Restraining Psyche Patient

[WashboardSlim]

In my EMS class we've been running a lot of scenarios; it's gotten to the point where our primary goal for the time being is to restrain a "psyche patient" acted out by a fellow student.

I really have no idea if the most recent ones are realistic or not - basically we're supposed to assume any sort of LE has dropped off the face of the Earth, so it's just us (usually 4 members to a team) and the patient, who is apt to swinging, pulling hair/clothing, biting, etc.

The next scenario involves taking down the biggest guy in class - he's probably 6'3 and weighs over 200 pounds easy. So this got me thinking.

We're going to have to use a lot of force to bring him down and the instructor loves to make these as difficult as possible (giving the patient a "knife" for example). I'd really love to get some advice from real EMS personnel on what you guys would do in this situation and what my team and I can expect.

If you need any more info I'd be happy to provide it. Thanks!

 

[downunderwunda]

Proper restrain is determined by patient size & the type of restraint you will use. Proper restraint will require up to 8 people.

I would suggest you talk to a proper psych ward to learn hoe to do it properly.

 

[marineman]

psych patient with a knife? Believe me I have plenty of time until a new class of cops get trained and put on the road. There is not a chance in hell I would step foot in that house. If the teacher says no law enforcement are available I would say that I'll be staging down the street at the diner with a cup of coffee until they become available and sit down.

Yes learning how to handle these patients while keeping everyone safe is good but it could also lead to people thinking they know what to do and not really ensuring scene safety.

As far as restraining I prefer almost a straight jacket type position if possible where arms are crossed and secured to opposite sides of the cot. If you do it right you can still get a set of vitals and an IV if you really need one but they can't generate as much force pulling that way. Really DT4EMS would be the best at telling you how to bring the guy down, I have a method that works for me but that's what he does for a living so I'll stand by.

 

[DT4EMS]

Hmmm............

The name of the school you are attending is what?

There is NO reason anyone should be teaching EMS how to restrain a person with any weapon much less a knife.

I normally stay away from saying anything negative but if this type of training is actually taking place it is WRONG. Trust me....... when your motive is "care and medical restraint" and the other person is intent on hurting you......... game over. You lose.

I have spent the last 12 plus years studying and teaching EMS scene safety tactics. At no point would we ever have you try and restrain a person holding a weapon (by choice).

Even when I train officers in knife use and defense........ we train them to flee the knife. It never jams and it never runs out of ammo. Look at my bio......... I train in Kali-Silat. I am a student of the blade arts. Even semi-trained blade practitioners like myself get cut.... a lot....... in training learning to escape a blade attack.

Before restraints are taught they may want to look into the "position" the NAEMSP took on patient restraint. According to their paper it takes 5 people to medically restrain a patient.

Now, with this I disagree because how often do you have 5 similarly trained personnel on scene to help with restraint.

Look into it.......... a person who is intent on causing you harm........... and has the capability to do so............. doesn't really need you.............. at the moment.

 

[Aidey]

*once staged an hour and a 1/2 at 4am for police to become available to clear a suicide scene*

I'm guessing your teacher isn't going to accept you guys sitting in the diner drinking coffee (although I personally would do that) so here's what I've got.

Ascertain why the patient has a knife, is he violent, thinking you are KGB agents coming to steal the chip implanted in his head? Or is he depressed and threatening to cut himself? It's going to be easier to get the knife in the second scenario than in the first. For me, it's always just been talking to the patient and figuring out the right way to get them to the hospital safely. The only time I have not been able to talk down a patient is when it was a guy high on PCP. In his case, I didn't even try. I also want to mention I have never tried to talk down a patient without police support either right there, or within shouting distance.

 

[JPINFV]

The key to dealing with any armed and violent patient is to simple be able to run faster than your partner.

 

[medic417]

The key to dealing with any armed and violent patient is to simple be able to run faster than your partner.

Exactly I don't have to be faster than the attacker I just have to be faster than the slowest of the team.

Now if you are in a situation where there is no choice but to fight to get out the O2 tank is pretty hefty should knock them out if you swing it. But your goal is to make hole you can run through not to get control of patient. Your instructor may be trying to get you to think scene safety. I would do something like above and run.

 

[BossyCow]

I hope your instructor was seeing if you had the common sense to determine that a pt with a knife is not a safe scene and you wait for Law Enforcement.

You need a minimum of 5 people for restraint and more is better. There's another thread where techniques are described which you might want to take a look at.

 

[BLSBoy]

*once staged an hour and a 1/2 at 4am for police to become available to clear a suicide scene*

I'm guessing your teacher isn't going to accept you guys sitting in the diner drinking coffee (although I personally would do that) so here's what I've got.

