Fire away other EMS-ers..

[mysticlakecasinoemt]

Spare sarcastic retorts please. I don't need or want that sh*t. If you

do, it shows how really non-EMS caretaker you really have become.

Seeking advice. Learned today that a cooperative altered level on drugs had

a concealed 38 no one knew about until he reached the hospital. My part of things

was first EMT/Security Guard there at the casino until he was loaded into the rig.

Pt. was conscious, loopy, mis-answering orientation questions, but thoroughly and

smilingly cooperative, right down to the lacing fingers over the chest and

obeying even the smallest instruction.

He was found seated in a wheelchair acting limb and head restless with

non-seizure behavior similar to Turette's Syndrome.

What are good alternative ways to CYA for a possible concealed when

you're under a no hands on searching patient if not a life threat absolute

standing employer order? He wore baggy, "Fat Albert" pants

belted at the thighs, and a low hung oversized T-shirt. You know that inner

city gang look. All he was missing was a do-rag.

Gun wasn't found until hospital arrival bed transfer in the ER.

Fire paramedics missed it too.

We as a service are allowed no weapons or defensive gear of any kind

in this part of Minnesota on the reservation.

Thanks for useful views and no thanks for the Neanderthalish stupid ones from

the peni-- excuse me, peanut gallery.

[akflightmedic]

Wow! Whats up with the hostility?

I am hesitant to talk to anyone who asks for advice in such a hostile way, but I will do it anyways.

Whats the big deal? I have probably tx lots of weapons and never known it. We don't do searches. If you have a no hands search policy, then you did your job. You had no reason or suspicion to search this individual. Why do you need to CYA? If you can't search, then you are not going to find anything. Did you ask the pt if he had any weapons of ANY kind on his person? He just might have volunteered this information.

Sorry I dont see what the fuss is all about...

[Beagle189]

Your management won't let you search a pt for their stated reasons (acting as Security Guard). But when acting as EMT, and I assume that is part of your function there, You can do a hands on assessment. Check chest and sides for equal expansion - your hands move around the chest and you can feel for a weapon. Check for Abdominal distension/firmness/masses. Palpate for back pain. Check for pelvic pain on palpation, Extremity pain on palpation/Sensory,Motor,Circulation checks. As you palpate each region your also checking for weapons. Be Sneaky,Be polite/caring, do a thorough assessment, but remember YOUR SAFETY comes first.

[SSG G-man]

Think of changing DECAPBTLS to DE CAP (like no caps as in guns/rounds) BS(self explanatory)!! As you do a head to toe check, you are also doing a pat search. Maybe a little different, and most watching would never know. And I would say things out loud as you do it, so you have a witness, "No deformites, blood, etc in upper right arm. No tenderness or swelling on lower back, no abdominal tenderness, no cepitis in hips."

Just my $.02

[MedicNorth]

Wow - I can't imagine trying to do an assessment without hands-on! There can be all sorts of reasons for all sorts of complaints that you are unlikely to find with out physically touching - tenderness, distension, etc. I would check into company protocols to find the exact circumstances that allow hands on. How can you tell life threatening without a complete assessment?

Finding weapons on a Pt would not be high on my list of wants, either. I hope you didn't get into trouble over this - there are enough hurdles in this game without making you into security too.

[Dustdevil]

Yeah, I don't get the hostility either. I guess I am just not Neanderthal enough to see the opening when it presents itself. :?

In the case of a non-traumatic patient, it is certainly not unusual that a weapon would go undiscovered. You didn't say where it was located, but abdominal and chest auscultation may very well have revealed the weapon. If not, I disagree that you should be doing a full body pat-down on each and every patient you encounter. You're just looking for trouble with that sort of policy. And, of course, how long did you even have the patient before EMS arrived? Only a certain level of exam is expected from first responders. I don't think you did anything wrong. For that matter, I don't think EMS necessarily did anything wrong either.

I also don't see the big deal about finding weapons on each and every patient. Lots of people carry weapons. Lots of them are fully within their legal rights to do so. Not everybody with a weapon brought it along just to kill paramedics with. If he had come in there intending to use his gun, he would have already done so. Personally, I don't care. It is not contributory to their medical condition, so it is not high on my list of concerns. And if I were confined to a wheelchair, I think I might be taking extra self-defence precautions too.

I do think I would take this incident and use it as ammunition (no pun intended) in a formal proposal that EMS personnel be taken out of security uniforms for obvious safety reasons. When you close in on this guy with your security uniform on, you're cornering a scared animal. He doesn't know you are there to help him. He just knows you're security. You may precipitate a violent encounter simply by the way you are dressed. There is absolutely no excuse for that, and your management should deal with the issue.

