Using force to defend yourself.

[Fox800]

I'll bring this up because I recently ran on a diabetic who is well-known by responders and his family as becoming combative when hypoglycemic. He's a pretty strong dude and could definitely give most EMS providers a good fight.

The patient was initially unconscious/unresponsive, with a BGL of 10 mg/dL. After administering some D50%, he became very combative.

What's the most extreme example of EMS providers using force to defend themselves that you know of? Has anyone you know/heard of ever been prosecuted for using force to legitimately defend themselves from a patient with altered mental status (lets leave out examples of providers using force in an obviously malicious manner)? Does anyone know of any case law regarding this matter?

I came closer to getting bitten that I ever have, and while we were able to control this patient, it would have been dicey if there weren't six of us on scene. If it were just my partner and I, we would have had a heck of a time.

 

[medic417]

I have used the minimum required force to defend myself and as a result subdue a dangerous patient on more than one occasion.

 

[Fox800]

I have used the minimum required force to defend myself and as a result subdue a dangerous patient on more than one occasion.

Thanks. Really. Very informative. <_<

 

[TransportJockey]

Thanks. Really. Very informative. <_<

That's pretty much the way the laws about it are written. Use the minimum necessary force.

 

[medic417]

Thanks. Really. Very informative. <_<

Any one that suggests beat the hell out of a patient will get you sued. What is minimum required force? It is what is required to stop the threat and nothing extra. At times that could even be deadly force. But to use force make sure there was no other option such as backing away.

 

[fma08]

Make sure it is documented well. Perhaps take preventative measures and have LEO, FD, or First Responders restraining his arms and legs before he becomes conscious if he has a strong history of being combative?

 

[medic417]

Make sure it is documented well. Perhaps take preventative measures and have LEO, FD, or First Responders restraining his arms and legs before he becomes conscious if he has a strong history of being combative?

Actually entering a known patient with violent tendencies w/o proper precautions is not a smart ideal. In fact if you end up hurting the patient by using even minimum force you could get in legal trouble. Why? Because had you taken proper precautions there would have been no need to use the force that caused patient harm.

 

[DT4EMS]

This is the subject I have focused on for 14 years...........

First there must be a clearly defined difference between a "pateint" and an "attacker".

I teach the "Diabetic" is one of our "6 D's", the calls with the potentiall for violence. There are tactics that are considered "reasonable" when it comes to using any force with a pateint and those tactics that are considered "reasonable" when dealing with an attacker.

Be very careful about what you read......and then put into action. I have spoken with many folks in the medical field who have been terminated becasue they used force while on the job. Some were completely justified in the force they used, but failed to report and document it properly.

You need to understand force levels and their relationship to the force being used against you. You MUST have a clear understanding of what is considered "reasonable".

And as an interesting note........... the major use of force case that is the basis for "reasonable" in law enforcment cases was over a DIABETIC!

 

[MonkeySquasher]

Learn verbal judo. It'll save your bacon for some who ISNT altered mental.

For this guy, I agree, have Fire/partner restrain him while the line and D50 are prepped. Then push and let him come around. You certainly can't knowingly risk yourself by doing a IV/D50 and waiting for him to attack you, but you also can't stand there and wait for his BGL to hit 0 and for him to seize and die, either.

 

[Shishkabob]

Has anyone you know/heard of ever been prosecuted for using force to legitimately defend themselves from a patient with altered mental status

That's the thing... if it's legitimate, you wont be prosecuted. If you're attacked, you have the right to defend yourself up to the point of controlling the situation.


Back in February, I ran on a postictal patient who was combative. He took a swing at me, and was consequently Tased by the LEO there with us. Spent the next few minutes with 1 cop, 4 firefighters and me wrestling him to get him under control.



If all else fails, 5 of Valium or 5 of Haldol does wonders

 

[8jimi8]

If all else fails, 5 of Valium or 5 of Haldol does wonders

sometimes.

sometimes haldol doesn't touch them.

 

[Shishkabob]

sometimes.

sometimes haldol doesn't touch them.

That's when you offer them a lollipop.

 

[exodus]

I would get some people to help lay him on your gurney, then restrain. And once he's good and all there, un-restrain him. It's perfectly acceptable to restrain pt's you know will be violent because in their right mind, would they still beat you? Or would they want the treatment to keep them and their rescuers safe? Implied consent, you can restrain aloc patients if you want.

 

[johnrsemt]

Versed IM or IN to control violent patients

Glucagon to pull liver stores

 

[tazman7]

We are allowed to "use as much force on them, as they are using on us..." My question is so if a guy spits at me I can hit him with an oxygen tank?? haha (kidding)

I usually try not to get into those situations but I have had a couple people come at me while doing the transfer. The soft wrist restraints suck. I tend to go for pillow cases and sheets. They work great. Just wrap the sheet around their chest, and tie it around the part of the cot that sits up. Tie their hands to the rails, lay them flat so they get worn out quick. Then put a nrb on them to prevent spitting.

