What would you do?...

Here is what I probably would have done.

The medic would have taken the patient (any altered patient should be treated by a medic if one is available) gently restrained with soft restrains with a police car following.** I would have started an IV and checked Sp02 and blood glucose. I probably would not have started an EKG unless the Sp02 or blood glucose was off.

** - I do not let my patients be handcuffed unless they either give me the key, or a police officer with the key is physically in the ambulance. If their hands are cuffed behind their back, it's hard to start and IV or backboard them (if needed). If they are cuffed in front they can still swing at you. If only one hand is cuffed to the gurney they can still swing at you. If both hands are cuffed to the gurney that is the most useful method, however, if you need to roll the patient because they throw up you have to flip the whole gurney, which is rather difficult. With soft restraints/posey restrains they can be cut off if needed.
 
The original question: whether or not to have your partner --with a higher level of training-- handle the call.

I answer it like this: if I were in that situation, and believed I could have handled the potential for violence better than my partner (their sex aside), I would have done so...

...with the caveat that the guy probably wouldn't have made it to my bus in the first place. If he's going to start swinging when released from the back of the cruiser to my litter, I ain't loading him until he's cuffed. And if he's cuffed, a cop's coming along. And being as THAT will never happen, the cops would have taken him in their ownselves.

IF, for some bizarre reason, a cop actually agreed to come along with the PT in the back of the ambulance, I'd have my ALS partner check me for signs of lucidity, for obviously, I'd gone completely mad. If I'd actually passed their assessment, and a cop really did get on board my bus, I'd have them drive just because I'd want to actually SEE --with my own eyes-- protocol being followed. Then I'd buy a lottery ticket on the way back to the nest.


Later!

--Coop
 
Sasha said:
Did he have any s/s associated with narcotics?
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Unknown. What my partner was thinking that he may have taken something other than etoh. I am NOT a medica and I will have to look up are protocols on narcan and get back to you. But I remember a medic saying something about LOC coming into play. I will get back yo you...
 
Aidey said:
Here is what I probably would have done.

The medic would have taken the patient (any altered patient should be treated by a medic if one is available) gently restrained with soft restrains with a police car following.** I would have started an IV and checked Sp02 and blood glucose. I probably would not have started an EKG unless the Sp02 or blood glucose was off.

** - I do not let my patients be handcuffed unless they either give me the key, or a police officer with the key is physically in the ambulance. If their hands are cuffed behind their back, it's hard to start and IV or backboard them (if needed). If they are cuffed in front they can still swing at you. If only one hand is cuffed to the gurney they can still swing at you. If both hands are cuffed to the gurney that is the most useful method, however, if you need to roll the patient because they throw up you have to flip the whole gurney, which is rather difficult. With soft restraints/posey restrains they can be cut off if needed.
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I can check a chem BG. I can check O2 sat's. I can't start a line... But he wouldn't stay still even if he was restarined. and I don't think any real medic would want to stick a person with a needle if they won't stay still and there is any chance that a needle will come back at them after it was stuck in someone else. this guy would not stay still even with myself, my partner and 5 cops holding him down.
 
Aidey said:
Here is what I probably would have done.

The medic would have taken the patient (any altered patient should be treated by a medic if one is available) gently restrained with soft restrains with a police car following.** I would have started an IV and checked Sp02 and blood glucose. I probably would not have started an EKG unless the Sp02 or blood glucose was off.

** - I do not let my patients be handcuffed unless they either give me the key, or a police officer with the key is physically in the ambulance. If their hands are cuffed behind their back, it's hard to start and IV or backboard them (if needed). If they are cuffed in front they can still swing at you. If only one hand is cuffed to the gurney they can still swing at you. If both hands are cuffed to the gurney that is the most useful method, however, if you need to roll the patient because they throw up you have to flip the whole gurney, which is rather difficult. With soft restraints/posey restrains they can be cut off if needed.
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You are on the right track with this but proceed with caution. :)

Remember to separate a "patient" from an "attacker". When a person is in custody...... it is just that. Handcuffs must not be used as a medical restraint. You will lose in a lawsuit. So the moment you continue to classify the person as a "patient" and they are in handcuffs........... Lucy......... you got some splanin' tu do...........

If the person has an AMS due to intoxicants or drugs......... you can have law enforcement restrain them.............. Let me re-phrase this.................

