Safety First

I recently read a story that came across the EMS wire about an EMSA paramedic in Oklahoma City who was assaulted by a patient and as a result, she lost her unborn child.  Last week, I read a story about a politician or lawyer (forgive me, I cannot find the actual article to reference it) who assaulted a medic and was not charged.  Over at Rogue Medic, Tim brought to light a man who assaulted a Chicago medic who got off easy.

Our job can be dangerous.  Sure, for the most part, our calls are routine, and we are not at risk, but then there are those cases, like the ones referenced above, where we are put at risk.  When these incidents happen, I’d go as far as to say that paramedics and EMTs are more at risk than doctors and nurses who have other staff there who could potentially back them up, and police officers, who are trained to deal with such situations.  When a provider is one on one with a patient who could potentially become violent, or does become violent, there is not a more dangerous scenario that we as prehospital providers are put in.

Some of these tips are my own.  Some of them I picked up from Mike Taigman and the street safety course he was teaching through a couple of years ago.

First of all, each of us needs to remember that scene safety carries into the back of the ambulance.  Next time you’re in the back of your truck, take a look at your surroundings.  Where are the potential “weapons” kept?  Are there sheers or IV needles in the cabinet right next to the patient?  Are they accessible on the bench seat?  What do you keep on your belt, and how well is it secured?  Make sure your sheers are always fastened if you carry them.  And although I have not found much of a use for them in my years as a medic, make sure your knife is discretely tucked away.

Work a “pat down” into your assessment.  It can be as simple as a head to toe assessment, and can be very discretely done.  Most patients would not even realize it.  I have been lucky enough to have never pulled a gun off of one of my patients (I can’t say the same for some of my colleagues) but I have found my share of knives.

Now that the area around you is safe, think about how you handle yourself.  Think about your positioning.  Some might say that the safest place on these calls is the airway seat, behind the patient.  I don’t always find that to be true.  I always want my patient in full view.  I want to be able to see what they are doing, and I want to be ready to react to it.  When dealing with a potentially violent patient, now might not be the time to be taking notes on a note pad, or getting a head start on that chart.  Your attention needs to be focused on the patient.

I always looked at how I had my patient packaged too.  I always told my patients I “wanted to keep them warm” or in the summer “wanted to keep them clean” when putting them on my stretcher.  During most of the year in New England, you can justify not only putting one layer of blankets or sheets on a patient, but you can get away with two.  My best scenario would be to put a blanket over a patient, then strap them in, then place a sheet or blanket if it was cold enough over the straps.  I always liked people’s hands to be on the outside because I want to see what they are doing, and creating a barrier with the blankets keeps them from rummaging around in their pockets, in case you or an officer might have missed anything before wrapping them up.

Also, think about creating an environment that won’t agitate the patient any more than you have to.  If you need to call a patient report, have your partner do it from up front.  Create some sort of code word with your partner so they know when you feel you might potentially be in danger, or if you feel that you’ll need help when you get to the hospital.  If you are the one driving the truck, always know where you are.  Be familiar with cross streets and major landmarks in case you do have to pull the truck over to help your partner, or restrain a patient.

Finally, when you do have to strain a patient, think about how you do it.  If you have safety goggles available, this is a great time to wear them.  Furthermore, don’t mention that a patient might potentially spit.  Don’t put that idea in their head.  And as always, the ideal position for a patient to be is on their backs, one arm up, one arm down at their side so their muscle groups work against each other.  I always liked the added touch of putting a non-rebreather on them.  This helps eliminate the possibility of a patient spitting.

Finally, when documenting the how, where, and why of restraining, I always preferred to use phrases like “the patient was restrained for their own safety and the safety of providers.”  Make it clear how you did it, and always make safety the priority.

The key is awareness, keeping your head on a swivel, and creating a safe environment for you, your partner, and your patient.  But what happens when that unfortunate incident occurs, and someone gets assaulted by a patient, or worse gets injured?

It is time for law makers, and leadership in EMS on a national level to advocate for legislation to protect prehospital providers.  Punishment for assaulting EMS personnel needs to be swift and harsh, regardless of who they are, or what sort of record they have.  The primary role of an EMT or medic is to provide care to the sick an injured.  They put themselves in compromising positions every shift just to help out their patients, whether they like them or not, or whether they want it or not.  The unfortunate occurrence of assaults is becoming far too frequent, and needs to stop.

Above all else though, remember to always put safety first.  The number one priority for every ambulance crew needs to be personal safety, and you must do everything you can to maintain as safe an environment as you can to insure that everyone on the truck goes home at the end of the day with the same number of holes in their body as they came to work with.