Done this a few times not and the medical director was ok with it.

 

[Akulahawk]

I've had to deal with combative patients too, like the post-ictal or the low blood sugar... If you know they're going to have violent tendencies, restrain the patient while setting up for proper treatment. Once they get going, it's MUCH harder to control them without risking injury to them or yourself.

 

[DT4EMS]

We are allowed to "use as much force on them, as they are using on us..." My question is so if a guy spits at me I can hit him with an oxygen tank?? haha (kidding)

I usually try not to get into those situations but I have had a couple people come at me while doing the transfer. The soft wrist restraints suck. I tend to go for pillow cases and sheets. They work great. Just wrap the sheet around their chest, and tie it around the part of the cot that sits up. Tie their hands to the rails, lay them flat so they get worn out quick. Then put a nrb on them to prevent spitting.

Done this a few times not and the medical director was ok with it.

Not too bad except...... if you are dealing with someone who may be having issues with excited delirium, don't place anything across the chest that would interfere with breathing........period.

A NRB mask on a patient can place liability on the provider........for instance....... if something goes wrong....placing an NRB on a person not requiring high flow O2 ..... "is the NRB mask an approved spittle protection device?" Would not turning on oxygen while using an NRB cause an increase in CO2 the person would be rebreathing? If they were fighting prior to or during your restraint is there an increase in lactic acid and a need for blowing off of the lactic acid?

Now the kicker.........

How many people are you using to "medically restrain"? Do you know where the NAEMSP stands on this? I can assure you lawyers know the number the NAEMSP has take the "position" of.

 

[tazman7]

Not too bad except...... if you are dealing with someone who may be having issues with excited delirium, don't place anything across the chest that would interfere with breathing........period.

A NRB mask on a patient can place liability on the provider........for instance....... if something goes wrong....placing an NRB on a person not requiring high flow O2 ..... "is the NRB mask an approved spittle protection device?" Would not turning on oxygen while using an NRB cause an increase in CO2 the person would be rebreathing? If they were fighting prior to or during your restraint is there an increase in lactic acid and a need for blowing off of the lactic acid?

Now the kicker.........

How many people are you using to "medically restrain"? Do you know where the NAEMSP stands on this? I can assure you lawyers know the number the NAEMSP has take the "position" of.

Using a nrb mask to prevent spitting is actually in our protocols. Obviously you have to hook it up to oxygen 15 lpm to do this or if you didnt it would be the equivalent of putting a plastic bag over someones head..

I have only had to do this two times. And it was for a person that 5 cops could hardly keep down because he was the size of Paul Bunyan.. Plus the guy had hepititis a,b,c,d,e,f,g, aids, and every other disease..and was spitting blood all over the place. I have actually had ppatients handcuffed and put the pt face down, but a leo has rode with in the back.

What is the lawyer going to be more mad about, me restraining a person with the best thing I can use in the ambulance or seeing a medic getting his a$$ kicked in the back of the ambulance.. If they dont like creative ways of restraining people that is still safe (checking breathing, pms) then they need to give us handcuffs and tasers. Because a junky little soft restraint doesnt always do the trick...we arent always tying down a 90 pound 90 year old woman who is postictal.

 

[lightsandsirens5]

Back in February, I ran on a postictal patient who was combative. He took a swing at me, and was consequently Tased by the LEO there with us. Spent the next few minutes with 1 cop, 4 firefighters and me wrestling him to get him under control.

Aint it fun? Had a narc OD last winter that we used Narcan on. I was just out of ILS class and my Intermediate partner was doing pt care. So while I am bagging the guy she draws up 6mg of Narcan and attaches to the dripset. I assumed she was going to push 2, maybe 2.5 and the check resps. Well, she starts, I watch her push about 1 or 1.5, I look over at the monitor to check SPO2 and rhythm and by the time I look back she is just finishing pusing all 6 mg! AHHHH!!! The last thing I thought before he woke up was "This is about to get really bad........" In 10 seconds he went from dead to fighting like a maniac. He picked my partner up (And she is not a featherweight) and threw her about 3 feet onto a couch. We had two cops on scene with us, one county deputy, us two Intermediates and one firefighter Basic. It took the two cops, the firefighter and I to hold this guy while the deputy cuffed him. One cop had him in a headlock, the basic was holding one arm in a winglock I had his other arm and the other cop had his legs. If he had come at me though he would have got a fist to the jaw and a knee to the groin.

 

[Veneficus]

These threads are always so much fun to read.