IF the police on scene decided the person needed to be restrained........... LEAVE THEM THAT WAY. Not to say you can't modify the type of restraint with the direction of LEO, but cops are way better at restraints than EMS.

Medical restraints are designed to keep a person from hurting themselves. They fail in protecting the health care provider. Soft restraints can and will fail to keep a person restrained.

I have worked in several areas in several states. Both of which officers have rode in on a call or two with us. I have also worked where an officer, who had custody of a person, followed behind the ambulance.

Now you can handcuff a person and have them in the High Fowlers position......... vomiting is no longer an issue.

If the person was so lethargic vomiting may occlude their airway.......... I am not so sure soft restraints and a little elbow control (see article I wrote on it) would keep you from hurting the "patient" or vice versa.

Please don't take any of this as a personal attack. That is not my intention. Your statement is valid and actually a common perception. I just want to help keep you employed and more importantly.......safe.

Kip
 
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Arkymedic said:
In your state, if a medic is present are they required to "tech"? I understand the arguement you make for wanting to be in the back since she was female, but is it allowed? In AR, a paramedic is required to take the call regardless of circumstances if they are present and the unit is ALS (which almost every EMS service is). In OK, I have seen the opposite where services can be BLS, ILS, or ALS and some medics put the basic or intermediate in the back on most every call.
One of the services I used to work at a crew responded to a call for an intoxicated subject that had been kicked in the head by a horse in the middle of night. When the unit got there SO was on scene and ultimately the medic (also a female) "feared for her life" and put her male basic in the back. The pt had a severe head injury and required being sent to another facility by helicopter and his BAC was over 3x the legal limit and DOH was called later and it turned into a very very big deal and a political situation due to other circumstances.
Again, I understand the desire to protect a partner, but I would most definately have restrained him and once he swung at us PD would go too. I do not care if he meant to hurt you or not, he swung and struck you (regardless of how hard you think it was) and that compromises your safety, your partner's safety, and that of others on scene. At that time why did PD not cuff the patient? I also would have checked a CBG on this patient because as spisco mentioned, hypoglycemia can often mimic intoxication but I would not have given narcan. Thiamine could be given, but with unknown history, I would be cautious throwing drugs at him. Also, just remember that everyone reacts to substances in different ways so the statement "PD told us that his friends told them that they were at a party and they had the same amount to drink" is highly unreliable.This is in no means suggesting females are unable to take care of themselves or to handle a patient nor do they need rescuing.
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NO. And even with PD we still have a scence satfy issue. I didn't feel safe with her in the back even with pd. I wanted to take the Pt alone but PD wouldn't let me. Also we didn't have fire with us and pd doesn't drive for us. I guess I could of asked for a 2nd truck. He was drunk. I could smell it when they opened the crusier door. And at the moments he would talk to us he did say he was drinking. After at the hosp, they called family and the family stated he had a history of etoh and drug abuse. Pd never saw him hit me. I am sure if they did see it they would have. At another call, I had a pt that was in custudy try to kill himself by bitting his wrists, they cuffed him to the stretcher. But when he was arrested he was holding a 40 and sword. that might have something to do with it. I think when he started swinging I started thinking ahead of myself into the call. Also PD can't just bring the guy to ER in that state he would have to go by ambulance anyway. And I wasn't even saying that female emts can't handle themselves, either.
 
Veneficus said:
What is the purpose of pushing narcan on an agitated patient? It competes for opioid receptors. Opioids depress patients. This is quite the opposite effect described here. If by some chance he was on an opioid in addition to his other issues he would have been more awake and more agitated. Maybe with some acute pulmonary edema to boot.

A patient swinging at me buys some physical and possibly chemical restraints dependng on what I think is wrong. If I am in house they just bought a foley cath as well as one of those tape on colostomy bags too. Not because I am malicious, because I don't want myself or anyone else getting hurt. The punches don't hurt till he lands one in your eye and we start calling you "patch" or knocks the tip of your xiphoid into your liver and you wind up in the ICU with the providers there wondering if they have to take a section of your liver out.

