Restraining Psyche Patient

[Veneficus]

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?

cheer for the underdog.

Run Forest!!! Run!!!

 

[rescuepoppy]

You use the minimum amount of force necessary to escape the situation.
BLSBoy I like that response. Minimum amount of force and escape the key points. If the patient comes out with a weapon after I get to them then whatever gear I brought in and layed in the floor will just stay there until the LEOs can get there to clear the scene. My partner(s) and I will be somewher away from the patient until then. I made myself a promise a long time ago that I would not do anything on purpose to hurt myself,and I like me too well to take on someone who is armed.

 

[ttoude]

My state (NM) offers a "CPI" training class on proper and safer ways to handle that.

The problem is its such an obscure optional state training class that unless I worked here (Living support for the developmentally challenged) I NEVER would have known. Wonder if I could get CEU's for that........

Anyway, track down an company in your town that helps Challenged people to live on there own in private residences. There called group homes in NM, But in my home state a "group home" is for recent jail prisoner releases. So the names will vary state to state.

It might take some doing to find out what the companies/fields are called where you are but the training is uniform nation wide.

Try googleing Crisis Prevention institute.

V.S. varies WIDELY in this particular community, as well

And just a tip, they use the back of their head as a last resort weapon, so NEVER stand directly behind a challenged individual. You WILL lose teeth when they swing their head back to defend themselves.

 

[DT4EMS]

I can speak with a high level of certainty ( I have an intimate knowledge of NVCI/CPI) that CPI is NOT for use with a violent patient.

(Read my other post with the letter I received)

CPI has great verbal de-escalation techniques. But the restrain techniques taught are things like "Children's Control Position" and the Team approach.

CPI is great for dealing with small children, or people significantly smaller than the person applying the technique.

I would love to be on the stand to testify on behalf of a provider INJURED because they attempted to use a skill taught in CPI on a person trying to injure the provider.

 

[ttoude]

Again this will vary by state, so dig deep. CPI in one state may be something different in another state.

In one house I work in is a 19 y/o autistic, a 23 y/o Bi-polar manic, and a 20 y/o severe MR. All with some level of independance and all really good guys. But in no way are they children and when a 260 lb man comes running at u full bore you quickly realize that psych restraint is REALLY important.

Interestly after its all over, they appologize for the attack. I say no prob and we continue with our activity.

These guys are in a constant state of emotional disturbance and verbal redirection is always tried. Some times it comes down to protecting your resident (PT), housemates, staff and yourself.

CPI, in my state

So how does all this tie into the topic? People who have made a career in this field deal on a constant daily basis what an average emt might see once a month.

I've been attacked up to 10 times in one day. So far no injuries to my guy or myself.

I feel very confident that when I get out of the bus and the AMS PT begins to behave poorly that I'll have a good idea what to do.

 

[BossyCow]

For some reason pysch pts like me. Do they see me as a kindred spirit or just a few bad days away from where they are????

 

[DT4EMS]

CPI, in my state

So how does all this tie into the topic? People who have made a career in this field deal on a constant daily basis what an average emt might see once a month.

I've been attacked up to 10 times in one day. So far no injuries to my guy or myself.

I feel very confident that when I get out of the bus and the AMS PT begins to behave poorly that I'll have a good idea what to do.

You make a good point with dealing with it daily. It is like the difference between a prison guard and a patrolman on the street. The prison guard KNOWs who he has to work with where the patrolman on the street may go from stopping a 90 y/o grandmother on the street to being in a all out fight for his life the next minute.

Those are the similar differences between working in an emergency setting like the ambulance or the ER vs. working a long term care situation where you know your pateint.

I still stand behind CPI when dealing with a person who has a decreased metal capacity due to MR or a child. But I will also see a person from a cross the witness stand when a patient or provider is assaulted by a person certified by CPI.

I commend you for doing what you do. Dealing with and caring for people who have disabilities takes a person with strong moral character and a desire to help others.

Please don't take offense because none is meant. I have trained hundreds of people who have had CPI in the past and they will tell you it has no place in the emergency setting as a course for self-defense.

Restraining a psych patient in the ER or in the field due to an spontaneous occurrence is a very, very dangerous thing. Agian, I am not talking about a MR person or a child with a behavioral disorder like ADD or ADHD. The techniques taught in CPI/NVCI work well for them.

 

[ttoude]

No offense taken. But I gotta stand by it.

A 260 lb man that is fine one minute and has your hand in his mouth the next can happen in a living room or as you make the mistake of reaching across the PT to get a gause pack out of the bin.

The CPI training I recived had one page for children and 49 pages on safe management of an adult having a "Behaviour" or what we call being violent.

It's far more complex than I ever imagined. One excerise was targeted toward the pt grabing a handfull of a females hair and how to get a "release" without harm.

Another had me (5"11 220lbs) between to 5ft females bent at the waist in a way I could not grab, hit or bite & did not compromise the airway and the could "walk" me in any direction. maby I could post a pic of it.....

