Open question about patients who spit.

[Romania]

I have been following a thread on another news group about spitters. In this tread they are talking about placing a pillowcase over the patients head. I was wondering what you all think about this.

Personally I use either a NRB conected to oxygen, or a N95 mask (the cheaper replacements for the hepa mask) both, I have found work well.

Thanks

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Alan Romania, CEP
romania@uswest.net




[This message has been edited by Romania (edited October 07, 1999).]

[BURNSEMS]

A pillow Case !!!! Well you would probably set yourself up for a big law suit if the Patient Suffered from some unknown cause and Died, how would you Explain it, Our Protocol simply says place a Simple Face Mask or similar 02 delivery Device on the Patient,, if the patient has a Communicable Disease or even a history of one then you should be wearing PPE any way and utilize a approved mask... Just my opinion but I would leave the Pillow Case on the Pillow..

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Here today for a Safer Tomorrow

[Romania]

Well, I am glad I'm not the only one who was horified about the pillow case. It comes back to that whole do no harm idea!

Personelly I typically wear safety glasses on most calls, and a mask when needed.

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Alan Romania, CEP
romania@uswest.net




[This message has been edited by Romania (edited October 07, 1999).]

[K Romer]

I will confess to the "pillowcase" treatment. About 10 or so years ago, we responded to a local PD th find a rather intoxicated 14 y/o male in police custody and with the father close by. I don't recall the reason for transport other than the 14y/o alcohol intoxication.

Anyway the little cherub started spitting at both me and the dad. I turned him onto his belly and he just continued the same behavior. After several attempts at tryuing to get him to stop, I "pillowcased" him.

After reading the posts, I look back now and think how really bad that was or could have been.

Anyway.... pillowcases are out in my book.



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Kevin Romer
"Performance is Everything!!"

[Romania]

Before anbody gets upset. I am not trying to judge anybody. I am jsut trying to get some people thinking. I know I have done my fair share of stupid things in my career...most seemed right at the time.

Stay safe, and watch you back.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

[BURNSEMS]

Hey Romania, it aint nothing but a thang,, I dont think there is one of us who havent done something absolutly absurd, and went OOoops, that was not smart, I refer to it as a Learning curve, as long as we learn fromn our mistakes we are doing good, its those who shrug the shoulders of Blame and do it again and again that Bother me...

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Here today for a Safer Tomorrow

[lrantan]

I have used the NRB or a particulate mask, both work well. I have also seen the local PD use pantyhose since they don't have quick access to EMS eqmt. That seems to work, you can see the Pt., although I don't have quick access to pantyhose.

[K Romer]

The cops have "quick" access to pantyhose??? Well, well, well......

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Kevin Romer
"Performance is Everything!!"

[Medic 321]

Try 3" tape across the mouth,if you wrap it around thier head it wount come off from them struggling.

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Tim Gifford FF/Paramedic

[BURNSEMS]

OOOOOOOOH, 3" TAPE, is that Electrical, Duct, Medical, Surgical,,, I Hope they dont Vomit !!!!!!!!

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Here today for a Safer Tomorrow

[Dalmation90]

Hepa mask 'em.

[DED1645]

The pillow case is adaptive, but a definate NOT!!! I would use a NRB also. You could always use a hi-risk mask...

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David DeCant
firefighter/NREMT-B
Originally Mantua,NJ
Presently Lindenwold,NJ(I'm not a member of any of this District's dept's.)

[FD26]

Pillowcase, no.

3" tape, definitely not (especially not wrapped around the head-you might compromise the airway).

NRB-definitely. It keeps them from spitting on you and you can always administer oxygen if needed. If they try to take the NRB off, you can always use soft restraints if you carry them on your ambulance.

But remember also that you must keep yourself isolated. Even if it means wearing a mask and goggles.


