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eparadysz
10-04-2012, 06:00 PM
Setting: rural U.S., late night, gas station

Situation: 18-year-old male, violent psychotic episode. He's sitting or leaning against a car, screaming and cutting himself up with broken glass. He doesn't respond to anything except to slash at anyone who tries to approach him.

What I want to happen: Character gets sedated (specific drug used isn't that important, but suggestions welcome).

It doesn't have to be the most likely outcome, but is there a way this could play out that would be plausible? What would the responders have to do to administer a drug – would he have to be physically restrained first, or could they sneak up behind him? He's doing serious damage to himself, so the situation is urgent. His condition, by the way, is fantasy related, not a real-life mental illness, or due to drugs/alcohol. He has a companion, but she doesn't know much about him. Would they be asking her questions while he's freaking out, or wait until after he's subdued?

Thanks in advance for any information or advice.

Duncan J Macdonald
10-04-2012, 07:44 PM
I'm not an EMT, nor do I play one on TV. However, I have done ride-alongs with the local Volunteer Fire Department Ambulance EMTs.

One of the first rules when approaching a scene is to make sure you don't add yourself to the problem. If the dude is swinging broken glass at any/everyone who gets near, then I'm not getting near.

If 911 was called, then the police will also respond. They have the training and equipment to subdue him. Once that happens, the EMTs can get to work.

EMTs also travel in pairs, so one can be asking the companion what she knows while the other waits for the dude to get subdued. The questions will generally be aimed at what the causes of his current state are -- drugs, sleep-deprivation, etc.; how long he's been this way; and so forth.

Drachen Jager
10-04-2012, 08:33 PM
EMTs etc. would not approach until he was no longer a threat. The first people he'd deal with would be police. Some places he could very well end up shot and dead, but if you want him sedated, the police would first drop him, most likely with a tazer, though possibly using pepper spray/Mace prior to tazing him. Look up the effects of a tazer, there are plenty of videos on Youtube, it doesn't knock you unconscious like in many movies or badly written novels, it just causes your muscles to convulse uncontrollably so you fall down.

Once he's on the ground about five cops would rush in and kneel on him. They'd take all weapons away from his reach and cuff him, then they'd get him to his feet.

If he was still acting up, then the EMTs might give him something, though I'm not sure if they'd knock him out (for safety reasons). More likely they'd just give him something to calm him down.

asroc
10-04-2012, 08:44 PM
Hi, I’m a paramedic.

Like Duncan and Drachen said, a violent patient like that will first be dealt with by the police. EMS never enters an unsafe scene (officially). We don’t have weapons, after all, and our safety comes before the patient’s.

They’ll ask the companion as soon as possible. Any pertinent information can be vital for dealing with the problem, including what drugs can be given to him.

Once he’s subdued he will be physically restrained (strapped down), possibly handcuffed with a police officer coming along. Sedation (chemical restraint) is also a possibility if the EMTs are paramedics and he won’t calm down, since a restrained patient can still spit, bite etc. What drug they use depends on the protocol of the individual service. Benzodiazepines are popular, like diazepam (Valium), lorazepam (Ativan) or midazolam (Versed). My service also carries haloperidol and some others have atypical antipsychotics like Geodon at their disposal.

jclarkdawe
10-04-2012, 11:24 PM
As a former EMT, repeat Asroc's answer here. He wouldn't get drugs until everything else is exhausted and he's in route. Strap him down, restraints, and head blocks for the spitting can accomplish a lot. One problem is you don't know what's he's on and what's wrong, so you might screw up and use a drug that isn't good for the mix that he's on.


It doesn't have to be the most likely outcome, but is there a way this could play out that would be plausible?

Normally, there's no way your scenario would play out.

However, there's always the crazy EMT. And there are a few of them out there. Crazy EMT arrives on scene with sane partner, and no cops. After ten minutes of screaming for cops, still no cops. And no cops anywhere in sight.

Crazy EMT says they ought to use a trank gun. (Used for animals.)

Sane EMT says what is he, nuts? And oh by the way, we ain't got no trank gun.

Crazy EMT says, wanna bet? And pulls out a trank gun he's got stored someplace weird on the rig.

Sane EMT says, You crazy?

Finally, after discussion, and no police still anywhere in the county, Crazy EMT says, F*** this. I'm shooting the guy.

Paperwork would describe patient collapsing, them rushing in and administering whatever.

Reality check is not very likely. But could it be done for a novel and made to work? Probably. But it's not going to be too believable.

You never, ever jab a needle into someone moving around because there's a big chance of breaking off the needle. Yes, there are exceptions, but not in the midst of someone having a psychotic episode in a non-controlled environment.

Best of luck,

Jim Clark-Dawe

eparadysz
10-05-2012, 12:30 AM
Thanks for the responses (I love this forum).