BUT, even the instructor said when it comes down to it "Defend yourself with as little force as possible"

-Horror Story-
Our local PD has a special trained crisis team. A new employee called PD and they just came out tazed, cuffed, and arrested a 22 y/o non-vocal autistic.

When AMS PT's attack yes its bad but there ARE ways out there to "restrain" them till the cavalry gets there or till they agree to stop.

My wish is that ALL EMS somehow could get what I've found out in the last 3 months. My guys are very lucky. They are in a SSi funded warm house.

But NM has a 48 to 72 hr catch and release policy that puts guys like mine out on the street for EMS and Police to stumble across when the E.D.'s prn's where off and they get violent.

Restraint was one of my biggest questions in class beside ped VS. Its tricky/sticky but please seek out these companies and find out what u can. AMS attacks actually deserve more consideration than they get

 

[medic417]

just a few bad days away from where they are????

I think that applys to most of us long time EMS people. If our elevators lose one more floor we are done.

 

[ttoude]

BTW make no mistake my "guys" are 100% psych patients and routinely get violent.

 

[firecoins]

I has a psych patient escape once after just leaving an ER for IFT to a psych hospital. I had the rig pull over before they jumped out. I talked them back into the rig but they would only sit in the front passenger seat. I let them sit there for the ride back to the ER where they were chemically restrained before transfering them successfully to their final destination.

 

[jamiga]

Just thought I would add something that an old medic told me during my clinicals...

I am not advocating this at all, but just wanted to share!


Scene: 20-something yr old female psych patient (naked) in a room, running around the room screaming. After much thought and deliberation between the EMS/Fire crew, they finally 'took her down' by using a simple sheet. I imagine they got a guy or two on each end of the sheet and ran on either side of the pt, wrapping her up like a taco.

 

[ffmedic08]

Weellll....

I'm going to assume that your instructor is giving you this scenario because 1) he wants to drill home the point of scene safety, and see if as a medic student- you can still think back to the basics, or 2) you did not know that the pt had a knife until half way through attempting to talk to the pt.

As some have stated previously, the best form of action at this point is PD, and talking. You have got to converse with this pt long enough to get to know him, and his style. Its often not too hard to, for hte most part, figure him out and figure out what he's thinking and what he's doing. The more you talk and get to know him- the easier it is to predict him and his potential. Even just small talk can often, eventually, get a pt to calm down.

I understand where you are coming from with wanting info on how to prepare better for your instructors scenarios. My instructors threw a few of those at us as well - nad its hard. While you are in medic school - you automatically find yourself thinking too far into things... instaed- take a step back adn look at the basics.


Just a lil note from my experience... thats all.

 

[ffmedic08]

ps.

A maglight works well tucked into the lower of your back (into your pants or belt). It can serve as a pretty hefty self-defense tool, and usually the pt doesnt' know you have it. Used this one quite frequently..


Also.. you never know when you will need a light!

 

[ffmedic08]

For some reason pysch pts like me. Do they see me as a kindred spirit or just a few bad days away from where they are????

Same thoughts here! LOL!!!!

 

[daedalus]

Ok you got me there. But in my service we don't carry handcuffs, and that is what cops are for. I would never take down a pysch Pt unless they directerly came after myself or my partner.

Unfortunately, we do have to take down pysch patients. In fact, LAPD usually insists that we place our hands on the patient before they do, and if the patient resists, they than take over and do the hurting.

 

[HotelCo]

Unfortunately, we do have to take down pysch patients. In fact, LAPD usually insists that we place our hands on the patient before they do, and if the patient resists, they than take over and do the hurting.

That doesn't go over well with me.

If the patient is being combative to the point where he is obviously going to swing at me, PD goes in and restrains them before I touch them. I'm not going to put myself in that situation.

 

[CAOX3]

I have to agree your instructor is an idiot.

Even if it is due to a medical condition if I or my partner is in jeopardy we dont get out.

Sorry.

 

[EMTelite]

Nman ftl pe?

psych patient with a knife? Believe me I have plenty of time until a new class of cops get trained and put on the road. There is not a chance in hell I would step foot in that house. If the teacher says no law enforcement are available I would say that I'll be staging down the street at the diner with a cup of coffee until they become available and sit down.

Exactly lol... no point in running this scenario your scene is not safe why would you be there in the first place, the law requires that you and your partner are safe before you even enter the scene you do not have jurisdiction in dealing with combative patients if you have patient with anything that even resembles a knife you better be on the phone with PD

 

[ffemt8978]

Exactly lol... no point in running this scenario your scene is not safe why would you be there in the first place, the law requires that you and your partner are safe before you even enter the scene you do not have jurisdiction in dealing with combative patients if you have patient with anything that even resembles a knife you better be on the phone with PD

You actually have a law in your area that states you can only enter "safe" scenes? I would love to see that law.