Jeri
EMT
Ft. Worth, TX

[Pamela Baber]

Taking any and all necessary BSI precautions is the best defense against the patient who chooses to express displeasure over their situation in this manner. A non-rebreather is the best solution if the patient is in need of oxygen. If not, try using your full face shield on the patient. Limits their target area to the inside of the face shield and they usually quit when they have to look at it. definately don't like the pillowcase or duct tape idea! Aside from the legal aspect of their use, I would think that those methods would further agitate the patient.

The good you do today will be forgotten tomorrow.
Do good anyway.

[Phil4601]

Pam, I like your idea about using the full face sheid. Eventually if the "patient" spits enough it will only drip back onto their own face.

In my experience a regular surgical mask works well in most situations. NRB or Simple Mask are also good non threatening interventions for a "spitter".

But...If the person is hell bent and determined to spit on you they will find a way. Protect yourself by wearing the proper eye protection and a mask yourself if the person is agressive and combative.

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Phil
Stay Alert & Stay Safe

[axstrike]

Turn them on there side and let them spit away form you, or cover them with a hepa mask or a o2 mask, but dont use anything that would prevent you from keeping a good airway. ie tape, pillow etc.

[pyroknight]

A little Droperidol anyone?

I used a pillowcase as a police officer, but as a caregiver we are held to a higher standard. I agree with either of the masks readily accessible (I hope) on your rigs.

[smokeygirl]

I can think back to many many Pt's that I wanted to place a pillow case over their head!!! I've used NRB, the cheap TB mask's, masks with the face shields. Plus you can restrain them in a postion that keeps them from spitting on you. If you do that make sure you do not affect the airway and make sure they don't vomit. And becareful if the Pt. is ****ed enough to spit he or she could do other stuff if your not ready for it.

L.Cairns

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We dance where others fear to go.

[medic275@Hotmail.com]

Pillowcase? Not such a great idea. I swear by the simple or NRB, just remember to take off the valves if you use the NRB. The pillowcase is just asking for trouble.

[pompanofd]

I HAVEN'T SEEN TO MANY PT'S SPIT AFTER THE COPS CAME & TOOK CARE OF BUSINESS. SOMETIMES PT'S NEED A GOOD BEATING BEFORE EMS DOES PT. CARE. THE DAYS OF SITTING BACK AND TAKING ABUSE ARE LONG OVER. YOU GOTTA DO WHAT YOU GOTTA DO!!!!!!!!IF ALL YOU DO IS WORRY ABOUT LAWSUITS, YOUR IN THE WRONG BUSINESS!!!!!!!!!!!!!!!!BE SMART , BE SAFE....

[DKrebs]

Use of the NRB mask or face shield are the most appropriate means to solve such a problem. As with restraining patients we must use the most medically appropriate means to accomplish our goal. At the same time it must provide safety for the provider.

As author of the book, "When Violence Erupts", I was requested to assist a jurisdiction who had legal action taken against them following the death of a patient transported in a BLS unit. The patient, being violent, was transported face down on the stretcher. The particulars of the case are too voluminous to provide, however, he arrived at the ED in cardiac arrest and was not revived. (Do not restrain people face down even though many texts still show the practice as being acceptable. Ask police officers about positional asphyxia.) Sadly, the EMT's involved spent two years dealing with the legal implications of the case. Luckily our information, as well as material provided by other experts, allowed the case to be settled out of court.

My point is that we must think of the long term ramifications of acting outside of accepted practice. Use of a NRB or face mask is medically acceptable. In the case of restraint, backboarding the person is medically acceptable. (Granted, it may be difficult.)

Having been involved in such a case changed my attitude at the seriousness of such an incident. Don't dismiss the possibility!

[Ohiofiremed57]

TUBE-EM!!!

You know that spitting sounds alot like dyspnea to me...Nothing that a 7.5 E.T. won't cure.
I had a call a few months ago, CC OD, spit and hit me just right. Just over top of my Specs, and right into my eyes... A NRB or simple mask works excellent. I have heard war stories of accidentely droping O2 tanks to "bring the pt around"... YIKES!


