PD on scene goading your patient. What to do?

[LucidResq]

You know, Bullets, you also say you carry on-duty. Why not just shoot the guy? You're gonna land in hot water anyways, why not go all out?

 

[Seaglass]

Now, define 'taunt'. Saying "go ahead" is no big deal. Calling someone a cootie-face? Different story.

...

I'd be lying if I said I was never in the situation where a restrained patient threatened me and my comeback was "Ha, you can try" or something to that nature. Who cares? That's taunting? Wow this country is too PC.

In my book, encouraging a restrained patient to "go ahead" or anything of the sort is getting into a p*ssing contest. Why bother? If you're in restraints and I'm not, it's obvious who's boss. Interestingly enough, I've found that completely ignoring any attempts to engage me in something like that works fairly often.

With a psych patient, it crosses the line from stupid and immature to irresponsible. Their trust or lack thereof in their care providers is going to be vital to their recovery. We get to drop them off and never hear from them again, but we can complicate everyone else's job down the line by making their relationship with the system more adversarial than it needs to be.

Hell yes for spitting. A person who spat in a Dallas Police Officers face a couple of years ago was found positive for HIV. He was charged with assault with a deadly weapon against a police officer.

What was the outcome of the case? (I could see that going either way, especially depending on state law and the patient's mental status.)

I'm not worried about HIV from saliva on intact skin or clothing. If it lands somewhere else, I get to file some paperwork and get some tests, but the risk of transmission is so low that I'm not going to lose sleep.

If I had some reason to think they were deliberately trying to infect me, I'd see things differently. Luckily, I've yet to run into that. More luckily, sheer malice won't increase the viral load of their saliva.

In the state of Texas, attacking a Paramedic doing their job is a felony. You attack me, whether or not it hurts is irrelevant, you'll get in trouble--- as 2 already have this year.

Personally, I'm not willing to spend that much time in court. If I'm hurt, or there's some other compelling reason to press charges, sure... but it's just not worth it each and every time some drunk takes a swing in my general direction.

 

[Phlipper]

Originally Posted by Bullets View Post
sounds like your a nicer guy then me. if he spit on me i would have broke his nose.

You know, Bullets, you also say you carry on-duty.

Wow. Just ... daaayum. Sure hope we don't see Bullets in the news one day. :unsure:

 

[Shishkabob]

In my book, encouraging a restrained patient to "go ahead" or anything of the sort is getting into a p*ssing contest. Why bother? If you're in restraints and I'm not, it's obvious who's boss. Interestingly enough, I've found that completely ignoring any attempts to engage me in something like that works fairly often.

With a psych patient, it crosses the line from stupid and immature to irresponsible. Their trust or lack thereof in their care providers is going to be vital to their recovery. We get to drop them off and never hear from them again, but we can complicate everyone else's job down the line by making their relationship with the system more adversarial than it needs to be.

Let's be fair here... I don't go out instigating, but I am also no above a witty comeback that is non-insulting. You'd be hard pressed at convincing me that it's 'un-professional' to react non-violently non-harrisingly with some humor (albeit not to them) to someone else crossing the line first. "Good luck with getting free" doesn't strike me as un-professional.


Not like I go "I'll give you $100 if you are able to break free and hit me" or call their mom fat.....





Though she probably is.

What was the outcome of the case? (I could see that going either way, especially depending on state law and the patient's mental status.)

35 years in prison.

 

[Aidey]

Let's be fair here... I don't go out instigating, but I am also no above a witty comeback that is non-insulting. You'd be hard pressed at convincing me that it's 'un-professional' to react non-violently non-harrisingly with some humor (albeit not to them) to someone else crossing the line first. "Good luck with getting free" doesn't strike me as un-professional.

I think there is a difference between goading someone on and stating reality. Occasionally it is necessary to tell someone "Look, you're under arrest, you are going to the hospital. You aren't getting out of the restraints, and it will be a lot easier for everyone if you hold still and be quiet. The police are still standing here and aren't opposed to add more charges to your arrest".

 

[DrParasite]

sounds like your a nicer guy then me. if he spit on me i would have broke his nose. I also would have told the cop to get a case number for assault cause im pressing charges once i transfer care.

I have been spit on, once, when a combative drunk/druggie/skell decided to get extremely combative when he was woken up. I was told by PD that they were filing charges because of it.

The most I did was restrain him better in the reeves.

a cop once told me, once the cuffs go on, one the person is in restraints, the fight is over. That means, if he's free and swinging then you can claim self defense or appropriate use of force when you break his nose or punch a violent EDP (not that I suggest anyone ever do this), or in the cop's case, break an EDP's arm in three places when he comes at him with a knife. but once the patient is in restraints, you can't hit him, no matter what he does.

