Psych. patients

[EC116]

ok all, I want your opinions.

I've been a firefighter for a while now but I'm reletively new to the private EMS world. I took a part time job with an ambulance company so I can pick up a few shifts every now and then. Anyway, here's my question.

How do you restrain psych patients in the back of the ambulance if you didn't put them in restraints before you put them back there? Here's the situation. Tell me what you think I should have done..

We were transporting a 43 year old psych patient from an ER to a mental hospital. He was totally calm, and the ER doctor said that he didn't need restraints. I wasn't quite comfortable with this decision, but like i said, I'm new and didn't speak up.
Anyway, the ride was relitively calm. I allowed him to sit up so he could look out the back window, this seemed to keep him calm and content. About half way there he starts going nuts. He grabbed everything he could within his reach and stated throwing things all over the place. I grabbed his arms and basically laid on top of him until my partner could pull over and come back to help put the restraints on.

My question is, what would you do in this situation? I can think of several ways to get the guy under control, but nothing that wouldn't get me fired. Is there any way to restrain him without hurting him? I asked a supervisor and he said to use restraints. Well, duh! but what do you do in the mean time until you can get them on?

I've never had this problem before with the FD. We don't do transfers like that. Any suggestions you can give me would be appreciated so the next time I am prepared.

[swatemt]

Hey, I have done that type of psych patients before...in fact I had a long distance transfer like that last sunday night. The best thing to do is if the doc says that the patient doesn't need them and you feel that you do, tell the doc your concerns and then discuss it with him/her. A lot of times the doc will agree with you and let you do it your way!
If you don't have the restraints on...the best thing is to do like you did, sit on them and get their arms behind them if you are able to (the patient preferably face down on the cot). Then you just wait for your partner to get back their and put on the restraints.
The nice thing in my area is that we are allowed to carry handcuffs on us. They are about the easiest and fastest way to get the patient under some sort of control.
The biggest thing is to stand up to your patient and not let them know that you are afraid of them! If you have control...thats the way it will stay. Never be afraid of hurting your patient because if you aren't safe then you can't do any good to the patient or anyone else! Hope this helped! :)

[codeblue81]

I guess that I must be lucky. I haven't had any of those types of psych pts. yet. I've only had the OD ones. But in my basic class we were taught how to restrain, since there was a Mental Health hospital in town we ran to alot. One way of doing it is to have a scoop stretcher or stokes basket nearby. just throw it on top of the strecher and strap it on. He won't be able to get to you or hurt himself then. Hope this helps.

code_blue81 :D

[EMT_Wub]

Fortunaltly where I work, the police depts are good with helping us restrain when necessary on calls, as far as transfers, they usually do all of them that do not need medical care. If nothing else, you can immobilize them with the board and spider straps before you leave the ED. Improvise. Just make sure you are able to go home at the end of the shift.

[duffer]

Basically, there is nothing you can do once enroute if you did not restrain prior except stop the box, call for backup and start over.
I have had the pleasure of nearly being thrown out of a box going code three, by a sudden on-set of violence, back in my early years as a box medic. Remember if put in that position, your safety comes above all else, you do anything and use anything you can to get the upper hand. I know I did. As an fire officer, I will not let my medics transport anyone that is potentially violent without being restrained. I have even had PD to transport with a medic in the back of the squad on one extremely dangerous pt. Remember that these are as just as dangerous as any fire call you will make, these pt's can injure/kill you if you don't take precautions. You would never go into a fire without PPE so don't transport a potentially violent pt without being restrained and the proper help in the back of the box. Be safe. ;) ;)

[RESCUETEC]

In our city... our local protocol is that we dont transport psych pts unles they have any medical problems or obvious injuries but in my other job... i also work for a private EMS.... we trasport psych pt anytime and everytime! if i were in your case... i would have done the same thing and plus, use our handcuffs on him that we have in our ambulance. Its either you or him that gets hurt. :)

STAY SAFE :cool:

[EC116]

Thanks all for the replies. I thought the handcuffs idea was a good one too, but we are not allowed to use them. I use to be a police cadet myself, and am trained in proper use of them (Not that it's that difficult to figure out) but supervisors still say no, I can't use them. I can't figure those people out sometimes. I realize they are worried about liability..yada, yada, yada...But if we are trained to use them and they help to difuse a serious situation, and keep people from hurting themselves or others, why can't we? If a police officer is with us, we can use handcuffs then..... OH well, that's management for ya......