Ascertain why the patient has a knife, is he violent, thinking you are KGB agents coming to steal the chip implanted in his head? Or is he depressed and threatening to cut himself? It's going to be easier to get the knife in the second scenario than in the first. For me, it's always just been talking to the patient and figuring out the right way to get them to the hospital safely. The only time I have not been able to talk down a patient is when it was a guy high on PCP. In his case, I didn't even try. I also want to mention I have never tried to talk down a patient without police support either right there, or within shouting distance.

Bro, I have some one the most compassion and understanding for psych pts.

That being said, I will NOT attempt, unless my gut instinct, and situational awareness fails me, and I am in a bad situation, to attempt to talk down someone that is armed, especially with a knife.

As it was said, it never runs outta ammo, or jams.

There is a LEO video that is very applicable to EMS. Its called battling edged weapons, or something to that effect.

Gives you a whole new perspective.

 

[emtfarva]

what?

I was taught that we are not police. WE DO NOT TAKE PEOPLE DOWN THAT IS WHAT THE COPS ARE FOR.

 

[Aidey]

No, we don't. If an EMS person is taking someone down, something has gone very wrong somewhere and there is going to be a lot of paperwork involved. However, talking someone down with appropriate police support isn't always out of the question (and I think should be utilized more).

 

[Sasha]

No, we don't. If an EMS person is taking someone down, something has gone very wrong somewhere and there is going to be a lot of paperwork involved. However, talking someone down with appropriate police support isn't always out of the question (and I think should be utilized more).

Dude, if I have a psych patient who has a weapon and wants to use it against me, I'm waiting far away with the O2 cylinder within arms reach to bop him upside the head with if he decides to come and find us. Unless you are properly trained to talk someone down, it just doesn't seem like a good idea.

 

[281mustang]

I hope your instructor was seeing if you had the common sense to determine that a pt with a knife is not a safe scene and you wait for Law Enforcement.

x2, I can't imagine an instructor telling students to knowing go into a situation like that and attempt to take him down yourself.

 

[JPINFV]

I was taught that we are not police. WE DO NOT TAKE PEOPLE DOWN THAT IS WHAT THE COPS ARE FOR.

You haven't been in emergency medicine long, have you?

 

[Aidey]

Dude, if I have a psych patient who has a weapon and wants to use it against me, I'm waiting far away with the O2 cylinder within arms reach to bop him upside the head with if he decides to come and find us. Unless you are properly trained to talk someone down, it just doesn't seem like a good idea.

It's totally situational dependent, it's hard to accurately describe here.

 

[emtfarva]

You haven't been in emergency medicine long, have you?

Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.

 

[Griff]

When I went through LE Academy, we were taught to avoid close contact with anyone brandishing a weapon, period. The only exception being that the suspect pulled a weapon after you let him/her get to close to you (i.e. inadequate scene safety); you have no choice then, obviously.

I have not had any EMS training aside from BLS, so I may very well be mistaken, but I know that our medical personnel always stage well away from a scene involving known weapons. Even with less-lethals, controlling a suspect's weapon (and the suspect as well) without harm can often be quite tricky.

I personally would never intentionally approach an armed and hostile person, period, unless it was my specific job and I had the appropriate resources (i.e. backup, OC/Taser, etc). From a LE standpoint, officer safety is a higher priority than the medical needs of a hostile individual (then again, I am not EMS). Is this true within prehospital medicine, as well?

 

[JPINFV]

Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.

While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down unarmed patients. If this scenario was the same sans knife, then I see no reason why EMS shouldn't take down the patient provided there is enough people on scene to assist.

 

[Sasha]

While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down unarmed patients.

Keyword, unarmed.

 

[BossyCow]

While, yes, don't take down the armed maniac, yes, from time to time emergency medicine requires providers to take down unarmed patients. If this scenario was the same sans knife, then I see no reason why EMS shouldn't take down the patient provided there is enough people on scene to assist.

Absolutely, the diabetic pt who goes combative on you, the sweet little old lady who wigs out, the drunk, anyone who just had the narcan take hold, and any one of a dozen or more examples where the pt who was compliant is suddently combative.

I'm just saying if a pt has a knife, they are not yet my patient. I don't treat the armed. LEO can make the scene nice and safe first. Every scenario starts with "BSI and scene safe" this particular scenario didn't pass that test. I have to believe, as an instructor that this had to be a test on the ability of the responders to determine that the scene was not safe and not to enter.... I have to..... it couldn't have been otherwise because that would be.. well.. just crazy talk.