Sounds like I'll have to push the drugs back a bit. The trank gun idea is interesting, but I want to keep the focus on the MC, not the Crazy EMT drama. And I had a feeling the needle thing wasn't going to work (even though it seems to happen on TV all the time…)

But if anyone's still reading…

Coming at it from the other side, what would the EMT's do in that situation if the police were delayed (given the rural area and all)? My character is not actively threatening them, just very determined to hurt himself (cutting up his arms and face with the glass) and fending off their attempts to stop him.

Also, the drugs are the important bit. How extreme would his behavior have to be to get him some Valium or something (even after he's restrained)?

Thanks again.

Drachen Jager
10-05-2012, 01:11 AM
If the police were delayed, the EMTs should wait. Period.

Some might break the rules some of the time, but most would not interfere in the scenario you proposed.

Normally the police would be the first to get there, even in a rural setting, unless the ambulance just happened to be in the area.

John342
10-05-2012, 01:56 AM
Police reply here:

You said rural so a response might be delayed by several minutes... I'm talking like 15 to 30 depending on whether it's a county or state response. The FD in very rural locations may actually be volunteer, in which case they have to come to the fire station from their homes to get the ambulance... again that means a delayed response.

If your guy is cutting himself, he may well pass out.

Once the police arrive, it is likely there will only be one at first. Rural police officers can be the wisest most creative policemen on the planet... but they can also be very timid as well due to lack of training and hands on experience...
My opinion is, as a police officer, you would not go "hands on" with a guy like this alone. That doesn't mean others wouldn't (I am saying it wouldn't be smart, but I've worked with guys who did stupid things.) By hands on I mean trying to wrestle the guy into handcuffs.

My dept carries Tazers and that would probably be the difference maker in getting the guy into custody without further injury. Without it, I keep the guy from injuring others until the cavalry arrives. That means if he goes after other people I may shoot him.

Just in case you are thinking the volunteer firemen may help the police here... in 30+ years of being a policeman, I have never seen a paramedic assist in subduing a violent patient. Once they are strapped to the stretcher its a different matter. Ironically, I have had a doctor help me subdue a mental subject who was trying to break out of the ER.

Hope that helps,

John

glutton
10-05-2012, 01:57 AM
If the police are delayed and there looks to be serious danger of him killing/permanently damaging himself, and the EMTs won't put themselves in the line of fire... would it not be admirable of his companion to take it upon herself to knock him out or subdue him? :)

I favor disarming him one way or another and then dragging him out of reach of the broken glass, although this action may not be fit the companion's character.

GeorgeK
10-05-2012, 02:18 AM
Police reply here:

You said rural so a response might be delayed by several minutes... I'm talking like 15 to 30 depending on whether it's a county or state response.

The last time I called the cops for an tresspasser who actually SHOT at me, it took them 4 hours to show up! Yes, rural. Now I have a rifle because I can't count on cops doing their jobs.

Eventually I found out the shooter was a cop

asroc
10-05-2012, 02:38 AM
Coming at it from the other side, what would the EMT's do in that situation if the police were delayed (given the rural area and all)? My character is not actively threatening them, just very determined to hurt himself (cutting up his arms and face with the glass) and fending off their attempts to stop him.

If it's a choice between him shredding his own face or mine, I'm not going to tackle him.

The EMTs might try to talk to him, but they should keep their distance until it's safe. If the patient is agitated and violent police would probably be dispatched along with EMS and arrive at the same time or earlier.


Also, the drugs are the important bit. How extreme would his behavior have to be to get him some Valium or something (even after he's restrained)?


Sedation is appropriate whenever the patient continues to be a danger to himself or others. How that's interpreted is to some degree up to the EMT, but he does have to be able to justify it. In some jurisdiction he also has to call Medical Control first.
If the patient keeps wriggling, tearing at the restraints, trying to bite, scratch and so on and there are no contraindications, you give him 5 mg of Haldol and that’s usually the end of it.

John342
10-05-2012, 10:45 AM
The last time I called the cops for an tresspasser who actually SHOT at me, it took them 4 hours to show up! Yes, rural. Now I have a rifle because I can't count on cops doing their jobs.

Eventually I found out the shooter was a cop

Ouch!

anguswalker
10-05-2012, 01:15 PM
It is interesting that the assumption in all these responses is that forcible restraint is the first option considered. I live in the UK where most police are not armed (including with tasers) and many police and paramedics are highly skilled in defusing potentially violent situations and calming (at least temporarily) individuals who are acting strangely and/or violently. I am sure the same is the case in the US, particularly possibly in rural locations.

