# Attitude adjustment



## certguy (Nov 11, 2007)

My partner and I responded to a large prison for a prisoner down with a head injury . On our arrival at the dispensary , we saw a big , buffed out gorilla of a guy in c - spine . ( does anybody else think it's crazy to give convicted felons lots of wieghts to pump in the joint ?? ) The story was , he took on several guards who were trying to extract him from his cell , and when they finally tackled him , he hit his head on the way down . All v/s normal , no loc , a&ox4 , no n/v or visual disturbances , good neuro's , just a large hematoma to the occipital area . They wanted him transported to a county hosp . for further eval . So , with a guard in back with me and a chase car following , off we went . On the way , this guy really got on my nerves , yelling , cussing , spitting , trying to pull out of c - spine , and generally doing all he could to be anti - social . The guard said this behavior was normal for him . I put a mask on him , taped across his eyebrows for that little pain reminder to stay on the board , and even had to stop in the middle of my radio report to tell him to shut the h--- up ! When we got to the hosp. , the dr on duty , a small , cute female who made up for her size with the attitude of a grizzly , came in to take report . Our pt. proceeded to tell her in graphic detail , everything he'd like to do to her . She calmly said they got off to a bad start , asked him to hold that thought , then walked around to the head of the board , lifted it about 8 inches and dropped it ! OOPS !!!! my partner and I  looked at each other , shook our heads , and said  WE DID NOT SEE THAT ! Pt. let out a loud scream ( good thing it was the middle of the night and the ER was empty ) the tears were rolling , and every answer afterward was yes mam , no mam . Gee , no more bad attitude .


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## Anomalous (Nov 11, 2007)

Similar patient minus the prison part.  Similar doc.  NG tube did the trick.


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## MMiz (Nov 11, 2007)

Great story!


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## Rattletrap (Nov 11, 2007)

They use foley cath's as dry as possible around here


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## Onceamedic (Nov 11, 2007)

I can honestly say that I've never seen that sort of thing done.  They come in in cuffs, sometimes in the onion bags (spitters) and I'm sure that the cops that bring them in have roughed them up to get the cuffs or other restraints on them.  Once in the ED tho, we get drs. orders to restrain and/or hit them with vitamin H.  There is no need for health care providers whether drs. or paramedics to "adjust" anyone's attitude in the way you describe.  It's just plain unprofessional.


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## firetender (Nov 11, 2007)

Kaisu said:


> I can honestly say that I've never seen that sort of thing done. They come in in cuffs, sometimes in the onion bags (spitters) and I'm sure that the cops that bring them in have roughed them up to get the cuffs or other restraints on them. Once in the ED tho, we get drs. orders to restrain and/or hit them with vitamin H. There is no need for health care providers whether drs. or paramedics to "adjust" anyone's attitude in the way you describe. It's just plain unprofessional.


 

...for a professional but appropriate for a human being.


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## seanm028 (Nov 11, 2007)

I've heard of NPAs being used to "help" attitudinal prisoners with chief complaint of difficulty breathing.


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## MMiz (Nov 11, 2007)

Kaisu said:


> I can honestly say that I've never seen that sort of thing done.  They come in in cuffs, sometimes in the onion bags (spitters) and I'm sure that the cops that bring them in have roughed them up to get the cuffs or other restraints on them.  Once in the ED tho, we get drs. orders to restrain and/or hit them with vitamin H.  There is no need for health care providers whether drs. or paramedics to "adjust" anyone's attitude in the way you describe.  It's just plain unprofessional.


Have you worked long as an EMT?  Sometimes you have to be a bit unconventional, and I don't see any harm being done to the patient.


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## Ridryder911 (Nov 11, 2007)

Kaisu said:


> There is no need for health care providers whether drs. or paramedics to "adjust" anyone's attitude in the way you describe.  It's just plain unprofessional.



I would personally keep that opinion to myself in most ER's. Chances are your medical director and those that work in that sh*t, will differ from your opinion. As well, demonstrates your exposure and experience. It is called deterrent medicine, and is administered hourly and daily by the most famous physicians, and I have to admit after a breaking point have administered as well. It is not without given chances or warnings prior. I do not find it any more unprofessional as having a profession having to deal with being abused and harassed just because one is offering assistance and medical care. Causing harm nope, awakening them to act appropriately.... yes. 

There is no mention or sanction that states that I have to deal with or persistently be abused because I am in the health care profession. 

R/r 911


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## Rattletrap (Nov 11, 2007)

Ridryder911 said:


> I would personally keep that opinion to myself in most ER's. Chances are your medical director and those that work in that sh*t, will differ from your opinion. As well, demonstrates your exposure and experience. It is called deterrent medicine, and is administered hourly and daily by the most famous physicians, and I have to admit after a breaking point have administered as well. It is not without given chances or warnings prior. I do not find it any more unprofessional as having a profession having to deal with being abused and harassed just because one is offering assistance and medical care. Causing harm nope, awakening them to act appropriately.... yes.
> 
> There is no mention or sanction that states that I have to deal with or persistently be abused because I am in the health care profession.
> 
> R/r 911



All I can say is WOW! I honestly did not expect that answer from ya Rid. You made me proud.