Scene safety!!! Be selfish you are the most important person there.
Next to me of course ;) (you get the idea though)
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Question... What type of drug is Etoh? It is a depressant isn't it. And I found out today that narcan works on the combo of Vodka and Xanax. It worked for a pt that od on those two.
 
emtfarva said:
Question... What type of drug is Etoh? It is a depressant isn't it. And I found out today that narcan works on the combo of Vodka and Xanax. It worked for a pt that od on those two.
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Narcan works on opioid receptors. Xanax is a benzo. (Also known in Sashanese as an olam.) . Not the same thing. Perhaps your OD had OD'd on something more than Vodka and Xanax?
 
Sasha said:
Narcan works on opioid receptors. Xanax is a benzo. (Also known in Sashanese as an olam.) . Not the same thing. Perhaps your OD had OD'd on something more than Vodka and Xanax?
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nope saw the labs. benzo, etoh and thc. that is it. And he wasn't in my care when he OD'ed. I was taking him to a pysch facility for a 72 hour vacation.
 
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Retracted.
 
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emtfarva said:
Question... What type of drug is Etoh? It is a depressant isn't it. And I found out today that narcan works on the combo of Vodka and Xanax. It worked for a pt that od on those two.
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Who told you it worked?

Perhaps you are confusing narcan with the benzo reversal agent romazicon?

maybe you could help me out and explain to me exactly how this works biochemically? At least at the molecular level? You might find the answer in a lippincott illustrated review of biochemistry or pharmacology.

As for the etoh, I would be very interested to hear how it reacts to neutralize an OH radical.

Maybe you can find the answer here:
http://www.drugs.com/pro/narcan.html
 
emtfarva said:
Pd never saw him hit me. I am sure if they did see it they would have.
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You see, this led me to believe that PD had witnessed you being hit. If not for the PD, who were the other three people who helped you to strap them down?

My partner and I (Sharon) responded to a call for injurys after the assualt a couple of months ago. When we got there we find about 7 police crusiers. We found a very drunk Pt sitting in the back seat. PD was telling this guy he had to go to the hosp. We got him out of the crusier and started to try to get him on our stretcher.

At this point the Pt became very uncoop. and started to swing wildly. He even hit me in the face a couple of times. Not hard but he hit all the same. It took about 5 of us to get him straped down.
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I guess I could of asked for a 2nd truck
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Even if they did not see him hit you, most times they will take your word over a psych patients for "Hey! He hit me! CAn you do something?"

I didn't feel safe with her in the back even with pd. I wanted to take the Pt alone but PD wouldn't let me. Also we didn't have fire with us and pd doesn't drive for us.
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So let me get this straight, you were hoping they'd restrain him, didn't feel your partner was safe in the back with him, but wanted to take him alone in the back? Why? What is your reasoning for not wanting PD in the back if you were in that much fear for your partner's safety?
 
Sasha said:
You see, this led me to believe that PD had witnessed you being hit. If not for the PD, who were the other three people who helped you to strap them down?





Even if they did not see him hit you, most times they will take your word over a psych patients for "Hey! He hit me! CAn you do something?"


So let me get this straight, you were hoping they'd restrain him, didn't feel your partner was safe in the back with him, but wanted to take him alone in the back? Why? What is your reasoning for not wanting PD in the back if you were in that much fear for your partner's safety?
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PD Helped restrained the PT, or I should say helped put him on the stretcher. I didn't say anything to pd either
When he hit he was swinging not punching. it wasn't a closed fist. more like if i had my arms outstretched and turned to one side and hit a person just standing there. He wasn't punching he was just swinging. I don't know how to explain it. And my reasons for being in the back alone was that he wasn't responding to any of the females around (PD and my Partner). he was only responding to the males. and for a minute I was along with the guy in the back of the truck and he didn't do anything. I figured get him to the hosp quick and get him out of the truck. don't get me wrong, I think what was really triggering him was the cops. When we were in the back together he was still strugling but he was listening to what I was saying until the cop came in the back. And the reason I didn't want sharon in the back because he wasn't at all listening to any of the females. and plus not that size matters I was prob about 50% bigger than him. I am about 270 and he was about 130-140 range. If I had to I would have just crossed his arms and put my weight on them until I could get more help. Sharon could not do that. and when we put him on the stretcher we used a blanket and placed the stretcher straps tight around his legs. he tried to kick free but couldn't. For the 3 min ride the only thing the cop did beside getting spit on was hold one of his hands while I had the other..
 
