We just ran an article in the July issue of JEMS about combative and/or armed patients and how EMS providers can protect themselves against them. Many providers (and even I) have a hard time believing a patient could do such a thing. But every now and then you hear a crazy story. Do you have one? Please tell!

Also, to hear from an expert on this issue, read "Training EMS for Violent Encounters."

Tags: crazy, defense, patients, self, stories, violent

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scrambled_egg81 said:
Had a paranoid-schizo on a hold for ripping up bushes in front of his apartment complex wearing not but a smile. During the 3 hour transport (due to traffic), he asked to see his bag of belongings. He'd been pretty well behaved, so I complied since there was only a sweater and some paperwork in it. When he found that his cigarettes had apparently been taken, he went ballistic!

So we were forced to stop on the 215, in Riverside, middle of afternoon traffic, and try to restrain the guy. We eventually had to call for CHP assistance since he was so PO'd. Finally got him to calm down enough after he broke two compartment sliders and one of the handrails on the gurney.

Lesson be learned, ER docs: never take the cigarettes of a 5150.
Doing a security/support detail at a campground, had a call on an underage drinking party. We got a hold of one kid, about 16 maybe 17 years old. He had a few. I was holding him by one arm while we called for police backup. He was behaving fair at the time, but a few minutes before the police showed up, he took a swing at me - and missed. He ran off into the woods and the police and I went around a lake knocking on cabin doors with another youth who knew the kid. We didn't find him, but believe we were at the place he was hiding in, but we didn't have RS/PC to force entry. End of Call.

Lesson Learned: Even a well behaving kid can change in an instant. Beware at all times.
It's a three part post that ends with a decision whether or not to press charges against a man who stabbed himself in the leg.
http://yourhappymedic.blogspot.com/2009/06/round-1-dispatch.html

Got some great insight from a number of folks. It can start out simple and end in a sore shoulder. We all need to be careful!
On a sunny, thursday morning, just after being paged for a BLS transfer, my unit was diverted to what I would soon find to be the most unexpected and scariest call of my career.

The page was to assist police, nothing more - immediately I thought of what the call could be and began preparing my thoughts en route to the scene. We arrived to find a single story, moderately kept dwelling, fairly routine so far right? Entered to find a pt. in the basement that according to the police "took some pills". She was in bed, covered up with a blanket, wearing pajamas, holding onto a pillow for dear life and was crying. Further questioning deemed her suicidal, but not violent. She was just very upset regarding family problems and child custody issues. A plight that I had heard a hundred times before. She was obivously upset that an ambulance and the police were in her bedroom and didn't want to go to the hospital. I, feeling no threat - and seeing a woman that was just scared and sobbing, sat on her bed. I tried over and over again to generate her cooperation. My efforts failed. Still sitting on her bed, I said "ya know, the police are going to have to make you come with us if you won't come, please do this for me, no one is going to...." before I could finish my sentence, from underneath her pillow she produced a large knife and lunged at me screaming inaudible words. My heart stopped and I launched my self off of the bed and heard the unsnapping of gun holsters. I immediately retreated to the hallway and notified dispatch that the female produced a knife and is now at gun point. Clammy and shaken, I re-collected myself as the police pleaded with her to drop the knife and watched as they were forced to deploy a TASER to subdue her. As the prongs made contact, there was more screaming and a fight ensued on the bed, the knife went flying. I grabbed the knife and secured it right away. I was in absolute shock.... how the heck did a lady, and why the f*** did this woman have a knife with her in bed at 11 in the morning??? unbelievable. Did I just almost get knifed? those were just some of the things going through my head. The single hardest part of this call, was not wanting her dead. I had to do something to get control of my emotions and get over the fact that I was almost killed. After a lengthy trip up some really, really narrow stairs - in a stair chair; with a handcuffed, spitting, screaming woman, she was carefully transfered to the cot, into the rig and was pharmaceutically restrained and remained in handcuffs during transport.

Lessons learned:
1. Everybody and anyone can hurt you - weather they seem capable or not
2. Complacency almost killed me
3. Distance from an EDP is important (don't sit a foot from them, trying to console or not)
4. Weapons can be in even the most unusual places.

This call, and this patient certainly shocked me and taught me some valuable lessons, I hope it can do the same for all of you....

