PAX Centurion - May / June 2013

www.bppa.org PAX CENTURION • May/June 2013 • Page 41 “Stop resisting sir, you’re hurting yourself” L ast night I was attacked by a patient. It wasn’t the first time and it certainly won’t be the last. This particular patient had no ill will toward me; he was sick and had no idea what he was doing. However this is not always the case, sometimes we are attacked with malice. Sometimes patients have had a too much to drink, or taken too many drugs. Sometimes they lost a fight and are looking for someone to beat up so they can repair their bruised ego. And some- times, like last night, they have a medical condition which has altered their mental status causing them to fight with people who are trying to help. So how do we as professionals deal with these patients? Is there one set of treatment protocols for the sick and another for the A-Holes? The answer is: It depends. It depends when you were hired. I was hired in March of 2000, as a part of my academy experience the Public Health Commission (PHC) decided it would be a good idea to bring in an outside agency to show us how to “gain control” of people. Notice the last part of that sentence? Of “ people ”… not of “ Patients. ” So, for eight hours or so we threw each other around the gym, using some fantastic pressure point and nerve bundle strikes to get compliance from one another. You hold onto a guy’s thumb, bend it backward to the point of break- ing, and he will almost always comply with your commands. That’s great, if you’re dealing with someone who is generally sound of mind, and needs to be shown that their behavior will not be tolerated. These techniques are commonly used by corrections officers or nightclub bouncers. Now apply that tactic to a 35 year old male whose undiag- nosed brain tumor has finally grown to a size where it is compressing the area of his brain used to process rational thought. Or a diabetic who’s blood sugar has dropped to a dangerously low level. This pa- tient’s brain is telling him he is in the fight for his life.You could snap these guys’ thumbs clean off and poke them in the eyes with them; they are still not going to understand or comply with your instruc- tions. But that was the training I got, and it was much, much more than some of the folks I work with received. As I said, depending on your date of hire you are better or worse prepared to care for patients with altered mental states. EMTs and paramedics currently working at Boston EMS fall into one of three categories: NOTRAINING Some classes get no training in how to deal with these calls. They instead have to rely on personal life experiences to bail them out should they be met with violence. This of course is unacceptable, put- ting both the patient and the provider at risk of injury. BADTRAINING Some classes, like mine, were trained by outside agencies (who deal with criminals) in pain compliance techniques. We learned “Thumb-locks”, “Arm-bars”, “goose-necks” and “wrist locks.” Repeated knee strikes to the outer thigh were to be accompanied by shouting the phrase “Stop resisting Sir, you’re hurting yourself!” This was to assure any worried bystanders that we were in fact trying to help this poor soul and not just giving him a beat down (they told us it would help us later if we had to testify about it in court). GOODTRAINING Some classes were trained by EMS providers (who deal with patients) in non-pain compliant defensive tactics. Using the patient’s own momentum, and an understanding of leverage and biomechanics, the EMT or paramedic can often safely restrain a combative patient. This particular skill set provides confidence for the provider, safety for the crew, and has a minimal risk of injury to our patients. Unfortu- By Tony O’Brien, Boston EMS Treasurer nately there were only two or three classes who received this training in the past decade. In fact, the last recruit class to graduate from the Academy fall into the first category, having received no training in this area whatsoever. Attacks on EMS providers are on the rise. Not just here in Boston, but across the country and indeed around the globe. According to De- partment records, 106 of Boston’s EMTs and paramedics have been assaulted since 2011. Of course this number is much lower than the actual amount of assaults we have been subjected to. We don’t put pen to paper each and every time we are spat at, or when someone takes a swing at us. If we did, the number would be significantly higher. Recent reports from the UK, Ireland andAustralia also document significant increases in assaults. Dealing with an altered, combative, agitated or assaultive patient is something that every single EMT and Paramedic at Boston EMS will deal with multiple times during their career. Only a miniscule percentage of us are properly trained to deal with those patients. As we continue to attend in-service training, we are exposed to all sorts of material: We review cases, we are lectured by uniformed members and doctors. We are subjected to the political ideology of the Public Health Commission. As our job has become more and more danger- ous, the method in which we must deal with these issues has become more and more politically correct. We don’t respond to “Psych” calls any more. “Psychs” don’t exist in the world of the PHC. Now we respond to “E.D.P’s” or, “Emotionally Disturbed Persons”. So when a 9-1-1 call taker answers the phone and hears that there is a naked man running around the street slapping himself in the head with a live trout screaming “The British are coming, the British are coming!” they must enter the call as an EDP. The ambulance will arrive and most likely restrain the patient (using one of the three methods discussed earlier) then transport the patient to a hospital where they will be met by a triage nurse who will ask them what is going on with the guy. They will answer “He’s an EDP” and before they finish their brief story the nurse will have used the hospital’s overhead paging system by calling for a “Psych nurse to ambulance triage please”.Yes, they still call these “Psych” patients in the Hospital, as they do everywhere else, mostly because that is what they are. This is just one example of the “PHC’iffication” of our job. Another is the removal of our leather uniform jackets. They told us we could not wear the iconic garment because “Leather is tough to clean” and we are routinely exposed to blood, urine, vomit and every other body fluid imaginable. Well, I wear leather boots, and I can GUARANTEE you that they have been sprayed with way more fluids than my leather jacket ever was, yet I am allowed to wear them every day. The truth of the matter, as we all know, is there is no place for those intimidating-looking leather coats in the warmer, kinder and gentler world of the PHC. I believe it is for this same reason that we have such inconsistent training re: defensive tactics. It is all well and good for the PHC to feel warm and fuzzy knowing we are not using physical force to gain control of violent and dangerous situations. Their utopian view of the world, however, is going to get someone hurt. The sick, injured, drunk and the downright nasty have not been through the PHC’s indoctrination. Crews are rou- tinely met with violence. Patients continue to punch, bite, spit, head but, knee, kick and throw stuff at them. The only change has been on our end. The EMT or Paramedic’s date of hire could realistically de- termine whether or not they are seriously injured or even if they ever return to their family at all.