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medicstudentchris

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Just a few nights ago my partner and I were dispatched to a "non-violent" psych pt. After staging for about 5 or 6 minutes i asked my control center if PD was on scene, and was told "your scene is secure, pd isn't needed". We entered the scene, made patient contact, and the first words out of our pt's mouth was "I feel like killing someone".... Of course I had to ask "it's not me is it?" I have never worked in dispatch, so my question is how do thes EMD's determine if a psych pt is violent or non-violent. Needless to say, since i am still around, I wasn't the one he felt like killing, but we did leave the scene until PD arrived.
 
Sounds like you did the right thing. We almost always have police response on our calls medical and trauma. But hey that gives the guys something to do.
 
Our policy is that PD responds for any call involving criminal activity, drugs, weapons, suicide attempts or psych patients. The only exception would be a psych call from a doctor's office where the doc has determined the PT isn't a threat...we got dispatched for one of those recenty (the PT was having a panic attack, and it got dispatched as psych).

Its not really an issue for us since all 911 calls go to PD first and they then transfer to our regional fire dispatch. As a result, they send an officer on almost every EMS call as a "medical assist", which comes in really handy when the call turns out to be something other than what was dispatched.

As far as your call goes, hard to say why or how dispatch decided the PT was non-violent. It was probably from the info received from whomever called it in.
 
I can't remember the last time I went to a call and police were not there. They get bored driving around here so when theres a call, they all jump at the chance to have something to do. Even if its a BS call they're there.
 
Around here, the PD "is given" all calls... if the officers are busy, we don't see them...,. if they are bored, they show up at the Nursing Homes... A few weeks ago, had a Cop at an assisted Living facility for a Diabetic call... sugar was low, now is better after eating :o :rolleyes:. Guy is going to refuse. The cop has been there for 5 minutes, looks at me when I go out into the hall to grab the clipboard to fill out refusal paperwork, and asks "do you still need me"... my response: "I don't think we really needed you here at all.... I don't think anyone is going to bash me over the head with a walker :) ... but it is nic seeing you, and thanks for coming, Officer :) ".....

Jon
 
Originally posted by medicstudentchris@Aug 22 2005, 01:47 AM
Just a few nights ago my partner and I were dispatched to a "non-violent" psych pt. After staging for about 5 or 6 minutes i asked my control center if PD was on scene, and was told "your scene is secure, pd isn't needed". We entered the scene, made patient contact, and the first words out of our pt's mouth was "I feel like killing someone".... Of course I had to ask "it's not me is it?" I have never worked in dispatch, so my question is how do thes EMD's determine if a psych pt is violent or non-violent. Needless to say, since i am still around, I wasn't the one he felt like killing, but we did leave the scene until PD arrived.
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As a former dispatcher, the protocol we used was simply if the call was a from Dr & they stated the Pt is non-violent, then PD was not sent (But they would go if no other calls were pending), however, it was our decision whether or not to send PD on 201/302 Psych calls & 100% of the time they went. The Ems Crew would stage in the area until PD arrived & declared the scene safe for them to enter.

It all really depends on the dispatchers protocols or procedures are for handling them as to whether PD is called or not. Myself, PD was always going, even if it meant the PD I was dispatching for was on another call, I would call the next town over for them to send 2 Officers & Ems always staged. You can replace a Police Crusier or Ambulance, but can never replace a Ems crew. (This was in a town near Pittsburgh, Pa.)

however, now living in a rural area, our 911 Center's procedure is to call the State Police & We stage until given further orders.

You leaving the scene until PD arrived was a seriously good & smart move on your behalf. ;)
 
Originally posted by emtff99+Oct 12 2005, 01:14 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (emtff99 @ Oct 12 2005, 01:14 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medicstudentchris@Aug 22 2005, 01:47 AM
Just a few nights ago my partner and I were dispatched to a "non-violent" psych pt.  After staging for about 5 or 6 minutes i asked my control center if PD was on scene, and was told "your scene is secure, pd isn't needed". We entered the scene, made patient contact, and the first words out of our pt's mouth was "I feel like killing someone".... Of course I had to ask "it's not me is it?" I have never worked in dispatch, so my question is how do thes EMD's determine if a psych pt is violent or non-violent. Needless to say, since i am still around, I wasn't the one he felt like killing, but we did leave the scene until PD arrived.
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As a former dispatcher, the protocol we used was simply if the call was a from Dr & they stated the Pt is non-violent, then PD was not sent (But they would go if no other calls were pending), however, it was our decision whether or not to send PD on 201/302 Psych calls & 100% of the time they went. The Ems Crew would stage in the area until PD arrived & declared the scene safe for them to enter.