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## Onceamedic (Nov 11, 2007)

I hope I never treat people that way..  even obnoxious drunk crazy people...   and if I start, I will go do something else..


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## Ridryder911 (Nov 12, 2007)

Kaisu said:


> I hope I never treat people that way..  even obnoxious drunk crazy people...   and if I start, I will go do something else..



Come and post after working a 48 hour straight, and getting (literally) pissed on, and scraped, bitten, and spat upon. Of course, this being the fourth time you seen that patient this week..... 

It is amazing on how attitudes and mindsets change...

R/r 911


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## reaper (Nov 12, 2007)

You will learn over time. There is a point of being compassionate and a point of being abused by people.

 I treat all pt's with compassion and respect, until they lose that right. I am here to help people, not be treated like a dog. whether they are drunk or being a rear orifice, they will not treat me like dog feces.

If you think that you will never set a pt straight in your career, then you may want to switch careers now. Because you will ether end up being hurt or burned out from treating these people nice.


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## Onceamedic (Nov 12, 2007)

you guys dont know what abuse is.  Abuse is when you are 3 1/2 years old and you learn to suppress your gag reflex.  Abuse is when you are hit every single day of your life.  Abuse is when you internalize all that and believe that you deserve it.  Abuse is when you live on the streets at 15 because its safer than your home.
You learn about abuse when you realize that under the right circumstances, anyone is capable of anything.  Abuse is doing something wrong to someone because you believe they have it coming and you can.  Overcoming abuse is vowing to never do the same to anyone else.
pissed on... give me a break.  Its not personal.  You guys post again after you know about abuse like I know about abuse.


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## reaper (Nov 12, 2007)

Yes, I know what abuse is!

 If you know, then you would never let someone treat you that way again.

If you are still that affected by it, then you may want to talk with someone, before entering this field. You will see a lot of it and you need to be able to handle the situation before you.

We are not talking about abusing pts for our pleasure. We are talking about keeping pts from abusing us, because they think they can.

When you have a few years on the street, dealing with it, then come back on and make the same statements.

I do not tolerate anyone hitting or spitting in my face. If they want respect, then they will show respect.


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## Onceamedic (Nov 12, 2007)

I have no problem defending myself or anyone else in trouble.  The original post referred to a patient on a backboard who was dropped hard enough to cause tears by a doctor that did not like what he was saying.  Now who is in danger in this situation ?   I have been yelled at, spit at, etc..  I totally agree that we need to defend ourselves.  I am a proponent of DT4EMS and have practiced martial arts for many years.  I just don't believe it is our place to adjust attitudes when there is no real threat.


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## ffemt8978 (Nov 12, 2007)

Kaisu said:


> I have no problem defending myself or anyone else in trouble.  The original post referred to a patient on a backboard who was dropped hard enough to cause tears by a doctor that did not like what he was saying.  Now who is in danger in this situation ?   I have been yelled at, spit at, etc..  I totally agree that we need to defend ourselves.  I am a proponent of DT4EMS and have practiced martial arts for many years.  I just don't believe it is our place to adjust attitudes when there is no real threat.



I understand and partially agree with you, but there is a flip side to this that you seem to be missing.  Sometimes, in order to help somebody, you must first get their attention.  A lot of times, this can be done by your mere presence or verbal interventions.  Other times it can't.


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## Onceamedic (Nov 12, 2007)

ffemt8978 said:


> Sometimes, in order to help somebody, you must first get their attention.



not me man..  if they are over 21 and don't want my help, which they evidence by the way they treat me, then I got lots of other stuff I need to do. In the ED, I'll check on them every 15 minutes or so. I never get mad, I never say abusive things, I just quietly ask if they are ready to get helped.  If they want to lie there miserable for a couple of shifts then that is up to them.  Anytime the behaviour gets bad, I'm out of there again.


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## reaper (Nov 12, 2007)

That's great in the ed. on the street you can't walk away from your pt.

Learn now how to deal with bad pts, without taking crap yourself.

I have seen many newbies come in with the same thinking and they are gone in a few years, because they never learned how to gain respect from pt's.

No one is saying you have to beat your pts. There are ways to deal with attitude pts. That is what you need to learn now. And no, you can't just walk away from them. You are there to treat and you need to do it as fast and best way you can.


