000) and we are surrounded by other small towns. We are a call department but have a full time police dept. Because of the fact that we are a small community the police are not terribly busy and are almost always on scene before EMS. This is very helpful in a couple different ways. 

#1 the police on scene at every call helps to ensure scene safety, and helps to keep things from getting out of hand. The police have assisted us with quite a few unruly family members.

#2 All of our officers are trained first responders, they are able to start O2 admin. and give the ambulance a patient update while we are in route so we have somewhat of an idea what we are going to need from the truck when we arrive on scene.


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## DT4EMS (Aug 24, 2008)

Grady,

You and your dispatch acted correctly. If dispatch could hear aggressive yelling over your radio.............. they better send the calvary! 

I liked reading you attempted to go to the exit but he kept blocking it. That is a crucial part of a "self-defense" situation. 

Please, please follow up with the prosecution. Even if it is a low charge. Each time one of these "POS"= piece of.... gets in front of a judge, we start to change minds. They WILL begin to see the number of EMS providers that get attacked.

Now, you were lucky he was not armed, or you were not injured. Good job none the less!


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## Airwaygoddess (Aug 24, 2008)

*Planning works!*

Thank goodness that you and your partner are safe, and Kudos for your dispathers!  Hope you get to go on vacation soon Grady!


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## Grady_emt (Aug 25, 2008)

The subject was jailed for an outstanding warrant, disorderly conduct, resisting arrest, attempting to flee, attempted assault on public safety x 4, and  Felony Obstruction of EMS (min 1 yr prison, max 5 yrs   http://www.lexis-nexis.com/hottopics/gacode/default.asp O.C.G.A. § 16-10-24.2 )

He was denied bond due to the circumstances of the incident leading to his arrest and being deemed a threat to the general public and a flight risk.


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## DT4EMS (Aug 25, 2008)

Grady_emt said:


> The subject was jailed for an outstanding warrant, disorderly conduct, resisting arrest, attempting to flee, attempted assault on public safety x 4, and  Felony Obstruction of EMS (min 1 yr prison, max 5 yrs   http://www.lexis-nexis.com/hottopics/gacode/default.asp O.C.G.A. § 16-10-24.2 )
> 
> He was denied bond due to the circumstances of the incident leading to his arrest and being deemed a threat to the general public and a flight risk.




Out-Friggin-Standing!!!! Now that's what I am talking about!

Kip


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## aussieemt1980 (Sep 1, 2008)

Here in NSW the state ambulance trucks have a little red button on the computers. Pressing this button will:

1. Activate an alarm on the computers of the dispatch centre;
2. Send the GPS coordinates of the truck;
3. Cause the dispatcher to activate police and back up units;
4. lock up the computer systems until some one resets the alarms.

It is a silent alarm, and I know of a newbie that accidently pressed it in the station while doing something, a few minutes later the police rocks up, lights and sirens blazing as they were under duress. The newbie got into trouble because the dispatchers could not reset the system for 3 hours, and it locked an entire region up, so they had to do manual dispatch.

A good funny thing that I like to do is if I am asked to get something off the computer, I will come back and say "I hope that the information was in the section where you press the red button" and watch them turn pale.

We do get the occasional combative patient / bystander. There are new procedures in the state service that allows the medic to restrain a patient if they are combative, but they have not been extended to the private services (thank god, I can see some misuse of it). We handle the situation by avoinding confrontation and exiting ASAP, and waiting for the police (or security - depending on where we are) to arrive. That and both my partner and I are ex military - so we can handle the situation effectively.

It does not come up that often quite surprisingly, motor sport is of the nature that if the patient becomes combative, they are generally too injured to do anything about it. 

A bystander might jump in "I have a first aid certificate, so I am the equivalent of a doctor trauma specialist, so I will take over now thank you for your help" so I generally send them on some errand to make them feel that they are part of the scene. One day one of them will eventually twig that I actually bought an oxygen unit over with me, or that there is no such thing as the "Medical Detwitting Unit" in the truck (funny, when asked if they know what it is, they always invariably say "Yes! I was trained on that...."). "Der, um, I could not find it", "It is ok, I dont need it now as I am finished" (while thinking that the unit worked, the twit was out of my way).