It all really depends on the dispatchers protocols or procedures are for handling them as to whether PD is called or not. Myself, PD was always going, even if it meant the PD I was dispatching for was on another call, I would call the next town over for them to send 2 Officers & Ems always staged. You can replace a Police Crusier or Ambulance, but can never replace a Ems crew. (This was in a town near Pittsburgh, Pa.)

however, now living in a rural area, our 911 Center's procedure is to call the State Police & We stage until given further orders.

You leaving the scene until PD arrived was a seriously good & smart move on your behalf. ;) [/b][/quote]
My second call as a primary EMT was for a pediatric emotional disorder.... turned out to be a 9 y/o male with Autism and ADD who was throwing a REALLY bad temper tantrum, and parents were past their limit, and needed someone else to come so it wasn't kid vs. parent, and take them to the hospital.

I made an *** of myself by staging.

The PD didn't make the response until I requested that they verify the scene is secure.

The MDC text "From WCPD, you can tell 55a that it really is ALL SAFE here, so they can come in now" :(

I've grown a pair of Cahones, and am more willing to go in ahead of the PD now, but make sure that i've got a portable radio with me whenever. This is pretty standard for most companies.... if PD has an exteneded ETA, and there is no real danger, we will go in.

These are also the calls that make me regret deciding to not wear my vest on that night (I always wear it on weekends, not always on weeknight evenings.

Jon
 
Originally posted by emtff99@Oct 12 2005, 01:14 AM
These are also the calls that make me regret deciding to not wear my vest on that night (I always wear it on weekends, not always on weeknight evenings.
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It gets that dangerous??

Id be interested to hear about one of those calls...and how many of you have gotten into an actual physical altercation with a patient? My EMT class tried hard to teach us that we cant and shouldnt restrain anyone, as thats the police work, and were not police...are we going to be held liable if we restrain a patient thats violent?
 
Anything can get dangerous.

I live in PA. Recently, at a hosptial where I've spent a lot of time, a patient, in with 2 cops to have blood drawn for a blood alcohol level, pulled one of the cop's guns, shot that cop in the chest, shot the other cop, shot the ER tech who was getting ready to draw blood, and then EXECUTED the 2nd cop. He then proceded to shoot himself in the hand and run and hide in a car on a parking garage roof on the complex.

I've been caught in domestic disputes over "i'm not going to the hospital."

LAST NIGHT, I had a call for an alcoholic in withdrawal. The guy was fine for us, but his brother told us he would fight tooth and nail if he realized that we were going to take him to get committed for seeing and hearing things. This was made worse when the cop started to notice that the pt. COLLECTED edged weapons, including a REALLY REALLY REALLY big (14"+) machete in the closet, and lots of other knives. Thankfully, the patient was unable to kneel without 2 of us holding him up, let alone stand.

My Ambulance Captain (A medic at another local squad) had a call about a year ago for a "Injured person, ALS." Upon arrivial, they found that the "injured person" was actually SHOT in the back of the head..... they sh*t thier pants..... didn't know where the shooter was, and suddenly felt VERY unsafe.

At my squad, 2 of us regulary wear body armor. We don't really plan on getting shot, it is just a very nice thing to have, "just in case".... but it is REALLY uncomfortable in the summer :D. Also, several paramedics from the nearby hospital also wear armor.
 
At least you have police.. We have a Tri-County Sheriff. Lucky to get an 80 y/o former sheriffs deputy with a shot gun if we're in a pickle.

In the city, we couldn't get rid of the police. They always made the situation worse, made the suicidals want to kill themselves more.
 
Quite a few years back, I was running with 3 Different Ambulance Services & working for 1 Service. (1 Service we got nothing but medical calls, very little trauma, 2nd Service we got a mix of Medical & Drug Overdoses, & the 3rd Service we ran mainly Trauma & very little Medical)

While starting my time to become more active & run with the 3rd Service, Our Paid Crew is called for a 20 yom Possible 302 & PD COULD NOT RESPOND (they were busy with some other "important" business). As we are going to the scene, the Paid Emt is explaining to both the Medic & myself about the Hx of this Pt & he is "just a mixed up kid", & would like to see him join our Ems. Upon our arrivial, here is a 20 yom walking around outside his residence with a 10" Butcher Knife & Butt Naked!!