 

[adamjh3]

Linuss, I see where you're coming from, and it wasn't the fact that the officer was making smart assed remarks that irked me - hell, I'm guilty of doing it at times, too, though I try to avoid it. It was the fact that he continued to do so after my partner and I had already mostly contained the situation. He was saying things like "Go for it, come on, try it, I dare you, you'll get f****d up if you get out - oh wait, you already are."

Like I said, though, it wasn't that big of a deal as I was able to keep him calm throughout Tx. But I'm sure this won't be the last time I run in to a situation like this and I was looking for input on how to perform damage control while not (intentionally) stepping on any toes.

 

[SanDiegoEmt7]

SDEMT, it was out of ESU down in Chula. Like CMH for kids. Thanks for the kind words. I thought I handled it pretty well. We don't deal with PD much doing IFTs, so this was a first for me.

I used to deal with cops fairly often out of CMH. Most of the time, just seeing the cops would agitate them. One of my best lines was "Sir, I am not the cops, let me take you to get some help" or something to the same effect. When cops feel the need to provoke patients it makes things even more interesting. Coming from public mental health facilities I've had issues with the staff acting in a manner similar to yours. There's nothing you can really do, just run the call, attempt to calm the patient, but sometimes thats easier said than done.

Overall I've had a good interaction with 99% of the PD and CHP I've interacted with.

 

[SanDiegoEmt7]

Linuss, I see where you're coming from, and it wasn't the fact that the officer was making smart assed remarks that irked me - hell, I'm guilty of doing it at times, too, though I try to avoid it. It was the fact that he continued to do so after my partner and I had already mostly contained the situation. He was saying things like "Go for it, come on, try it, I dare you, you'll get f****d up if you get out - oh wait, you already are."

Like I said, though, it wasn't that big of a deal as I was able to keep him calm throughout Tx. But I'm sure this won't be the last time I run in to a situation like this and I was looking for input on how to perform damage control while not (intentionally) stepping on any toes.

That's completely inappropriate but there's only so much you can do. I might just tell the officer "Hey we got it from here guys, thanks" and have staff help me.

 

[Bullets]

shooting the pt is messy, i only carry for defense of my pt and myself, myabe my partner, depending on who im with that day

i guess i didnt read that he was already tied up, then he just gets a c-collar on backwards to cover his mouth. i dont hit restrained pts, just ones that are fighting me for whatever reason

Also, we get PD backup on about 10% of our calls, and those are either pronouncements or calls at some Officers family members house, town councilman ect. its usually me and my partner alone, maybe a cadet if im lucky. If we request PD we can expect a 10-15 response time on a radiocar. so sometimes i have to do things to protect my self that i dont always agree with, but who is the most important person? If a pt is in restraints, its me sitting on a guy while my partner ties him down with cravats

 

[jjesusfreak01]

If you have a restrained patient who is a spitting risk, just put a facemask or a freakin NRB over his head. Not going to hurt him and it solves the problem. We can call this the Occam's Razor approach to EMS. If a patient is in handcuffs you need an officer riding in the back with you (and it wouldn't be a bad idea to keep a pair of handcuff keys on you in case the officer bolts when you get to the hospital).

As an aside, I did go on a run from central prison once with a patient. One DOC officer in the back of the ambulance, one in a follow car. They maintain custody throughout the trip.

 

[bstone]

As an aside, I did go on a run from central prison once with a patient. One DOC officer in the back of the ambulance, one in a follow car. They maintain custody throughout the trip.

I've done that also. One in the back with us, one following in the car. Our pt was underarrest for domestic violence, but his wife had stabbed him through the forearm. Ouch!

 

[Aidey]

shooting the pt is messy, i only carry for defense of my pt and myself, myabe my partner, depending on who im with that day

i guess i didnt read that he was already tied up, then he just gets a c-collar on backwards to cover his mouth. i dont hit restrained pts, just ones that are fighting me for whatever reason

I wouldn't do that if I were you. Using a piece of equipment in an unapproved way can bite you in the butt big time if something goes wrong. If you are that worried about the pts mouth, put the c-collar on properly and then put a PPE mask over his mouth.

 

[Bullets]

I wouldn't do that if I were you. Using a piece of equipment in an unapproved way can bite you in the butt big time if something goes wrong. If you are that worried about the pts mouth, put the c-collar on properly and then put a PPE mask over his mouth.

ppe masks can be taken off, even when restrained. the velcro on the c collar cant. there is no risk of asphyxiation, the collar covers the mouth and eyes, the nose goes through the hole for breathing. we actually learned this in my EMT class, and saw my instructor do it in the field

 

[LucidResq]

there is no risk of asphyxiation

Oh really, did you test this in your lab?