[Dalmatian90]

Handcuffs may not just be a liability issue. CT's State EMS regulations prohibit them unless law enforcement or Department of Corrections is on board.

(Now if you want restraints...we have a 600 inmate correctional center...ankles & wrists shackled to the belly on all patients coming out...well, sometimes there'd be an exception for CPR in progress :D )

In the situation you had, I agree with the advice above. Talk to the doc. If you start to lose control of the patient pull over...at least he won't jump from a moving ambulance, and once he's running, it's law enforcement's problem!!!

--------
One of the most surreal incidents I've ever been involved with was a juvenile (big 16 year old) pysch who honest to god had the clinical diagnosis of "Authority Disobedience Disorder" -- he felt compelled to disobey for the sake of disobeying. Now, we're not legally allowed to detain someone -- that's law enforcement.

So for 10 minutes while waiting the Troop to arrive, he walked up a secondary state highway. Our Ambulance got in front of him, our Rescue behind him, and since traffic was light, we actually setup a rolling road block -- we allowed alternating lanes of traffic to pass this walking speed fiasco. Couldn't stop him legally, but we did our best to protect him. Finally he lunged towards the yellow line, and the school counselor (a former H.S. wrestler) decided the patient had crossed the line and was now a danger to himself, so he could be legally restrained by the counselor. Another five minutes went by as we directed traffic around this counselor with a student pinned under him before a State Trooper arrived and even had a new Trooper on field training as a partner...they were not impressed with "Authority Disobedience," although they got a chuckle out of it before conducting a Cuff & Stuff. "You are now in protective custody."

[Va Medic2]

You did exactly what I would have done in that situation under the old policy....But they have for the most part taken them off our ambulances here, in Va., due to new laws. Now if I am to transport them as such, I will try either 1) Get orders/meds onboard for sedation if needed, or 2) Get the ED staff to sedate them before transport... But of course, #1 requires you to be a medic in order to due so!!!! Alot of other good suggestions have been listed above if you are just a BLS unit. I have been lucky so far, as to not get any pt's like that, but have had a few that I was just waiting for them to crack at any time.....And others, I have had the ED staff sedate prior to transport..... Good luck!!!!!

[Captain203]

I would have done exactly as you did. All you can do is to sit on the patient until your partner can pull over and help out. As far as what to use for restraints, cravats usually work just fine, even though you may have to sit on the patient for a few minutes while your partnet ties knots!

[firemedic19077]

Look out for #1 is the name of the game. Get that person under control without endandering yourself. You will be suprised what you can do with tape. My favorite move I have used to stop a pt. was going off kicking, hitting and trying to bite (PD standing and watching) this 18 y/o female had a eye brow ring I simply placed my thumb on the ring and my hand across the forehead. I little tension on ring and problem stopped.

[Medic129]

EC116,

I worked for a private EMS not long ago. I had a similar situation arise, only with a younger patient. It was a basic, non-emergent transfer. The hospital said he had been fine for them and that they expected an un-eventful trip. The only intervention left in was a hep-lock. Anyway, halfway to the other hopsital, this dude started going nuts; freaking out, grabbing stuff, just like your guy. I had my basic pull over and I called for PD. I also called the hospital and told them what was going on. I asked for soft restraints. They not only gave me the restraints, but also ordered 5mg of Valium to calm his ***** down. Put the restraints on, gave the med, smooth (and quiet) rest of the trip. Just remember; when in doubt, call medical control.

[ 11-11-2001: Message edited by: Medic129 ]

[EC116]

I just don't have the luck. I have had so many psych. patients lately. I guess because I don't like them and are a bit uncomfortable with them they are drawn to me...lol. Oh well, at least I haven't had any more problems with them (knock on wood). And what's up with the suicide attempts lately. I mean, I know we get a lot around the holidays..but it's not even winter yet! Amazing.