Restraining Psyche Patient

[JPINFV]

I'm just saying if a pt has a knife, they are not yet my patient.

Oh, I'm not arguing that. My issue was with Farva's blanket 'not taking patients down' post.

 

[BossyCow]

Oh, I'm not arguing that. My issue was with Farva's blanket 'not taking patients down' post.

That's why the first word in my post.... the 'absolutely' was me agreeing with you.

 

[JPINFV]

/me fails.

Keyword, unarmed.

...but it's only a flesh wound.

 

[Sasha]

Sweetie, that's a t-shirt on a tree.

 

[Veneficus]

In my EMS class we've been running a lot of scenarios; it's gotten to the point where our primary goal for the time being is to restrain a "psyche patient" acted out by a fellow student.

I really have no idea if the most recent ones are realistic or not - basically we're supposed to assume any sort of LE has dropped off the face of the Earth, so it's just us (usually 4 members to a team) and the patient, who is apt to swinging, pulling hair/clothing, biting, etc.

The next scenario involves taking down the biggest guy in class - he's probably 6'3 and weighs over 200 pounds easy. So this got me thinking.

We're going to have to use a lot of force to bring him down and the instructor loves to make these as difficult as possible (giving the patient a "knife" for example). I'd really love to get some advice from real EMS personnel on what you guys would do in this situation and what my team and I can expect.

If you need any more info I'd be happy to provide it. Thanks!

Your instructor should be fired for this kind of BS. At least reported to the state.

First there is more than enough to learn in class than how to fight (a guy with a knife or otherwise)

Second since you should never be engaging somebody with a weapon, why practice it?

Third, martial arts schools are better than EMS schools for learning how to attack or defend against a knife. It will also take longer than medic class to learn to be good at this.

But if you really want to know the best way to take down a guy with a knife:

Shoot him with a gun.

If he threatens to harm himself, let him, much easier to subdue an unconcious bleeding person.

Did your instructor bother to tell you the legal ramifications of wrestling with patients? It boils down to you are not allowed to harm them. They have no such limitation regarding you.

If you find yourself suddenly confronted with a weapon run away and hide. (If you want to make this action sound heroic call it retreating and taking cover) If you cannot, forget medical help for this person, you are fighting for your life.

 

[Explorer127]

I have a question-

When would you use leather restraints instead of cravats to restrain someone? Which type of restraint is used more often? Why?

Also, do you prefer one over the other? Why?

 

[JPINFV]

Personally, I'd take a commercial restraint (leather or nylon) over cravats any day of the week, especially since you can preattach commercial restraints to the gurney.

 

[Veneficus]

I have a question-

When would you use leather restraints instead of cravats to restrain someone? Which type of restraint is used more often? Why?

Also, do you prefer one over the other? Why?

On the truck i like lots and lots of kling.

Leathers are great for extremely agitated patients. But usually a soft restraint will work for most. In my home state EMS persons are not permitted to use any nonhumane restraints.(aka handcuffs or anything else the pt can injure themselves on like zip ties) So it is a soft restraint or leathers.(or Kerlex)

When you engage leathers you have to wrap them with kerlex anyway and tape it. That makes it extremely difficult to work with prehospital. In addition there are straps as well as key locks on most of them. It could take the better part of 1/2 hour and 6-8 people to put somebody properly in leathers. Then when you get to the hospital you get to repaet the process because they have to come off your stretcher or board.

I also like to put diapers over their hands like boxing gloves to keep them from grabbing with their fingers.

 

[emtfarva]

Ok, ok I understand there is a point that you may have to hold down a Pt that has a medical situation. I am talking a about a true psych call. not hypoglycemia or postdictal combative pt or s/p head injury. I am talking about a person who truly wants to kill himself or others. we should not be messing with these types of persons without police and the pt restrained. I understand that we may get a person that is just plain old combative because he forgot to eat after taking his insulin. in that case we may have to hold down the pt. I have never seen a diabetic pt (in my short time in ems) come after me with a knife and threating to kill me. I could be wrong. just throwing it ou there.

 

[Jon]

If we REALLY need to take someone down, as Kip already alluded to, it takes 5 or more people - 1 to protect the head, and 1 for each limb. This requires practice, and prior knowledge - not "gee... figure it out".

It sounds like you are at the BLS level - How can your instructor find time to spend time to run multiple scenerios on this?


If the patient has a knife - they aren't a patient anymore - they are a potentially violent subject with a lethal weapon. You need to LEAVE. BEFORE THIS HAPPENS. If the knife comes out, you probably missed a bunch of warning signs... and you need to remove yourself from the situation and retreat to your truck to await LEO arrivial / scene secured.

When a former patient starts waving a lethal weapon - that's when the BIG RED BUTTON on your radio becomes your friend... put the call out... get help.

 

[DT4EMS]

Ok, ok I understand there is a point that you may have to hold down a Pt that has a medical situation. I am talking a about a true psych call. not hypoglycemia or postdictal combative pt or s/p head injury. I am talking about a person who truly wants to kill himself or others. we should not be messing with these types of persons without police and the pt restrained. I understand that we may get a person that is just plain old combative because he forgot to eat after taking his insulin. in that case we may have to hold down the pt. I have never seen a diabetic pt (in my short time in ems) come after me with a knife and threating to kill me. I could be wrong. just throwing it ou there.

I had one holding a knife in one hand and a grapefruit in the other years ago. He had already destroyed his house prior to our arrival. Threw a TV out of a window. It was due to hypoglycemia.

Once officers had restrained him, a little D50 later he was golden.