Sorry, I just don't see how putting a c-collar on backwards would be remotely comfortable for your patient and not pose some kind of risk.

 

[LucidResq]

Just because you think you're in the Wild West doesn't mean you should act like a cowboy and carry on duty and punch your patients. There are plenty of EMTs/Paramedics who work in worse areas than you that still manage to act in a professional and legal manner.

 

[MusicMedic]

ppe masks can be taken off, even when restrained. the velcro on the c collar cant. there is no risk of asphyxiation, the collar covers the mouth and eyes, the nose goes through the hole for breathing. we actually learned this in my EMT class, and saw my instructor do it in the field

what if something does go wrong and your patient gets harmed

the courts going to ask "why did you use that piece of equipment improperly?"

and your going to say "oh because it stopped him from spitting on me"

Courts going to say "well thats not what its used for, and since you used it improperly you caused harm on your patient"
and there goes your certification as well as legal trouble

you could easily use a N95 mask (the one that kinda cups over your mouth and nose) and tie it quite snug so they wont be able to knock it off by swinging their head wildly..



ive had to deal with psych patients ive picked up from the jails in LA City, luckly i havnt had to deal with PD aggravating the patient

but i have had to deal with Psych ER Nurses that have Aggravated the patient by Taunting/treating them with little respect.. ( i wish i reported it, but i didnt)

 

[LonghornMedic]

ppe masks can be taken off, even when restrained. the velcro on the c collar cant. there is no risk of asphyxiation, the collar covers the mouth and eyes, the nose goes through the hole for breathing. we actually learned this in my EMT class, and saw my instructor do it in the field

You are one step away from getting arrested and/or sued. That or you talk tough on the internet trying to impress us.

First off, carrying a gun on duty isn't necessary as long as you stage when required and being aware of your surroundings. If you feel your job is so dangerous that you need to be armed, maybe it's time for a different career. I've worked in some of the worst drug infested, gang ridden areas and have never felt the need to be armed. Do you wear body armor too?

Second, using a c-collar for anything other than its intended use is a lawsuit in the making. A NRB, with the elastic straps knotted so they don't loosen, will do just fine. They also make spit hoods that can't be defeated.

Leaving statements like breaking noses of patients, carrying guns on duty and improper use of equipment isn't such a bright idea. You never know who may be reading these postings.

 

[Bullets]

You are one step away from getting arrested and/or sued. That or you talk tough on the internet trying to impress us.

First off, carrying a gun on duty isn't necessary as long as you stage when required and being aware of your surroundings. If you feel your job is so dangerous that you need to be armed, maybe it's time for a different career. I've worked in some of the worst drug infested, gang ridden areas and have never felt the need to be armed. Do you wear body armor too?

Second, using a c-collar for anything other than its intended use is a lawsuit in the making. A NRB, with the elastic straps knotted so they don't loosen, will do just fine. They also make spit hoods that can't be defeated.

Leaving statements like breaking noses of patients, carrying guns on duty and improper use of equipment isn't such a bright idea. You never know who may be reading these postings.

i carry a gun because i am allowed to by the federal, state and local laws. Do i think my job is dangerous? Yes i feel we enter into situation where we may become targets for violence, and the only person i trust to protect me is me. If we dont have cops, or they arent near, they wont get to me until after something has happened. do i wear body armor? Yes, company issued Point Blank vests

And the nose thing was an error in my reading. I missed the part where it said pt was restrained, i thought he was actively fighting and spitting on me.

 

[Tincanfireman]

I've had police razzing the patients similar to the scene the OP described. Usually I'll just ask the cop to step out for a minute while I talk to the person, but stay close to the door. That lets the pt know that I have LE as backup, but far enough away to give them a chance to chill out a little. A filter mask/O2 mask fixes the spitting issue, but usually once the cops are out of earshot the person calms down so I can talk to them. No, it's not always the solution, and yes, I've arrived at the ER with the pt securely contained in a Reeve Sleeve, but I've never, ever struck a patient. By the very nature of the fact that they are spitting, biting, kicking, etc; it's a strong indicator of an altered mental status and you'd have a hard time convincing a jury or a EMS board member that it was justified. Just my .02...

(If the person in in custody (handcuffs), the PD has to ride in with us in the unit, or if we're coming from the Detention Center with a prisoner)