MAC

[This message has been edited by Ohiofiremed57 (edited April 23, 2000).]

[FMFDOCJ]

Tape...oh boy,we should re-evaluate the situation(airway breath..you know the rest).Become friends with your local OR folks and get your hands on some inexpensive OR masks,a whole lot cheaper than HEPA or NRB's. Pillow Cases should be reserved for the pillows not the obnoxious ETOH enhanced folks cause just like all our other friend say LAWSUIT waitin to happen. Be safe and protect you and your crew always.


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[Pamela Baber]

OhioFiremed 57

Tube 'em!!?

I think not. Threatening a patient is assault
and actually carrying out the threat is battery. In spite of their offensive behavior
let's not forget that these patients still have rights. "Subtley" dropping O2 tanks on
people is an inappropriate and abusive action. Perhaps it's time to re-evaluate your career choice.

[Romania]

Thank you all for your replys. THis thread was started to make people think.

There are a couple of issues that need to be adressed. Pam, thank you for covering the Tube thing. Ohiofiremed57, I hope you were being humorous!

Pompanofd, first please stop yelling. Second, guess what... those of us who are cheifs and commanders of agencies (as well as EMS coord.) have to look at the law suit potential... it is part of our job! In the field, if you just do the right thing and act in the patients best interest your on the right tract. And, yes even patients that have been roughed up by PD firt can still be combative and this is no solution! Take some of your own advice... be smart. Some patients are just going to be abusive... that IS part of this job.


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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[pvfr fyrfyter]

as a vol. ff/first responder who works in a maximum security prison, there is another safe option available. our prison just started using a spit bag about 2 years ago. this bag looks basically like a fishing catch net without the metal frame. bacause it is mesh, there is no air intake restriction, but the chances of catching a loogey(?) have been nil. weve had some professional spitters who have quit this action because they found out the hard way that this bag will win every time. not sure where the prison gets these but are probably available through most law enforcement sales catalogs. havent seen them in galls yet.

[Ohiofiremed57]

Apparently humor has disbanded for the EMS field... Let us talk about assault... A pt. spiting at you is assalt. It endangers your safety as well as the pt's safety.
We are here for pt. care but i'll be DAMNED if im going to endanger myself and my crews safety!!! NEVER!!! That being said...I think you had better re-evaluate YOUR carear choice!!! And if you can show me where it says, anywhere... that telling the pt. "if they can't control their spitting on their own, then I'll have to control it for them" is assault i'll kiss your ***....
As for the o2 tank thing...get a clue... Don't let your comon sence get in the way of your sence of humor....IF YOU HAVE ONE.

MAC Firefighter/Paramedic

p.s.This is my carear choice!Remember YOUR safety first!


[This message has been edited by Ohiofiremed57 (edited April 23, 2000).]

[This message has been edited by Ohiofiremed57 (edited April 23, 2000).]

[Pamela Baber]

Test Post

[Pamela Baber]

Stretching protocols to accommodate retaliating on a patient who is intentionally spitting is less than professional. I agree that personal safety and the safety of the crew is priority one. That's why we have and should always use PPE.
Assault in fact is any act or threat that puts the patient is apprehension of physical harm. Check any Basic EMT through medic text. And if still in doubt, contact an attorney. They might also mention res ipsa loquitur, Latin for "the thing speaks for itself", a doctrine used when the complaintant feels they have been harmed and
that it would be difficult to prove all four elements of negligence. The complaintant can prove that the instrument was in the control of the defendent and that the complaintant did not offer consent the burden of proof shifts from the complaintant to the defendent. The majority of these cases are settled out of court and in favor of the complaintant. We should never allow a patient's loss of control to affect our professional and/or ethical behavior. To retaliate to an assault with an assault is hardly an appropriate action. In cases like these I always remind myself, "here but by the grace of God go I". Our advocacy for our
patients should be primary. As far as "kissing my ***", could be as dangerous as not wearing the proper PPE when treating the patient who spits.