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Just Plain Ruff

EMS Crisis patient

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So Scenario

Called to the scene of a man who says he's depressed and just wants transport to the ED For evaluation of depression.

On arrival you beat the Police and being the Stud that you and your partner are, you enter the house with simply the med bag and nothing else.

You call out and a voice beckons you back to the back bedroom.

You walk back to the bedroom and find it empty. You turn around and find a middle aged man, wide eyed and deranged look with what appears to be a .357 magnum handgun in his left hand. He says "Aint none of us getting out of here today"

You(studly medic) and your partner(super studly medic) look at each other. You are able to slowly reach down and press your radio's emergency alert button before the guy realizes what you did and makes you take everything off except for your fabric uinform. Everything but your shirt, pants, and shoes. He proceeds to throw out the front door everything you brought in with you which of course lands in the front yard as the first responding police units arrive. He proceeds to yell "Don't you fucking cops come in here or the ambulance drivers are dead, you hear me?"

What do you do now?

What are some of the steps that you think you could use to defuse this situation before this house of cards falls down around you.

Apart from the "Should have waited for PD" thoughts running through your head, what can you do in the immediate time period before the hostage negotiators get there to get yourself out alive?

Have at it guys. (and please, don't use the book that was advertised on this site a few days ago).

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After the immediate I'm gunna poop myself thoughts, I would use open armed gestures, reassuring statements, validate his fears, and all of the techniques I've acquired through the years of EMS and hospital security work. Not a whole lot you can do if he's set out to die, but you can possibly talk him into letting you two go.

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Sounds like the size of your balls surpassed the size of your brain on this one.

Any signs of drug / alcohol intoxication?

Pictures of family on the walls or mantle? If so,

Any chance of them talking him down?

What does his demeanor appear to be. Is he highly agitated or calm cool and determined? This will make a difference in whether he can be reasoned with.

If he's highly agitated then the odds are you and your macho partner are going to have a hard time talking him down, so the chance of jumping him and disarming him comes to mind.

That or you sit tight and compliant until the law enforcement team take s control, through negotiation or tactical entry.

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I'm not going to finish the scenario because this is meant to be a discussion of what you have in your arsenal of tricks on how to possibly get out of this situation or shit hole you got yourself into by not waiting for the police. (this only qualifies as a shit hole if you have a policy of psych patients having police respond as well)

But what have you learned in your schooling, your field experience or just what has worked when you have been faced with a pissed off patient or a psychiatric crisis patient. (I wonder where our resident pamphlet author is on this one).

But What has worked in the past for you to talk someone down?

What has not worked and what has caused an otherwise normal patient to go apeshit on you? Sort of a what NOT To do type of thing.

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Partner goes high, I go low, 50% odds of survival. :)

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Open body gestures can be helpful. If they are shouting the best technique I have found is to really whisper. It throws them off and has been very helpful in calming a shouting patient down. Lower your voice and almost switch to a monotone, slow cadence. If they are creepy and calm, then I find making them think is helpful. Get them thinking about what happens if they don't succeed in killing themselves.

Unless you have had specific training in disarming someone with a firearm or knife, then your chances are very slim you will do this successfully.

I would have tried to chuck the jump bag/o2 cylinder at the guy and bolt for the door while he's recovering, or throw a chair at him to knock him off and get out of there.

This situation is likely not going to end well for anyone involved.

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I'd take off the rest of my uniform, underwear and all. I've already shit my pants, anyways. Maybe if I act even crazier than he is, he'll let me go. "The government told me I'd get porkchop sandwiches, and applejuice is stealing my thoughts."

In reality, it's gonna depend on who my partner is that day, and if it looks like we're gonna live if we cooperate. I get the vibe already that he's planning a "grand finale", so if calm/collected defusing doesn't work diddly quick, I'm going all in and attempting an aggressive takedown with an attempt at rapidly disarming the psycho. Getting shot in the leg while fighting someone who's gonna murder you is a hell of a lot better than getting shot in the face waiting for the hostage negotiators (which are approx 2-3 hours away, where I work).

That, or the studly facade will collapse in on itself and I'll become a whimpering mass of tears and urine in the corner of the room. Let's roll the dice!



I should also note here that the emergency buttons on the radios where I work were disconnected....so the wait-time just got even longer.

Edited by Jaymazing

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But What has worked in the past for you to talk someone down?

​Great big crocodile tears and sobbing hysterically....."My daddy told me there would be days like this."......

All kidding aside tho, I have been in some pretty volatile situations while working in certain (reservation) area's where police or other back up is seldom available due to the high area of coverage they have on any given night, and if they are, it's going to be a 30 min wait or longer.

I usually start out trying to find some common ground with my pt and see how that goes. If they begin to get hotter than I work a different tactic.

For example if I know them, I will start talking about their family and bring something personal to the conversation, ask him where the wife and kids are right now and what happened today to bring this crisis on. If he gets hostile and throw out the "Everybody hates me, I'm done playing, etc" then I will probably try to switch it around. Explain that I've always treated him with respect, etc. and ask him just what makes him think I have done him wrong. Then I'm going to ask him for some respect in return by letting myself and my bawling partner leave the premises.

So I'll go with that for now~~I'm in this process now, talking to him on a personal level~~now you tell me, what is He doing now?

P.S. We don't have any type of emergency button on our radios.....so the only hope I have for back up is that dispatch has realized we are on scene an extremely long amount of time and is trying to raise us on the radio..

Edited by ClutzyEMT

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Hmm,,,what is the student doing? Shouldn't he have been sent in there first to evaluate scene safety?

Reading this scenario makes me think that maybe I should get our emerg buttons reconnected. I had them d/c because they're right beside the volume knob and kept getting hit. They're the Keylock button now.

Scary thoughts Ruff, but an excellent and thought provoking scenario. One I could easily see myself getting into.

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Try to feign like i actually care about him. Then look for an opening to turn the tides on my attacker. Subdue him until police can arrest him.

That or do/say anything that will calm him down/let me go.

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