Stay safe everybody
Back in the mid 1990s when I worked for an urban EMS service, I had such an experience...more than once. The first time was December 25, christmas evening about 2030, I had only been on this job for approx 6 months and my first time working in a large city. We had reponded to an inner city neighborhood for an allergic reaction. The patiant was female and very uncooperative. We had her in the back of our rig and my partner was attempting to get another set of vitals before we transported. The patients husband was also sitting in the back with us at the same time (which we normally do not do, but hey it was christmas and he was being nice). The patient kept arguing with my partner about taking a bloodpressure and said he kept "slapping" her arm. Then the husband spoke up and agreed with his wife, not good... my partner was now engaged in a verbal with the husband and he asked him to wait outside of the ambulance until we were ready to transport. Needless to say that did not happen. The husband struck my partner and they begain to "wrestle" on the bech seat. I jumped inbetween them to seperate the two and grabbed my radio and requested police assistance. The two broke apart and the husband did get out of the one open door of the back of the ambulance. I will also tell you, the husband was approx 6'5" and 250lbs. It appeared as if everyone was calming down. The husband was still pretty upset and yelling outside, my partner was talking with him, standing on the back step of the ambulance. Down the street, I could see another one of our ambulance responding to assist us when they heard us put the call out for police. But then it turnes even worse. familly members from the patients home came running out and her son, grabbed my partner off of the step of the ambulance and threw him into the closed door (the son was approx. 6'2" and 200+lbs). I basically jumped on his back trying to get him off of my partner when I begain to get hit in my side by two other people. It just kept going from bad to worse. The other two medics arrived and was also immediatly confronted and assulted. It had now turned into a street brawl. people were coming out of nowhere and "jumping in" to fight. We had to abandon one of our ambulances just to get out of there. We had all four of us in one rig and made it to the end of the block when we saw and engine and ladder company coming up the street emergently. The engine company had been at the scene prior to our arrivle and cleared when we showed up, so when they heard us call for help they also responded. They saw us all bloodied and battered and the "mob" just down the street. The firefighter jumped off the trucks with axes in hand incase they decided to follow us to the end of the block. Then about 10-15 police squads showed up from every direction and started rounding up everyone at gunpoint. It was a hell of a scene. It felt like it took police forever to show up, but from the time of my first call for assistance until their arrivle, it was only 5-6 minutes. Alot can happen in that time frame. All said and done, it ended being 4 medics vs approx 20+ locals, not a good match. between the four of us, we ended up with numerous bruised ribs, one broken nose, several battered faces and hands. We considered ourselfs lucky.

This is truely a day I will never forget and hope will never be repeated for anyone. In hindsight we definatly could have done things different, but it truely shows how fast a situation can change and how dangerous our jobs can be. It can happen just as easy in a rural enviorment as an urban setting. Be street smart and look out for each other.
Most of my violent encounters with patients are usually NOT "EDP"'s. They are usually people intoxicated by alcohol or drugs, especially "dip". Most often the acute intox.

One instance that I can clearly recall is being sent to an "Injury" on the outside. Upon arrival (at night) I found a group of young adults gathered on the front lawn stoop of the residence. As I approached I was advised by one of the group that their friend had been drinking and as they had all been leaving the house he had lost his balance and struck his head on the wrought iron railing. She stated that he did not pass out and got right up. It was then she stated that they all noticed the bleeding and they had him sit down. He apparently had been telling them he was fine and did not want EMS. So she wanted to give me a heads up that he would not be cooperative.

When I approached the patient I noticed a moderate puddle of blood had collected by his feet on the ground. His shirt was covered in blood as was his head and face. I did the usual initial assessment while my partner went to get more equipment. As my partner was leaving I was interviewing the patient who was clearly still intoxicated with alcohol on breath. During this time he became belligerent and started using profane language. It appeared he assumed I was a cop as he kept repeating, "I'm not going to jail, I didn't do anything wrong, get the f*$k out of here your cop b&%$h!" His friends tried to explain to him who I really was and why I was there but he told them to "f&$k off!" As I was taking a few steps back to have a safer distance from him I advised my partner we would probably need "radio" which is our term for the police to respond. Just as this had occured the patient, with full extention of his leg, kicked me dead in the chest. Since he was sitting he didn't have the power that he could have had if he were standing I only stumbled back a bit from the impact. To compound the situation was that his foot had been sitting in that pool of blood on the ground I described earlier. So the blood splashed across my face and into my uncovered eyes and mouth. Not to mention a nice footprint he left on my uniform shirt! [trashed!]

While I won't go into the details of how we managed to remove him from the scene without compromising spinal precautions I will say it involved 2 other crews, a supervisor and 2 police units. Once he saw the reinforcements he became even more aggravated and enraged. It took that many of us to secure him safely to a longboard and get more important assessment information so we could treat him and relay information to the ER. While attempting to restrain him he also decided to spit in two of my co-workers faces. [real nice guy!]