The Medic again called for PD assistance, but again to no avail. The Paid Emt proceeds to get out & attempt to speak with the Pt. However, the Pt wanted nothing to do with us @ this point & headed in his home. We (The Paid Emt & Myself) followed him into the kitchen, as we rounded the corner, a Cast iron Frying Pan was coming directly for us. (Neither of us was hit at that time), Now at this point The Medic is still outside requesting PD assist & refusing to come into the Residence until the Pt was dressed, we are now into a physical confrontation with the Pt. The Paid Emt has the Pt on a counter, banging his head off the cabinet door, telling him "We are here to help you, not hurt you." @ the same time, the Pt is smacking the Emt (or trying to) in the head with another Cast iron Frying Pan, I am trying not to get stabbed & grab the frying pan @ the same time. Now all of sudden, there is a pair of hands grabbing me from behind & attempting to slap cuffs on!!

A 2nd Officer is now zapping the Pt in the groin with a stun gun, but no effect @ all. I am in the meantime screaming that I a part of the Ems Crew, which now the Medic is also screaming the same. After a brief 10 minute fight with PD & Ems, the Pt is placed in a Reeves (Face down**, bad move on our part) & Tx'ed to the Er for Pysch Eval. Upon arrival to the ER, a nurse screaming @ us for having the Pt face down & demands that he be released. @ which point, my comment was "sure, we can release him in the same room w/you, wait 3 minutes then come in & treat you for injuries." He was placed in Pysch for 30 days.

The reason behind the original PD had "other important business" was they were both using the restroom @ their station when the call came in & couldnt find any toliet paper!!!! Quite a few things were wrong from the start, 1st which was the Paid Emt or myself should have NEVER chased the Pt into his home (we are now in his area & dont know it), 2nd knowing a weapon was involved, another request for another Town PD should have been made by both the Medic & Dispatcher. 3rd,, make sure your PD knows your Ems Crew members, especially ones in Street Clothes on Scene (The reason why the 1st Officer was slapping cuffs on me, he didnt know I was a part of the Ems Crew).

**Face down in the Reeves: Another Service approx 1 week before, brought a 302 Pt in the Same ER, (after fighting with him also) upon arrival to the ER, the Pt was found dead.**
 
Ok.... I've got to agree with the police on this.... anyone with a knife, within 20 feet of me, is an imminent threat to my safety and security. My butt would have been back in the truck SO FAST, doors locked, and parked down the street (better yet, a mile away). I would be getting PD there... and this guy would be going to the ED, in braclets, with Police IN MY RIG. No other option, except the PD take him in THEIR CAR.

As for chasing the guy into the house.... Dude.... you should have been 302'd yourself. That is a rather stupid way to die.... the guy already has a REALLY BIG KNIFE..... how do you know he isn't going inside to get his AK-47????

As for the patient secured face-down on the reeves.... I actually belive the stuff on "sudden in-custody death syndrome"...... it isn't really positional asphyxia... it is a bizzarre process that psycho cases and OD's have occasionally. Tasers, position, mace - they are scapegoats for this process.
 
We always have pd on every psych call because we've had too many that changed face during transport.

Wont go into a psych call without pd, ESPECIALLY a pediatric, too many legal issues there.
 
Originally posted by MedicStudentJon@Oct 18 2005, 10:07 AM
Ok.... I've got to agree with the police on this.... anyone with a knife, within 20 feet of me, is an imminent threat to my safety and security. My butt would have been back in the truck SO FAST, doors locked, and parked down the street (better yet, a mile away). I would be getting PD there... and this guy would be going to the ED, in braclets, with Police IN MY RIG. No other option, except the PD take him in THEIR CAR.

As for chasing the guy into the house.... Dude.... you should have been 302'd yourself. That is a rather stupid way to die.... the guy already has a REALLY BIG KNIFE..... how do you know he isn't going inside to get his AK-47????

As for the patient secured face-down on the reeves.... I actually belive the stuff on "sudden in-custody death syndrome"...... it isn't really positional asphyxia... it is a bizzarre process that psycho cases and OD's have occasionally. Tasers, position, mace - they are scapegoats for this process.
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That call was about 19 years ago(been in Ems now close to 22years) & I have learned quite a bit from it. it was also my 1st 302 call, not knowing any better then & also thought "since" the Paid Emt knew the Pt personally, I figured things were ok, until coming around the corner & the fight ensued. I did forget to mention PD did have him cuffed after realizing who I was, zapped him no less than 15x in the groin to no avail.

