More violent patient management

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eggshen

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I would like very much to hear from anyone associated with an agency that utilizes any type of official policy or training regarding violent patients. I am involved in implementing a policy regarding these types of things and would love any wisdom offered. For the recorod we have adopted PPCT. Too late for any ofther suggestions.

Egg
 
Not sure if this is what you are looking for, but we have protocols for behavioral disorders and patient restraint. We don't do any training regarding violent patients,although I wish we did.

I am on my way out the door to take my son to my parents' house, but when I get home tonight, I would be happy to scan our protocols and send them to you, if you are interested in taking a look at them.
 
cravats, cravats and more cravats....oh and a good knot would help too.
 
Mercy4Angels said:
cravats, cravats and more cravats....oh and a good knot would help too.
Click to expand...

Duct tape is faster, easier, and cheaper...:P

Seriously, DT4EMS might be able to help you with this.
 
eggshen said:
I would like very much to hear from anyone associated with an agency that utilizes any type of official policy or training regarding violent patients. I am involved in implementing a policy regarding these types of things and would love any wisdom offered. For the recorod we have adopted PPCT. Too late for any ofther suggestions.

Egg
Click to expand...


What do you mean by violent. For truly violent pts, my policy is to call the experts--the police.
 
ativan im, and lots of it. "the pt started to seize, i swear"

seriously though, verbal de-escalation when done properly works wonders. failing that, defensive tactics
 
im going to be a cop. so ill have cuffs on me then.
 
Mercy4Angels said:
im going to be a cop. so ill have cuffs on me then.
Click to expand...


Congrats on doing both :) Please, please make sure you seperate the two. It is dangerous to confuse which uniform you are in. Beeh there, done that.

BTW, PPCT Violent Patient Management is from a respected company. It will meet the same street level acceptance as the PPCT for officers has. Most officers on the road are not happy with PPCT.

Bruce Siddle has gone on to train Feds and has helped publish books for guys like Grossman. PPCT is similar to CPI. More to protect the company/agency than the medic or EMT.

Still they have very sound "principles" provided your instructor had the tools to help you find the answers.
 
By using PPCT we now (hopefully) may remove some of the improvisation associated with dealing with combative patients. As well I hope to provide something for those that have no proir training. In regards to your statement about it protecting the agency? My admin is quite gunshy about those things so I think you found the nail with the first swing.

Egg
 
Mercy4Angels said:
im going to be a cop. so ill have cuffs on me then.
Click to expand...

Cuffs are for cop cars and girlfriends, they have no place on an ambulance. As previously said, keep 'em separate for your safety and the safety of those you work with.
 
Our SOP's for violent pt's are:- (please note I dont have them infront of me but from memory are)

1. Establish rapport
2. Restraints is possible (loony straps)
3. Midazolam (15mg max dose)

The policy states that chemical restraint should only me established in police presence. I'd usually have a couple of coppers restrain and so I can get an IV and start with 5mg midaz.

For a voilent head injured pt I might have to start with IM midaz with enough on board to settle him before I can start an IV and might follow up with IV midaz to top it off - if he's too bad we can RSI - this is quite common in my area as we cant evac a violent pt unless it's certain that he wont "arch" up in flight so he would usually get RSI'd before flight.
 
Restraints both chemical and physical are all well and good but what about the pt. that decides now is a good time to wrestle and you have no cops yet. Here cops are added to the call by civilian (retarded) dispatchers who have no practical experience and have never been to the projects.

Egg
 
I have no experience (yet) in this, but I'd say getting some ativan into them and strapping them down to the stretcher is as good a method as any :P. I have no knowledge of midazolam, would it have effects similar to clonazepam or ativan?
 
the talkative "de-fusing" only works in about 10% of these situations, and if your a certified "ghetto-medic" id say its 2%. Chemical restraint (I like Haldol IM,even though it may take a bit) sometimes getting them held down enough to start an IV, utilizing the ativan etc. route can also be dangerous to you. What do you do when you get a monster? by that I mean, a barbarian sized crackhead minus the axe and shield, and youve called for the police but its only the crew right now?.....coming from experience, and seeing another medic single handedly thrown down a flight of stairs (the medic was a big guy too, 230 lbs, 6'2", fit) I have a few schools of thought on this, and welcome any other opinions, after all, we are ALL here to learn more right?

1. NEVER let anyone get between you and the way out, ALWAYS look for a secondary exit.
2. de-escalation via verbal should be used if at all possible, establish rapport, wheel-n-deal if you have to. Win the patients trust.
3. Always be prepared for the worst case scenario, never enter an environment without something in your hand you can throw (ie clipboard,...an easy distraction)
4. hands hands hands, watch the hands, be cognisant of patients body posture and stance.
5. Last resort (worst case), defend yourself !!!, everyone should have SOME sort of defensive tactics training. At the least most martial arts schools have some as little as 2 weeks long, it wont make you jackie chan, or a skilled knife fighter, but enough to break someones grip on you and get away. I STRONGLY recommend this to the female EMS community as well. Who knows when you might be able to use that info/training in another situation.....*hint hint*

what is the group vote from the forum?
 
I'd say that all of those suggestions are great. I'd try talking the pt down first, but realistically, that won't work, especially if they are 'pharmaceutically-gifted at the time. Physical restraints would be most likely the next course of action to go with (something relatively harmless, like an arm-bar til you can get them strapped to a stretcher /otherwise immobilized, then if theyre still violent, I'd go with clonazepam (find that stuff works better than ativan a lot of the time). Out of curiousity, what are the most common chemical restraints used by EMTs?
 
I'd go with talking them down, and failing that, get out of Dodge. If it is too late for that, call in support and just try to restrain them as best you can. If you can get them in restraints on the stretcher, put a scoop stretcher down over top of them and buckle them up so they can't sit up. Never used the scoop myself, but I know a few ACPs that swear by it....when it comes, I'll do it too.

I was just in our local H today and they were still buzzing about a coke fiend that was brought in in restraints that sat up and broke the restraints (leather). When he stood up, the stretcher was up behind him too, until he broke the restraints....he dragged the stretcher around by one restraint still anchoring one leg as they fought to get him down. He was peppered and then tasered 8 times to no effect. They just had to dogpile on him and use a paralytic to subdue him. Fourteen people off with injuries.

Then there were some more aggressions at the ER this morning too. We appear to have someone selling crack laced with PCP and this is causing a lot of problems. *sigh* it is a beautiful world sometimes.
 
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