In the end we all had to be taken out of service for exposure reports and to get tested for possible contamination. This caused us more stress than the call itself! It also put two EMS crews out of service for over and hour on a busy night in a busy urban area endangering citizens who would have to wait that much longer for the units that were all on jobs.

Several parts of this always bring me concern in how we are trained to respond to patients like this. When you get a call for an "intox" or "drug" or "edp" you usually are more cautious and prepared to deal with the potential for violence that may occur. Even with an "arrest" you realize the danger that the family members can bring if they cannot control their emotions. But an "injury" on the outside secondary to a "fall" doesn't usually raise the level of suspicion and caution as those. Not to mention, knowing our patient was "intoxicated" would have better prepared us to deal with him. Why wasn't this information relayed to us prior to arrival I'll never know but still its something to think about. [yes I did ask!]
The other issue is how to truly deal with an aggressive, violent patient without compromising his well being. The police arrived and immediately wanted to restrain him and throw him on the stretcher so to speak. However, he had a head injury after consuming alcohol. Is he aggressive because of vodka or because of a bleed in his brain? How can I restrain him from injuring others while still insuring his safety?

Of course in the end my safety comes first, but the general public usually doesn't see it that way.

In the end, I wonder more and more, am I more worried about the patients injuries, myself and my partners safety or myself and my employer being sued and why can't I tell which it is?

sad state of affairs this world we live in.

be safe out there

IrishEDP

PS sorry so long!
I have one to add. I can't remember exactly what we were originally paged out for. Maybe a laceration? Regardless it never indicated that it might be a violent scene. It was dark and there we no street light on the road, the street the patient lived on was just wide enough for the ambulance, defiantly not wide enough to turn around. We did not realize the street also was a dead end. We parked and approached the house; the wife was waiting she told us nothing more than her husband had cut his hand and was in their room. We knocked, announced who we were and that we were there to help him. He responded by yelling and throwing things. Like any good medics we retreated to our truck and notified dispatch of what was happening and they called for police assistance. It was Friday night and it was very busy for the police, it took them 45 yes 45 minutes to get to us! In town! We tried to drive away to stage for the police only to find out that the road did dead end and there was no where to turn around. The only option was to drive as far as we could down the dead end street, turn off all the lights and wait or to try backing out. Before we could back the patient found us and approached the driver’s side of the truck, we locked the doors and had the windows up, he began pounding on the window and asking us how we could just sit there and let him bleed to death. His cut was about 1/4 of an inch across and the depth of a paper cut. We tried to calm him and assure that we would soon help him and this just made him angrier. The police finally arrived only to find themselves faced with a guy who then decided to act like an angel! The cop was very irratated with us and he thought that we were crazy for calling. He did not believe that the patient was ever violent. The whole experience sucked. So I guess the big lesson here is never get trapped! Always have a way out. And if you think a street might dead end check it out first or get yourself turned around to face the exit.
Had a frequent flyer, she would call us about once a month. Depressed , suicidal and pharmaceutically gifted. The er call us to help them with a patient and transfer her to the nut house. On our arrival, she wipes out a hunting knife, tries to stabb the doc , cuts up my partener. And then to top all the rest tried to commit hara kiri on herself.
We still can not figure out where that big knife came from, and I am sure I do not want to know. Like Dr House says "they all lie, and you can't really trust them.

Y'all be safe
Wow, I hope that cop is an exception and not all of your cops suck that bad down where you are. In my area, we and the police are on the same team. Up there, that jerk off could be all the angel he wanted to be, his word wouldn't hold a candle to mine. Sorry to hear that.

Aerial said:
I have one to add. I can't remember exactly what we were originally paged out for. Maybe a laceration? Regardless it never indicated that it might be a violent scene. It was dark and there we no street light on the road, the street the patient lived on was just wide enough for the ambulance, defiantly not wide enough to turn around. We did not realize the street also was a dead end. We parked and approached the house; the wife was waiting she told us nothing more than her husband had cut his hand and was in their room. We knocked, announced who we were and that we were there to help him. He responded by yelling and throwing things. Like any good medics we retreated to our truck and notified dispatch of what was happening and they called for police assistance. It was Friday night and it was very busy for the police, it took them 45 yes 45 minutes to get to us! In town! We tried to drive away to stage for the police only to find out that the road did dead end and there was no where to turn around. The only option was to drive as far as we could down the dead end street, turn off all the lights and wait or to try backing out. Before we could back the patient found us and approached the driver’s side of the truck, we locked the doors and had the windows up, he began pounding on the window and asking us how we could just sit there and let him bleed to death. His cut was about 1/4 of an inch across and the depth of a paper cut. We tried to calm him and assure that we would soon help him and this just made him angrier. The police finally arrived only to find themselves faced with a guy who then decided to act like an angel! The cop was very irratated with us and he thought that we were crazy for calling. He did not believe that the patient was ever violent. The whole experience sucked. So I guess the big lesson here is never get trapped! Always have a way out. And if you think a street might dead end check it out first or get yourself turned around to face the exit.
Here's some crazy stuff for you...and I average about 8-10 fist fights a year myself here in Detroit.
We have had Medics that have been shot, shot at, stabbed, in knock down drag out fist fights and spit at.