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Veneficus said:
Who told you it worked?

Perhaps you are confusing narcan with the benzo reversal agent romazicon?

maybe you could help me out and explain to me exactly how this works biochemically? At least at the molecular level? You might find the answer in a lippincott illustrated review of biochemistry or pharmacology.

As for the etoh, I would be very interested to hear how it reacts to neutralize an OH radical.

Maybe you can find the answer here:
http://www.drugs.com/pro/narcan.html
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The ER doc mention that in his report. according to him When EMS arrived the pt was unresponsive. the medic started a line and admin 2mg narcan and the pt began to come around. When they copied the Pt's chart they missed the 2nd page of the report and I couldn't confirm the report. but the medic that was at the call is working tonight. I will talk to him when I get in at 8pm and comfirmed the story. As far as your other question I don't have an answer for you. I put a call into Bill Nye but he has returned it yet. I will get back to you if he ever calls me back. MA does not carry romazicon yet.
 
DT4EMS said:
Now you can handcuff a person and have them in the High Fowlers position......... vomiting is no longer an issue.
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Unless they are backboarded.


I know it kind of sounds like making excuses for why my patients shouldn't be handcuffed, but like I said, if the officer hands me the key, or is physically in the ambulance then I'm ok with it.

At my previous employer the ambulance couldn't talk directly the the police on the radio. We had to radio our dispatch, who had to call their dispatch, who had to radio the officer.
 
We are supposed to document in every single restraint case why we restrained them and show at least two attempts to verbally de-escalate the situation. Handcuffs are out during transports and we must use soft restraints. I've gotten pretty good at putting soft restraints on a handcuffed pt so LEO can remove the cuffs.

We are often unable to have LEO in the back with us. They arrive in their own cars and are not allowed to leave their vehicles on scene and ride with us. On the rare case where they are driving two to a rig, we can take the extra but that's generally a trainee and the exception not the rule around here. LEO follows our rig in theirs. That's as good as it gets. So, often there's a bit of a struggle over... no.. he's fine.. take him in your car... and no he's not.. ambulance...
 
I don't understand why you took this person in the first place. You responded to an injury from an assault. Was the drunk in the crusier injuried? Did the drunk give you permission to take him to the hospital? Did they want to go to the hospital? If the drunk is capable of resisting and halfassed swinging they are well enough to go to hospital or jail in the police car. The police can restrain him, transport to and babysit him at the hospital as required.

Here no matter how drunk a person is if they don't want to be assessed or transported to hospital they have the right to refuse. It then becomes a police matter.

As to who should have attended the pt. It comes down to what did the pt need? That should determine who attends. The LEOs are there to protect us amongst other things. Let them do their job.
 
Outbac1 said:
I don't understand why you took this person in the first place. You responded to an injury from an assault. Was the drunk in the crusier injuried? Did the drunk give you permission to take him to the hospital? Did they want to go to the hospital? If the drunk is capable of resisting and halfassed swinging they are well enough to go to hospital or jail in the police car. The police can restrain him, transport to and babysit him at the hospital as required.

Here no matter how drunk a person is if they don't want to be assessed or transported to hospital they have the right to refuse. It then becomes a police matter.

As to who should have attended the pt. It comes down to what did the pt need? That should determine who attends. The LEOs are there to protect us amongst other things. Let them do their job.
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in some states i the US it is just the opposite, if a person even smells of alcohol, you are legally protected to bring him in. I like the idea of "clinically" intoxicated, but w/o a lab in my home state the liability is too much
 
You have to take in drunks? What a waste of resources. If I have a drunk with an obvious injury or reason to have medical attention I'll try to talk them into going. Or if they say they want to go then I have to take them. Otherwise drunk is drunk they can sleep it off somewhere else, like a friends house or a cell.
 
Outbac1 said:
You have to take in drunks? What a waste of resources. If I have a drunk with an obvious injury or reason to have medical attention I'll try to talk them into going. Or if they say they want to go then I have to take them. Otherwise drunk is drunk they can sleep it off somewhere else, like a friends house or a cell.
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yep, The police do not want the responsiblity. and also as many peolpe have mention acting drunk doesn't mean you are drung. too many DM have died in jail because they didn't get medical treatment. And according to MA, Achoiclism is a diease and has to be treated that way. so that makes it a medical problem.
 
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