The uniform issue aside, it sounds like your approach to the patient was a good one. You were obviously non-confrontational and put him at ease instead of copping the cop/security guard attitude and mindset that is so common among medics. Your attitude will go farther to "disarm" your patients than a pat-down will. Patting people down only makes them fear discovery and possibly make them take desperate measures to avoid it.

[CROM]

Let's see - It doesn't mention that the pt was wheelchair bound only that he was in one. Many casinos have wheelchairs for their patrons if they get ill.

Lots of people do carry legally concealed firearms without the intent to shoot Paramedics/EMT's. But Obviously the writer had a suspicion that the subject might be carrying a weapon and be inclined to violence. Anytime Drugs or alcohol are involved with a weapon carrying individual the desire to use it increases. Not only that, but any loaded firearm can discharge at the most inappropriate time (with you at the wrong end),so knowing that it is there can be helpful to you. No it doesn't factor into the pt's medical condition but it factors in to your safety. So I understand the writers concern.

[Dustdevil]

I agree with the concern. I'm only saying that concern does not rise to the level of doing a body cavity search of every patient you treat. Especially when you are just a first responder.

[mysticlakecasinoemt]

Wow! Whats up with the hostility?

I am hesitant to talk to anyone who asks for advice in such a hostile way, but I will do it anyways.

Not hostility.. I received flip replies from this forum all the time from long

time posters who're retired EMS folks who'd rather show they know more than

the new folks and who seem to like to rub it in. Sorry for that. Took a while for

me to stop shaking and be able to sleep some.

My original post was through fear, shock. Nothing like being in danger when

you least expect it. I thought my eyes were open. Surveillance has clear footage

of that whole incident. I was with the guy for four and a half minutes before MD Fire

came from across the street to take over.

He was conscious, almost friendly if loopy. He was in that wheel chair because he requested

one when he came in through another entrance and was given one because he wasn't smelling like booze. He had the appearance of having muscular dystropy or as having another prior old head injury disability.

He was 31 on his I.D., fully cooperative, and happy we were there to help.

Then that gun showed up out of nowhere in the ER and took us all into hell in seconds.

As to the hands on/ off policy. Even touching a casino guest without permission as a security guard is battery in the eyes of the company and any casino visitor is allowed to pursue any action taken by a guard if they feel they've been inappropriately physically touched if they want to press charges for just about any reason at all.

But, if anyone takes a swing at you, any guard is allowed to do whatever it takes to protect themselves. On the reservation, there is no excessive force limitations so anything goes

with the casino's blessing, since all incidents like that are usually being watched by cameras

ahead of time whenever one of us has to approach anyone for something like an ID check,

a policy compliance enforcement, etc. We are allowed no defensive weapons at all.

On the other side of my job, as an EMT, I'm given free rein to do whatever I need

to physical hands assessment,.. only if a patient's unconscious, near that state, or obviously bleeding with trauma, but only then. Not when they're awake and able to make lucid like choices. We have to ask every step of assessment and before any given treatment,

ie : Do you want oxygen?, can I take a BP?, etc, to make sure not to infringe on their

rights as a patient.

A hundred things ran through my mind this morning and all were nasty possibilities. I was

surrounded by hundreds of innocent slot and card players, out in the wide open.

Cut me a little slack on my earlier reaction, it was my first inches away face to face encounter with a lethal weapon in what I thought was a very very safe scene. And my gloves were full of

blankets and used gluc tester wipes.

In my first post, I was feeling vulnerable, numb, and I was mad I was caught with my britches down so thoroughly. The guy's clothes were inner city "fat albert" with baggy pants belted at

the thighs with an oversized long hanging T shirt. Couldn't see anything on this tiny Asian guy.

He was cooperative, and followed requests instantly, until that last instant in the ER.

I had four surveillance cameras on my call and they didn't see anything odd either. And I use

them all the time to zoom in for a breathing status, head to toe look all the time while I'm still

getting there from another area of the casino with the medical gear.

I still don't know whether or not I could have done anything different. I swear, I'll smack the

next guy who pulls out a gun on me. I was too stunned to even react for this one, and I could have died for it.

Cops had their useless two cents worth. They said, why didn't you call us first?

(They take ten minutes or more to come out to our area, even on a code three call most times.)

[Just Plain Ruff]

Just be glad no-one was hurt and that he wasn't out for trouble. Sounds like a routine call and one that you would not routinely search for a gun or any type of weapon.

This is one thing that you can put in your little toolbox of things to be careful of in the future.

I hope this doesn't happen again but just one to be looking for in the future.