One of our own was shot in the line of duty as he was robbed in quarters.

A couple of weeks ago, one of our own was stabbed in the arm by a man that claimed to be "sick."

I had an intoxicated man spit in my eyes...I spent in excess of an hour getting the Morgan Lens treatment and a year's worth of blood draws. (I dislocated the man's jaw...Former Army here.)

2 weeks ago, a man that requested our services decided that when asked what was bothering him medically, the man decided to strike the Medic in the chest and began to swing violently on him. (Unfortunately for him, the Medic is a former Marine and it ended badly for the patient who ended up with a decent head injury.)

A few years back, a psych patient kicked one of our Medics in the knee causing his Patella to become completely pulverized. The patient turned on his partner and his partner defended himself. The end result was that his partner was a former boxer and struck the psych patient 2 times and the patient was in a coma for 3 weeks and then died. (The partner was cleared in the death.)

Last fall as my partner and I responded up the street from our quarters to assist another crew that was hit by a drunk driver. As we were talking with the crew to make sure they weren't injured, a van drove up on us and began firing a a pistol at us...the very next evening, somebody drove past our firehouse and opened fire on it.

Almost every week our members are assaulted physically and verbally. The best advice I can offer anyone is to be alert at all times no matter where you are. Any situation can turn violent on any scene and violence is up against EMS professionals everywhere no matter if you work in an Urban, Suburban or Rural setting.
Things sound really tough in Detroit! I have a hard time believing a medic actually killed a patient and was found totally not at fault. Everyone in my old service knew exactly what those metal clip board were for besides writing reports but we were taught that we are supposed to run away first, we were told that if we fought we could very well be at fault for the patients injuries. I would like to know other people's thoughts on this.


Eric D. Liddy Sr. said:
Here's some crazy stuff for you...and I average about 8-10 fist fights a year myself here in Detroit.
We have had Medics that have been shot, shot at, stabbed, in knock down drag out fist fights and spit at.

One of our own was shot in the line of duty as he was robbed in quarters.

A couple of weeks ago, one of our own was stabbed in the arm by a man that claimed to be "sick."

I had an intoxicated man spit in my eyes...I spent in excess of an hour getting the Morgan Lens treatment and a year's worth of blood draws. (I dislocated the man's jaw...Former Army here.)

2 weeks ago, a man that requested our services decided that when asked what was bothering him medically, the man decided to strike the Medic in the chest and began to swing violently on him. (Unfortunately for him, the Medic is a former Marine and it ended badly for the patient who ended up with a decent head injury.)

A few years back, a psych patient kicked one of our Medics in the knee causing his Patella to become completely pulverized. The patient turned on his partner and his partner defended himself. The end result was that his partner was a former boxer and struck the psych patient 2 times and the patient was in a coma for 3 weeks and then died. (The partner was cleared in the death.)

Last fall as my partner and I responded up the street from our quarters to assist another crew that was hit by a drunk driver. As we were talking with the crew to make sure they weren't injured, a van drove up on us and began firing a a pistol at us...the very next evening, somebody drove past our firehouse and opened fire on it.

Almost every week our members are assaulted physically and verbally. The best advice I can offer anyone is to be alert at all times no matter where you are. Any situation can turn violent on any scene and violence is up against EMS professionals everywhere no matter if you work in an Urban, Suburban or Rural setting.
Just last night, we got called to transfer a suicidal teenage girl from our little hospital to the psychiatric unit at the University hospital in Salt Lake. The nurse said she wasn't happy about going, but she should be okay during transport without any meds on board. I was by myself in back with her, because we decided that would be wiser than having the male medic in back with her alone. We weren't five minutes into the 45 minute trip when she started to unravel. She spit, she screamed, she swore spectacularly, she flung her body, she lashed out with all extremities. The second time she unbuckled herself from the gurney, I had the driver pull off the freeway to come back and help me restrain her. We used kerlix and tied all four extremities to the sides, and put a surgical mask on her. But she fought like a wild monster, and tried to aim her kicks and spit at strategic places. Not a fun transfer. At the receiving facility, they knew her history, had a room full of people waiting for us, and said our nurse on the other end should have also known her history and had us to restrain her before we left on the transfer. We'll sure know next time.

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