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## mycrofft (Sep 4, 2008)

*I'm surrounded by officers but stilll...*

I'm cheered not to be reading the old "I was in the back when the pt went off and I accidentally hit him with a D cylinder" story here. We occasionally went "hands on" in my old civilian days, but looking back it was usually unnecessary except for the fact that it was tying up 30% of the city's ambulance coverage while we talked to resistive and assaultive weirdos.

I don't believe in proportionate response, I believe in leaving if it gets too tense, and if backup arrives, I don't want a "fair fight", I want enough "presence" to prevent the balloon going up at all.

(Worst wound my field partners ever received? 15 y/o girl, about 96 lbs. high on Elavil, fighting off him, two Security Police, and myself on a stairway landing; bit him on the arm, below his summer length fatigue sleeves. She snagged my long sleeve, but no beef).


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## EMTDON970 (Sep 4, 2008)

I believe all psyche calls that are violent is a police matter UNLESS they have cut themselves and have pretty substantial bleeding or have Overdosed and is unconscious.

Why jepoardize an EMS crew, we are not cops we are EMS crews.


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## BossyCow (Sep 5, 2008)

EMTDON970 said:


> I believe all psyche calls that are violent is a police matter UNLESS they have cut themselves and have pretty substantial bleeding or have Overdosed and is unconscious.
> 
> Why jepoardize an EMS crew, we are not cops we are EMS crews.



So, if you know going in that the pt is psych and violent, you call for LEO support. What about that pt that doesn't present as either psych or violent until they are in the back of your rig?


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## EMTDON970 (Sep 6, 2008)

BossyCow said:


> So, if you know going in that the pt is psych and violent, you call for LEO support. What about that pt that doesn't present as either psych or violent until they are in the back of your rig?





LEO?? whos he?


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## Epi-do (Sep 6, 2008)

LEO = Law Enforcement Officer


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## mycrofft (Sep 6, 2008)

*I thought you meant my cousin Leo!*

I'm with BossyCow. Forget "fair fights" , gimme the "blue tide" any day. Often the street officers know these folks already anyway.


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## BossyCow (Sep 8, 2008)

So, Grady, are you starting to wonder if maybe its you? Are you doing something that is just p:censored:ing people off?


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## Grady_emt (Sep 10, 2008)

yourself BossyCow :unsure:


Yes, that did cross my mind though.


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## Airwaygoddess (Sep 10, 2008)

*Paging the Crazy car!*

I can see it now.........  "Confused, Combative, Call Grady!!  
poor Grady...........^_^


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## EMTDON970 (Sep 13, 2008)

Had a"combative" pat teh other night, a prisoner from jail, wasnt so combative with all the jail guards around him, its beyond me why a prisoner who is being violent that is already in jail needs to go to the hospitsl for a psych eveluation.

He was 302'd (involuntary) 13 times and arested 6 times..

waste of resource....


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## medicp94dao (Sep 14, 2008)

I am sure I am not the only one in here that comes from a tactical EMS background i.e; Military and Police. That being said.... I was doing some ER time. I had just finished talking with the ER doc ( former SF Medic turned MD ) and the charge nurse about a pt, when we heard someone scream... a pt who WAS in restraints had somehow managed to get loose and was chasing an ER nurse. Myself, the Dr., and two other medics grabbed the guy. The other medics were also military background. We had the guy on the ground with numerous arm bars and pressure points so fast he didnt know what hit him. By the time security arrived with new restraints, the pt was complaining we were too rough...... and wanted security to arrest us. Before anyone says we should've waited for security or we put ourselves in danger... You know you probably would of done the same......