Diabetics, especially younger ones have thought I was an "alien" or a monster when starting the medical treatment.

This is why the Diabetic is listed in our section called "The 5 D's".

They are the Diabetic, Deranged, Domestic, Drugged, Drunk. We spend several hours on these during a Defensive Tactics 4 EMS course.

Please remember............ sometimes your internal drive to help someone else puts your safety at risk. You have to be vigilant in your personal safety.

 

[WashboardSlim]

Holy cow! Has this turned into a discussion haha

First off I feel I should clarify some things. I wasn't very clear in my first post, but in no way, shape or form has our instructor's goal been to teach us how to suplex the mentally ill.

The scenario which involved the knife I mentioned went like this:

Our team ran on a 17 y/o pt who was apparently very depressed and generally not feeling well. When we "arrived", she was sitting in the middle of the room and barely paid attention to us when we approached her.

One student knelt down beside her to initiate a conversation and try to get some information while another started to get her blood pressure. She wouldn't really talk to either of them, she just kept asking "What are you going to do for me?" "Who are you?", etc. She waited until all FIVE (something I messed up on in my original post - there were five of us, not just four) members were within reach, then made her move.

Beneath her left thigh she was hiding a "knife" (red marker). She drew it without warning and went absolutely berserk, trying to "stab" anyone she could.

So it wasn't so much sending in a group of EMT's to do actual LE work, but to get us to a point where we had no choice but to try and restrain the pt for our own safety. The point of the exercises was to kind of hammer into our heads how quick a situation can go South and how far it can go.

For instance, one time our instructor was in the back of an ambulance with a psyche pt when he suddenly decided to try and get out while they were going 55 down the freeway.

Thank you guys so much for all the input! I understand a lot of you have been in real life situations like these and I'm pretty blown away.

 

[Sapphyre]

Um, Yeah, Washboard. That's why, here, calls that come in involving the pt being "depressed" usually have LE dispatched first. Usually.... And, if the parents are telling me that their daughter is depressed, and LE's not there, and they're acting like that, I don't approach until we have extra resources, and have spoken about how we're going to handle it.

 

[emtfarva]

Beneath her left thigh she was hiding a "knife" (red marker). She drew it without warning and went absolutely berserk, trying to "stab" anyone she could.

So it wasn't so much sending in a group of EMT's to do actual LE work, but to get us to a point where we had no choice but to try and restrain the pt for our own safety. The point of the exercises was to kind of hammer into our heads how quick a situation can go South and how far it can go.

For instance, one time our instructor was in the back of an ambulance with a psyche pt when he suddenly decided to try and get out while they were going 55 down the freeway.

Thank you guys so much for all the input! I understand a lot of you have been in real life situations like these and I'm pretty blown away.

At that I would have left the area with all my crew and wait for PD. Only restrained the Pt to escape.


At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.

 

[ffemt8978]

At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.

You may want to rethink that...if your patient is up and trying to get out of the ambulance, just what do you think will happen to them with the "dog stop"?

And what do you think the ramifications of that will be after you get done with your new trauma alert?

 

[emtfarva]

You may want to rethink that...if your patient is up and trying to get out of the ambulance, just what do you think will happen to them with the "dog stop"?

And what do you think the ramifications of that will be after you get done with your new trauma alert?

first of all I would prob only use a dog stop for a pt that is about to get up not up out of the stretcher. and if the pt was standing I would also be standing. I work in a van. not enough room. I should have worded that statment a little better. In the case you mentioned I would tell my partner to stop the truck when possible and let the pt get out if he wishes and again let PD deal with it. I would only really use a dog stop if the pt is trying to unbuckle his seatbelts and saying he wants to get up or out. I have never really used it. Most of my sections have been very coop. or I have orders to restrain them.

 

[Sasha]

At this point I would yell dog and my partner would know to stop the truck as fast a they can. then i would let the Pt leave and let the PD take care of the problem. When you transport a pysch pt make up a code word for trouble between you and your partner. and use it if you need it. they call this one a dog stop.

I can totally see not chasing a psych patient after they have escaped, but to let them escape? Not even try and stop them? Really?

 

[emtfarva]

I can totally see not chasing a psych patient after they have escaped, but to let them escape? Not even try and stop them? Really?

yep I am an emt not a poilce officer. I have not been trained to take down Pts. That is what law enforcement is for. I am not going to get killed. let PD, they get paid more than me. + they have guns and tasers, mace etc...
I have a clipboard and maybe an O2 tank which I am not really able to get at quickly.
I tell him that he can't do that but I will not stop him physically.

 

[XxBigBrotherxX]

in my EMT-B class we were told that is is never our job to restrain patients..you have to remember that the safety of you and your crew members come before the pts safety. But personally if i was in a position where there was a hostile pt and i was being attacked...i would have to kick their ***...im sorry but im from the Bronx, NY. over here you learn and see how easily it is for a life to be lost, even if that was the intentions involved. Your life comes first..

 

[BLSBoy]

in my EMT-B class we were told that is is never our job to restrain patients..you have to remember that the safety of you and your crew members come before the pts safety. But personally if i was in a position where there was a hostile pt and i was being attacked...i would have to kick their ***...im sorry but im from the Bronx, NY. over here you learn and see how easily it is for a life to be lost, even if that was the intentions involved. Your life comes first..

So you are gonna wait for PD to come out to restrain that diabetic with a BGL of 42, but is acting quite irrationally?

And yes, if you "kicked their ***", you WOULD be sorry.

You use the minimum amount of force necessary to escape the situation.

I live and work in Atlantic City.
Are we stating where we live/work now?
I thought that was to go in our info?<_<