Might it not be possible for one of the paramedics (who perhaps slightly knows the guy) to approach him unarmed? As I see your plot situation, it could go like this (variation on jcd's scenario):

2 EMTs arrive. Police not anticipated for 45 minutes.

Argument between EMTs, one saying they need to wait, other wanting to try approaching subject.

EMT 1 manages to talk subject down temporarily & gets him to put down the glass (maybe he's a bit woozy anyway from loss of blood). He approaches & sits next to him.

Subject suddenly becomes violent & EMT 1 wrestles with him, more or less subduing him, but also screaming for help.

EMT 2 (inexperienced) panics, rushes in & administers sedative.

Cue argument- what if EMT 2 gave him something that will interact with what he has already taken? What the hell was EMT 1 doing trying to talk him down anyway? I SAID we should wait. etc. etc.

Couldn't that work? EMT 1 just needs to have a rather over-inflated idea of his own ability to defuse fraught situations & to have underestimated subject's level of disturbance slightly. EMT 2 just needs to be a bit inexperienced and prone to hasty & unwise judgments.

John342
10-05-2012, 01:52 PM
It is interesting that the assumption in all these responses is that forcible restraint is the first option considered. I live in the UK where most police are not armed (including with tasers) and many police and paramedics are highly skilled in defusing potentially violent situations and calming (at least temporarily) individuals who are acting strangely and/or violently. I am sure the same is the case in the US, particularly possibly in rural locations.

Might it not be possible for one of the paramedics (who perhaps slightly knows the guy) to approach him unarmed? As I see your plot situation, it could go like this (variation on jcd's scenario):

2 EMTs arrive. Police not anticipated for 45 minutes.

Argument between EMTs, one saying they need to wait, other wanting to try approaching subject.

EMT 1 manages to talk subject down temporarily & gets him to put down the glass (maybe he's a bit woozy anyway from loss of blood). He approaches & sits next to him.

Subject suddenly becomes violent & EMT 1 wrestles with him, more or less subduing him, but also screaming for help.

EMT 2 (inexperienced) panics, rushes in & administers sedative.

Cue argument- what if EMT 2 gave him something that will interact with what he has already taken? What the hell was EMT 1 doing trying to talk him down anyway? I SAID we should wait. etc. etc.

Couldn't that work? EMT 1 just needs to have a rather over-inflated idea of his own ability to defuse fraught situations & to have underestimated subject's level of disturbance slightly. EMT 2 just needs to be a bit inexperienced and prone to hasty & unwise judgments.

Well of course it could work... so could an EMT whose day job is a Karate instructor. It's just a question of believability. This is what the OP said.
"18-year-old male, violent psychotic episode. He's sitting or leaning against a car, screaming and cutting himself up with broken glass. He doesn't respond to anything except to slash at anyone who tries to approach him." That doesn't seem to fit the scenario you are describing.

cornflake
10-05-2012, 02:15 PM
It is interesting that the assumption in all these responses is that forcible restraint is the first option considered. I live in the UK where most police are not armed (including with tasers) and many police and paramedics are highly skilled in defusing potentially violent situations and calming (at least temporarily) individuals who are acting strangely and/or violently. I am sure the same is the case in the US, particularly possibly in rural locations.

Might it not be possible for one of the paramedics (who perhaps slightly knows the guy) to approach him unarmed? As I see your plot situation, it could go like this (variation on jcd's scenario):

2 EMTs arrive. Police not anticipated for 45 minutes.

Argument between EMTs, one saying they need to wait, other wanting to try approaching subject.

EMT 1 manages to talk subject down temporarily & gets him to put down the glass (maybe he's a bit woozy anyway from loss of blood). He approaches & sits next to him.

Subject suddenly becomes violent & EMT 1 wrestles with him, more or less subduing him, but also screaming for help.

EMT 2 (inexperienced) panics, rushes in & administers sedative.

Cue argument- what if EMT 2 gave him something that will interact with what he has already taken? What the hell was EMT 1 doing trying to talk him down anyway? I SAID we should wait. etc. etc.

Couldn't that work? EMT 1 just needs to have a rather over-inflated idea of his own ability to defuse fraught situations & to have underestimated subject's level of disturbance slightly. EMT 2 just needs to be a bit inexperienced and prone to hasty & unwise judgments.

Anything is theoretically possible but in general, no.

An EMT isn't going to risk approaching someone wielding something sharp, clearly willing to use it, and (apparently) fairly incoherent.

Even if they did talk to him from a distance and get him to put the stuff down, going over there and then sitting down? That's in the 'I want worker's comp!' category.

Also, as above, a paramedic would only administer something like that as a last resort and would likely only use it after calling in to check. They're not dr.s and have no idea what someone might be on already or allergic to or etc.

eparadysz
10-07-2012, 06:26 PM
Thanks again for all the responses. Lots of good information and ideas here.