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## downunderwunda (Feb 7, 2009)

aussieemt1980 said:


> Here in NSW the state ambulance trucks have a little red button on the computers. Pressing this button will:
> 
> 1. Activate an alarm on the computers of the dispatch centre;
> 2. Send the GPS coordinates of the truck;
> ...



I realise this is a rather old thread, however the inaccuracies in the quoted post need to be addressed.



> Here in NSW the state ambulance trucks have a little red button on the computers. Pressing this button will:
> 
> 1. Activate an alarm on the computers of the dispatch centre;
> 2. Send the GPS coordinates of the truck;
> ...



There is not a little red button on the computers, never has been. There is a button sequence that needs to be pressed to activae to avoid false alarms.

In the event of what was described, i have serious doubts of what was described with police arriving. Firstly, there is a protocol dispatch have to follow on the activation of an alarm. They will attempt to call the car by radio. If unsucsessful, they jknow the vehicle is situated on station & what other staff will be on station, so they would attempt to call the station. Then, & only then would they have police dispatched. 

The 'newbie' would have been spoken to, but not goytten into trouble as described as the system lock up is a computer programming problem, not an issue caused by them.

Please ensure you have your facts right before posyting & trying to discredit the transport service in the state. I have seen from your posts that you believe we are all idiots & you are far superior to us all. Well if that is the case, please, join us & impart your knowledge & expertice on us. You can still continue your studies while employed by us & provided you pass they will pay yr Uni fees.


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## aussieemt1980 (Feb 8, 2009)

Thank you for that clarification, I was going off what the ambo told me, so it looks like that he was yanking my chain a little (and maybe the pale faces was "oh my god" from the frogs).

I do respect what ASNSW does. I have a lot of respect for what you guys (and girls) have to face everyday and are a credit to the communities that you serve. Please do not assume that I am writing you all off, as I am not. As I have mentioned in previous posts, ASNSW is always called upon for transport for my patients, and we work alongside ASNSW at many events.


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## downunderwunda (Feb 8, 2009)

I would suggest you verify your "facts" before you publish them here or anywhere else.


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## ffemt8978 (Feb 8, 2009)

downunderwunda said:


> I would suggest you verify your "facts" before you publish them here or anywhere else.



Play nice or play elsewhere...


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## downunderwunda (Mar 13, 2009)

ffemt8978 said:


> Play nice or play elsewhere...




When is the suggestion that a person publish correct detail on here not playing nice. Surely it is more important to have correct detail than embilished BS. I dont understand why I am being chastised here. I want acuracy in this thread. What was posted was not just inaccurate, but blatanly wrong. 

Not only was it wron, it was posted by a person outside the organisation. Someone who has no idea of the proceedures in place. To ask them to verify fact is wrong how???????????????


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## curt (Mar 26, 2009)

EMTDON970 said:


> I believe all psyche calls that are violent is a police matter UNLESS they have cut themselves and have pretty substantial bleeding or have Overdosed and is unconscious.
> 
> Why jepoardize an EMS crew, we are not cops we are EMS crews.



I don't know about that. I know that we're not really the ideal service to deal with violent psychs, besides it never being exactly pleasant, but you can't ignore the possibility that it's being caused by an underlying medical problem, such as CO poisoning or hypoxia. It'd be a shame if they were hauled off to jail for the night and, in turn, kicked off because nobody bothered to look for a medical emergency until it was too late.


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## DT4EMS (Mar 27, 2009)

curt said:


> I don't know about that. I know that we're not really the ideal service to deal with violent psychs, besides it never being exactly pleasant, but you can't ignore the possibility that it's being caused by an underlying medical problem, such as CO poisoning or hypoxia. It'd be a shame if they were hauled off to jail for the night and, in turn, kicked off because nobody bothered to look for a medical emergency until it was too late.




Agreed............with caution. With the number one on-the-job injury coming by way of assaults......... if they are willing and able to fight you........... police handle first. Police restrain THEN provide medical treatment.

Research Graham v. Connor and you will see that you don't always have to be "right" you just have to be "reasonable". 

Always error on the side of SAFETY................ yours.

Kip


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