Sleepy Boy or Fetch My Dart Gun

We get called for a violent psych at the juvenile school. Wait for PD, our dispatcher tells us.

A violent psych at the juvenile school. The last violent psych I had at a juvenile school was a fifty pound ten-year-old who was standing up on top of the cabinents in the principal’s office jumping up and down screaming at the top of his lungs after already having thrown all the books that were on top of the cabinent down on the floor. I reached up, plucked him off the cabinents, tucked him under my arm, laid him on the stretcher and wrapped him in a blanket, then told him to knock it off, which surprisingly he did.

When we arrive, a staff member meets us in the hall and asks us if we are familiar with Andy.

I am not.

Big kid, thirteen years old, autistic, out of control today. They have six people holding him down, he says.

Six people, I think, right. Talk about overkill.

I enter the room, nod to the cop, who is standing by the door. I look about the room, then look down on the ground, where there are indeed six people holding Andy down. Andy is two hundred fifty pounds minimum, maybe two-seventy. He has the muscled shape of a big bear. There is a grown man on each limb, a large grown man leaning over his torso, and another man holding his head down. He looks up, despite the hold the man has on him, and roars. I swear the room shakes.

“You’re just one crew?” the cop asks. “You have restraints?”

***

Now when I first took my EMT class many years ago, I wasn’t too keen on the section of the course where we practiced restraining patients. I mean I wasn’t certain I wasn’t going to vomit at the first sight of gore, and I wasn’t certain how good I was going to be at wrestling patients. I was as tall as I am now, but not nearly in the shape I am in now. I was sort of skinny and flabby at the same time.

I was lucky that one of my partners when I first stared working was a black belt karate instructor, but other times I worked with tiny women. In the same way I hoped that I never had to deal with the massive chemical hazmat train wreck mutlicasulaty plane crash call, I hoped I wouln’t get called for the big guy who wanted to kick my ass.

I cultivated a calm approach, and learned to rely on my voice and on the trait of patience, which I have in fair abundance, and when faced with being patient or getting pummeled, I am always happy to be patient. But there are always some patients who patience doesn’t work on. That’s why we have cops, but cops don’t like to get worked up any more than paramedics.

In recent years, restraining patients has also gone somewhat out of favor due to some tragedies — patient’s dyig of asphxia. A couple years ago, our protocols were rewriten to address issues of restraint. In the case of Andy, in my mind, I flip through the first two pages of the protocol to half way down the third page, under the title “Chemical Restraint.”

***

“We’re going to sedate him,” I say. (If this was movie, I would have said to my partner, “Fetch my dart gun.”)

2 mg Ativan and 5 mg Haldol IM.

He screams when I stick him in the thigh. He presses against his restrainers, tries to spit, but they quickly put a face shield over him. He calls me nasty names.

Then we sit and wait. He settles down for a moment, but any time anyone moves or tries to talk to him, he starts fighting again.

Ten minutes go by. He is still angry and yelling.

I excuse myself and go out to the ambulance and call medical control. The doctor approves my request for a second dose. “By all means,” he says.

Andy nearly throws everyone off him when I hit him in the other thigh.

I sit back down in a chair and wait.

A staffer asks what the plan is now.

“I’m going to sit here until he’s asleep,” I say.

Five minutes later, he starts to snore.

One by one I have each of the restrainers get up. We nudge Andy, and he opens his eyes, and sleepily gets up and lays down on the stretcher like a little boy who has stayed up past his bedtime.

He snores all the way to the ER.

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Peter Canning

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  • Comments
    Mike
    You Don't Have to Put on Your Red Lights
    I totally understand what you guys are saying and how you feel. It's a shame that because there are bad apples in a basket, we as people think the whole basket is bad and this is so far from the truth. I was an EMT for a little while, it was my part time job…
    2015-03-29 15:05:53
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33

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