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## certguy (Nov 12, 2007)

Kaisu , 
   In a perfect world pts would be cooperative and courteous . THIS IS NOT A PERFECT WORLD . The reason the DR did that wasn't out of spite , but to show the pt there's a line he can't cross . Unfortunately , prisoners who feel they have nothing to lose will take it to the next level unless stopped . That guy took on several guards for the sheer fun of it . If he wasn't stopped , I believe there was a good chance he would've trashed the ER the first chance he got . You and your partner's safety come first above all . This is one of the unwritten ( till now ) laws of EMS ; THOU SHALT NOT MESS WITH ME OR MY PARTNER !!! I once had a PCP'er go off in the back of the rig and was bouncing my 180lb partner off the ceiling like a rag doll by sheer arm strength while still in c - spine . In situations like this you can't be nice , and you can't walk away . You're partner's in danger . You jump in and protect him or her just like you expect them to protect you . An emt I worked with who was a good friend nearly died at the hands of a pcp'er . He grabbed her so hard by the neck 3 of her cervical vertibrea were displaced and 2 years down the road she went out on permanent disability . Her partner didn't lift a hand to help , just hollered for pd and kept going . This caused a lot of hard feelings . You will find in your career that you need to treat some pts differently than others . Psychs , druggies , gang bangers , drunks ,  and prisoners will take advantage of you if given the slightest chance . You will need to set bounderies or sooner or later you will get hurt .


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## BossyCow (Nov 13, 2007)

Kaisu, 
First, let me say that I am as aware of abuse as you profess to be.  Second, you will put yourself in danger if you start out by assuming your patients are victims instead of abusers. The pt. described in the initial scenario was violent and abusive.  Many of them are and most of those are skilled in how to look harmless.  

Yes compassion is wonderful, and I practice it often.  I am also uniquely aware that this person for whom I fell compassion has the potential to turn on me like a snake.  

We are taught that our first duty is to protect ourselves.  We must remain safe. Patient care, patient comfort, patient warm fuzzy feel good niceities are secondary to our own personal safety and the safety of our co-workers. This doesn't need to make us cold, heartless meanies.  It just keeps us alive and unhurt.


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## Onceamedic (Nov 13, 2007)

I don't assume they are victims and I am always very careful to keep myself safe.  I was objecting to the initial post - where the man was of no danger to anyone because he was tied down to a back board.  I guess everyone has their hot button issues and this is mine.  I have never stated that it is ok to risk my personal safety or the safety of my partners.

PS.. if you knew as much about abuse as I so than you would know that doubting a survivor's story is pretty much the most painful thing you can do to them.


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## certguy (Nov 14, 2007)

Kaisu ,

  As a student you need to keep an open mind to what we're trying to tell you . The learning process never stops and there's a wealth of knowledge in the vetrans that post here . You should be like a sponge and soak up as much as you can . You can learn a lot here , but only with an open mind . Look on the vets as big brothers and sisters . They've got your best interests in mind and they're trying to keep you from learning from the school of hard knocks like many of us have . I no longer work the field full time due to a disability , but I've learned a lot along the way as the others have . Let us help you come up . As for your last post , NEVER assume a pt. in c - spine , handcuffs , or restraints is no longer a threat . Remember my last post . My partner and I made that mistake and we both got hurt . We were lucky . My partner had a knee injury and pretty much full body bruising , I caught 1 left - handed punch that knocked me the lenght of the bench seat and nearly knocked me out . The pt. was still partially on the board . Believe me , the first time you see a pt. break 4 point leathers it'll get your attention . Recently a 15 yr. old grabbed a cop by the crotch while handcuffed and injured him . Of course , all the media saw was the cop bouncing the guy off the trunk of his cruiser to get him to let go . The cop was portrayed as the bad guy . Who really was ?


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## BossyCow (Nov 14, 2007)

Kaisu said:


> I don't assume they are victims and I am always very careful to keep myself safe.  I was objecting to the initial post - where the man was of no danger to anyone because he was tied down to a back board.  I guess everyone has their hot button issues and this is mine.  I have never stated that it is ok to risk my personal safety or the safety of my partners.
> 
> PS.. if you knew as much about abuse as I so than you would know that doubting a survivor's story is pretty much the most painful thing you can do to them.



I'm sorry.. did I do that?  Don't believe I did!  Wow.. really is a hot button issue for you isn't it!


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## ffemt8978 (Nov 14, 2007)

Play nice everyone


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## OreoThief (Nov 15, 2007)

wow.... had to bring the sheriff out.


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## hitechredneckemt (Nov 15, 2007)

i am a surviver of abuse and i agree that some pts need a little attention getter sometimes. some a little more than others.


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## OreoThief (Nov 15, 2007)

Abuse happens in lots of different forms, and I'm not here to judge or evaluate forms of abuse. A "survivor" needs to make sure that they can leave emotional baggage outside of the truck, to ensure that they are always acting in the best interest of the patient at all times. I've heard of counselors and therapists that are actually in need of therapy themselves, and are not emotionally stable enough to properly provide services to others. Some actually do it as a form of therapy for themselves. Just make sure that personal can be separated from professional. That's my two cents. B)


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## hitechredneckemt (Nov 15, 2007)

I agree that personal and professional have to be separated, at least while the patient is on board.


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## So. IL Medic (Nov 17, 2007)

deterrent medicine - - excellent terminology there.


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