PLAYING IT SAFE
Luckily, many ambulance calls are without violence, anger, or the need for police accompaniment. But… until you get to the scene there are no guarantees, and sometimes that can mean “Anything can happen.” Considerable risk calls may be the result of crime, drugs or alcohol intoxication, or psycho/social stress disorders. Even a loud family argument can result in carry-over anger and hostility. Our EMS personnel are tasked with the challenges of providing proper health care AND protecting themselves and their crew mates.
New York State laws outline specific protocols for handling aggressive patients, emphasizing the importance of safety for both the provider and the patient. Listening and talking to the patient directly in a calm voice, involving them in their treatment, preferably not crowding them (not any more than the back of the rig allows), being “reasonably” honest in answers, and careful in restraints (secure, but not to the point of causing pain) will often help to alleviate many of the patient’s fears and animosity. Always display compassion.
Listen to dispatch when you are called into action, hopefully the 911 operators will relay any concerns about volatility, weapons, or even history at tat specific address. Upon arrival at your scene, do not enter if it is an active crime scene, or if there is a suspicion of infinite danger (fire, weapons, potential explosives). Call for police and/or fire department back-up and enter only when you have an acknowledged “All clear.” If necessary, request accompaniment from police officers when making entry and presence while you load your patient.
Enroute, if the crew feels threatened by the patient’s anger or fear, then depending on the amount of restraint they can use ranges from SOFT bondage (eliminating free hand or flailing feet) to use of stronger straps and restrictions. If you are unable to reasonably restrain the patient, with the objective of no harm to you, your crew, or the patient, then definitely call for police escort (sometimes a police officer will accompany you IN the rig or may just follow behind in a squad car.
Even the parent of a small child can be aggressive due to fear – if necessary, find a way to gently calm the fear, and if possible and reasonable, allow the parent to sit in back (buckled in) to keep his/her child company and calm their own fears about EMS treatment. Document everything regarding restraints, threats, any use of force (hopefully soft), and names or IDs of anyone beyond your crew that is present.
Unfortunately, the stressfulness of the illness or accident MAY magnify and possibly alter the patient’s image and memory of your actions. Be as kind and gentle as possible, always Keep yours and the patient’s safety in mind, and document fully any uses of restraints, medications, and accompanied law enforcement. The incident could, and may, be brought to a courtroom and you and your crew will need accurate and truthful documentation. Rely on honesty and factual records.
At the end of the day, you need to know that you did whatever was necessary and possible for the patient’s wellbeing. It is also crucially important that you and your crew can return to the safety and comfort of your own homes at the end of your tour.
I'm a former NYS EMT and still part of an EMS & FD family. I like to think I can write ;)
