Here's the COMEBACK:
The hint would be: "Ever see one of those old movis where the kids are skinny dipping and some meanies tie their clothes into knots? And they walk home in a barrel or a newspaper?". (a'la "Our Gang" comdey shorts).
The answer is this: cotton or other complex structured "natural" cloth is virtually impossible to untie once it has been tightened while stretching, and especially if wet. The fibers run in too many directions and the stretch cinches the knot. Also, since it is extremely hard to apply a uniform circumferential constriction to the neck to occlude the carotids, you have instead occluded the jugulars which acts like a phlebotomy tourniquet...your face and neck almost instantly start to swell, overlayering the cord.
The answer is that you are screwed. To get even the "V" blade cutdown knife under that would mean lacerating the neck, quite probably into the distended jugulars, etc. Forget your K-Bar, Buck or Victorinox Swiss Officer's knife. Slipping tetrasnips in works, but takes time you don't have. And doing it yourself while alone with the pt back there?
The solution, in my case, was having two officers in arm's reach and me keeping the pt beyond arm's reach and "bladed" after I did his vital signs. I was lucky, too, but luck in the long run comes from being prepared and careful. How about having patients turn out their pockets? Or refusing to transport a disturbed pt without law enforcement in there with you?
(In my case, the pt had about ten feet of about 3/8ths inch improvised fabric cord wound around his torso and upper legs. Not really easy to quickly whip out at that point, but he was not frisked until after I was done with him.
"Hey, nurse, come back, is this normal?...", then "yippee tie yie aye").
Play safe out there, sisteren and bretheren.
