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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Recent Posts
Thoughts on Ebola October 23, 2014
STEMI Call October 14, 2014
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  • Comments
    RJ in florida
    Thoughts on Ebola
    this appears to becomming political. The lack of an african quarantine is because if the government orders it, the airlines can go back to the government for lost revinue when its over. If they do it on their own its a business descision and have to eat the loss. The appomtment of a non doctor…
    2014-10-24 19:36:32
    tom combs
    Thoughts on Ebola
    Best effort is to quarantine/contain in W. Africa. Flight restrict all wanting to leave until 21 day safe or otherwise proven to be zero risk. It's in everyone's best interest. Here is a radio interview I gave 10/13. Unfortunately the situation is essentially unchanged. Thanks and be safe! I appreciate what you do. http://www.rmapublicity.com/images/stories/Audio/Nerve%20Damage%20-%20Wall%20Street%20Journal%20Tji%20Morning%20-%20October%2013,%202014.mp3
    2014-10-24 14:26:16
    Vince D
    Connecticut Limits Long Boards
    Beautiful! Congrats!!! I think this is the perfect level of aggressiveness and I can't imagine any regions advocating less intervention for a really long time. In fact, I don't think I'd want anyone being more aggressive than this with SSI for a long time. The only line that had me stroking my chin was: "Elevated…
    2014-10-23 08:43:16
    ParamedicTC
    Ebola
    Check out this site with an informative graph.
    2014-10-22 23:39:21
    Don
    STEMI Call
    Thank you for a good honest post. I think those classic or "typical" presentations we learn in school are the exceptions really.
    2014-10-18 17:34:21

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