Why was this guy even in an ambulance?

[JakeEMTP]

A back board and a roll of Kerlex for each extremity is going to secure a patient much better that any handcuff. Also tape their heads down- Tactical immobilization.

2 back boards works wonders. Picture and Oreo cookie. I have to agree with Herbie here, a little Versed never hurt anyone.

[Dustdevil]

2 back boards works wonders. Picture and Oreo cookie.

You have to be careful with that one. There are quite a few so-called "experts" out there who will be quite happy to take the stand and testify as to the inappropriate nature of that move. As popular as this manoeuvre seems to remain, it has been "officially" verboten for over 20 years. If one of your patients ends up dead or injured from positional asphyxia from this (not that uncommon), you become both unlicensed and incarcerated very quickly.

[whit72]

Jake EMT wrote:

2 back boards works wonders. Picture and Oreo cookie

Interesting concept.

How about being able to differentiate what a police matter is, opposed to an EMS matter. Therefore securing the fact that no one including the patient, will be subject to further harm.

If he is stable enough to kick, scream, bite and spit. He is stable enough to do it in the back of a police car.

[DT4EMS]

Situations like this very one arise almost daily. If it isn't incidental, it is purley accidental the average EMS provider ever even hears about it.

Most of the time someone points it out it is usually during an anecdotal story. When the NAEMT released the numbers of assaults last year everyone jumped up and down saying t couldn't be that high.

Now even others like OSHA and the National Fire Academy are starting to receive "Papers" written on the subject. (Not by me).

I can tell you that most police departments have it IN POLICY that if a suspect complains of injury, they MUST be transported by EMS to an appropriate facility. The average offier "assumes" EMS are good at patient restraint. (It's not their fault). If you work in an area where there is only 1 deputy or officer for that sector, he/she will have to follow, not ride with.

Be very, very cautious of anything restraint wise that restricts breathing of a suspect/patient. Just like Dust said, there are many "experts" now that will gladly take the $100.00 per hour to testify how all decision making folks including the NAEMSP have released position papers on patient restraint and restraint asphyxia.

I can assure you this type of a call is a no win for either EMS or LEO.

[hfdff422]

positional asphyxiation is why I recommended utilizing a single backboard, and simply modifying a normal trauma transporting postion by adding Kerlex at the wrists and ankles. Also a NRB is necessary to keep them from spitting on you.

[*** CDN BACON ***]

I can tell you that I would not leave my weapon behind....never heard of such a request ......

a handcuff above the head and one to the side bar .....both in positions to prevent slip up down left or right....secure the ankles (triangular)to the end of the stretcher, and your done.

Spitting and flailing does not equal good to go in a cruiser...liability???... by that premise violent diabetics and some seizures and head injuries drug overdoses...excited delirium....may very often not get the care they require..not to mention alot of people will be sued

[whit72]

I believe this was a domestic, not a medical. Combativeness is not always linked to an underlying medical condition. Unless you consider being a prick a medical condition.

The safety of my partner and I are my main concern.

As far as LE personal riding with us, they do at times. With their gun.

[PRPGfirerescuetech]

Anyone ever notice a moderate lack in education regarding this topic?

[AZCEP]

Anyone ever notice a moderate lack in education regarding this topic?

Worse, aside from the few LEO's that have responded, there would appear to be a definite "cowboy" attitude about the situation.

[Eydawn]

Isn't it purely speculation to wonder why this guy was in an ambulance since you have no idea what his potential injuries were? Just saying... maybe he has a psych history well known to the cops, maybe he's a diabetic who never takes his meds, maybe the cop broke his arm or his ribs taking him down... it's all an imaginary scenario at this point. It's a moot point.

Fact: He was combative and assaulted both a police officer and an EMT.

Fact: For some reason, it was determined that he should be transported via ambulance, not squad car. Rationale: unknown at this point. Regardless, it was determined to be appropriate.

Now, let's discuss possible ways to restrain a combative patient.

A: Physical restraint that does not compromise the airway. This includes full immobilization to a long spine board, with hand and foot restraints to keep the patient from flailing/striking anyone in the patient compartment. The "oreo LSB sandwich" is a lawsuit waiting to happen. Ask a partner to sandwich you when you've got some down time and then wiggle around. Think about how your respiratory capacity is diminished, and how an agitated state with an already elevated respiratory rate might make this situation deteriorate rapidly. Also, it would probaby be better to place a dust mask or N-95 on a spitter than an NRB with no O2 flowing through it. Just a thought.

B: Psychological restraint via the presence of an LEO. This LEO, remember, must conform to his operating procedures. He's in there to keep himself, you, and the patient safe (pretty much in that order) and will use whatever force is necessary to accomplish this goal. Usually this will involve psychological force in numbers, as well as helping you tie Mr. Incarceritis (Help! I'm going to jail! I have CHEST PAIN!) down, and/or utilizing further physical force as necessary.

C: Chemical restraint. Subdue the patient physically long enough to make chemical sedation a possibility. Then further physically and/or psychologically restrain as necessary after sedative administration.

Moving on... any other thoughts or ideas on dealing with combative patients, criminal or not?

Wendy

CO EMT-B

MI EMT-B