Managing Mentals Minus Meds

Ya, so I was playing with how many M's I could get in a single headline, but the topic remains. You need to know how to deal with these patients and stop crying for a medic intercept.

Step 1, remain calm. Don't freak out when you get the call for the 47 year old man who is threatening homicide and has attacked a nurse. Things are never like they seem. You don't know ANYTHING about this patient yet, don't build a picture without a patient. Hide restraints at the head of your cot, just in case.

Step 2, talk to your patient BEFORE you talk to the charge nurse. If possible. Your patient might be nutso, but he/she does have feelings and if they can see you avoid them to talk to the nurse this will just perpetuate the fact that they think someone is out to get them. Introduce yourself, ask them what is bothering them, and LISTEN. Don't act like some know-it-all and just nod and make excuses to leave. Listen intently, no matter how long it takes. This is your patient and you need to treat them the same way you would treat any other patient. Don't be an ass. Most of the time this is a simple problem of the patient not caring for a nurse or an aid. Even thought hey have a history of mental illness they are still people and they get their feelings hurt too. Talk to your patient, not at them.

Step 3, "Ask" your patient to get on the cot. DO NOT place them on the cot unless you absolutely have to. I mean you have NO OTHER options. These patients have needs too and if you move to immediately restrain them your going to have problems. You will take a reasonable stable nut and turn them into a raging psycho. Not really how you want to spend the next hour in transport. Do it the easy way, don't be stubborn, don't try and be super EMT.

Step 4, Respect your patient, and let them talk to you during transport. Get involved with their care. Don't play into any crazy fantasies, but don't belittle them for their comments either. Acknowledge what they have said, and gently steer them out of their manic thoughts to more positive conversations. Keep it light, like favorite foods, animals, music etc.. Don't try to provoke the manic behavior, don't be stupid. These patients are time bombs and you need to know what the fuse looks like. Be careful.

Ok if you have followed these basic rules and you still have one that is intent on removing your head for you there are several things you can do to restrain the patient or to defuse the situation without the use of meds. Don't yell and scream. Calm is the key. Tell your partner to pull over and assist you. 4 point restrain the patient with whatever your company uses as a approved restraint. DOCUMENT, DOCUMENT, DOCUMENT!

If they are still wildly flipping out, you can use a sheet to restrain their middle. If you do this right, there will be almost no way for the patient to remove themselves and hurt you. The key to all of this is to remain calm and perform these procedures with muscle memory. I strongly suggest lots of practice with the biggest guy you have at your station.

If you have tried ALL of this, then call for your intercept, but know that by the time the medic arrives, your patient will most likely acting like a perfect angel making you look silly. No matter how many times you tell the medic "He/She wasn't like this 10 minutes ago" they will not believe you and you'll have some explaining to do back in the barn.

Good Luck, you can do it!

Rarely do I post reader comments to the main article, but this guy had some damn good points.


FireResQGuru said...

Great advice! I agree with everything you said.

Might I also add 1) Never underestimate your patient. The 90 pound chick can be just as dangerous as the 400 pound guy in the right set of circumstances.

2) If they are suicidal vs. homicidal, be sure to address their issues. Just asking them if they want to hurt themselves or others is NOT enough. you need to get a feel for what they are thinking and why they are acting that way. Try to empathize (not sympathize) with them to make that calm connection you were talking about.

3) Be nice. You said calm, which is great advice, but be nice. I don't care if it's your 14th patient of the night in a 10 hour shift - You need to be nice. you really do get further with a nut case by being nice, but not condescending. I yield my soap box....