Beleive me,, any Pysch calls I go on, PD is ALWAYS DEMANDED not requested. However, where I am @ now, We have the State Police & their response times are not the greatest to say the least, but we stage away from scenes until otherwise. A few months later (Same Service) We were called for another Poss 302, as were coming down the street, my partner spotted the Pt outside of his residence, carrying a chrome plated .45 running towards our unit. Needless to say, Transmission hit reverse real quick, backed up 2 blocks & headed for the Police Station, until the PD was on scene. That matter didnt turn out good for the Pt however, when PD arrived, a quick gun battle erupted & the Pt was deceased. To this day, I still think his intent was to kill us or someone near him.
 
Originally posted by emtff99@Oct 18 2005, 11:48 AM
Beleive me,, any Pysch calls I go on, PD is ALWAYS DEMANDED not requested. However, where I am @ now, We have the State Police & their response times are not the greatest to say the least, but we stage away from scenes until otherwise. A few months later (Same Service) We were called for another Poss 302, as were coming down the street, my partner spotted the Pt outside of his residence, carrying a chrome plated .45 running towards our unit. Needless to say, Transmission hit reverse real quick, backed up 2 blocks & headed for the Police Station, until the PD was on scene. That matter didnt turn out good for the Pt however, when PD arrived, a quick gun battle erupted & the Pt was deceased. To this day, I still think his intent was to kill us or someone near him.
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I hear you about the State PD..... Luckily for us, at my one company, the Township we have that is covered by State PD happens to have one of their 2 barracks in the county, in the township.... we usually don't have to wait too long, and they usually show up in force when needed.

At my other squad, we are less lucky.... tavel time, even running hot, is 15 or 20 minutes from the closest barrack, and even though the state is supposed to have a car in the township 24x7, it seems we are always told that our car's ETA is "Travel time from the barracks".... We will sometimes go in on EDP's without the PD, but not usually.

As for the guy with the gun.... suicide by cop is one way to kill yourself. And I agree with that reaction.

As for the knife fight.... We all do stupid things, and I get the impression from your post that you were riding as a "third" and have learned from the experience. I commend you for backing up your partner, even if they did do something stupid.


Thanks for posting.

jon
 
Hmm...our EMTB teacher said that scenario happened to him. The dialogue was exactly identical.
 
Originally posted by AnthonyM83@Oct 18 2005, 06:43 PM
Hmm...our EMTB teacher said that scenario happened to him. The dialogue was exactly identical.
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Crews pulling upon the scene & finding a 302 Pt walking around with a weapon is more common than people realize.
 
ALWAYS wait for PD, and take an engine or truck crew in with you for good measure. Most people (I said most, not all for sure) in this profession are reasonably fit, but 1 man that is out of his mind could easily overpower a cop and an ambulance crew.

The cop is going to tell a psych patient that he is not going to jail, but it might feel like a close enough second to a psych patient when you start strapping him down to the cot to set off a loose cannon.

Note: one or two rolls of Kerlex will hold most people down easily enough, and they aren't going to break a good Rugged Ferno.
 
I'm thinking people don't even necessarily need weapons to be dangerous. We've had patients on meth and stuff who were totally out of control. There was one who had blood all over his hands. We though we had him under control -- he had gone unconscious and stopped breathing -- when he leapt up, smacked a bunch of us, and barrelled out of the rig into the street. It eventually took five medics on scene and the police officer to restrain him. By that time, he's spattered his blood on a couple of us, given bruises to a few more... not fun.

In my world, no one gets faulted for being too cautious. But wow -- I still can't imagine working somewhere where I'd need to wear a vest or anything. I'm glad someone else wants to do it, though!
 
I just wanted to add a couple of points.........

1) Your safety is most important.........but there is a problem........... since lawyers are blood sucking scum...........there is a lawsuit pending becasue a medic refused to go into a suicidal patients home without PD. It is in litigation NOW!

2) If you think because you checked for scene safety you are ok.............well good luck. A lot of the people I have talked to were attacked on scenes where they had NO IDEA or warning.

3) Have a plan. Mental rehearsal is as important as any hands on skill you will ever learn.

4) Train, Train, Train.

Not every agency has the luxury of having PD with them on every call.......been there done that.
 
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