Preparedness & Recovery

Aggressive Patients Pose Added Dangers for EMTs

EMTs have no way of knowing if any given patient's high-stress situation will devolve into violence.

by Amanda Spadaro, The Times Herald-Record, Middletown, N.Y. / August 7, 2017
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(TNS) - An emergency medical technician in the back of an ambulance with a patient doesn't have protective gear like law enforcement personnel might.

EMTs have no way of knowing if any given patient's high-stress situation will devolve into violence.

That's what happened on July 16, when a patient pepper-sprayed three EMTs from the New Windsor Volunteer Ambulance Corps as she was being taken to St. Luke's Cornwall Hospital.

That was an extreme case, but assault is not uncommon. It's also a felony under the state penal code.

The prevalence of assault rings true with the experience of Rachel Hubel and Vincent Engenito, EMTs with the New Windsor Volunteer Ambulance Corps.

And Dawn Marshall, Michael Bigg, Rich Lenahan and Rich Muellerleile are just a sample of other regional EMTs and paramedics who have faced verbal or physical assault in some form.

The stories vary: kicked in the chest, punched, bitten or spit on.

Sometimes, patients throw whatever they can get their hands on or threaten to jump out of the ambulance.

At a minimum, verbal abuse is an inevitability, Engenito said.

In fact, about 52 percent of respondents to a 2005 survey by the National Association of Emergency Medical Technicians said they've been assaulted by a patient.

To make matters worse, EMTs and paramedics said they aren't properly trained on how to handle escalating situations.

They are "virtually helpless," according to Rich Muellerleile, Ulster County Emergency Medical Services coordinator and deputy chief of the Town of Shandaken Ambulance Service.

Lenahan teaches EMT classes in Orange County and said the standard curriculum has no training to prepare students for the possibility of violence.

He is also a paramedic and captain of the Monroe Volunteer Ambulance Service.

He says he wishes the curriculum included specific, intensive behavioral and de-escalation training.

While EMTs and paramedics are certified every three years in New York, the state's Department of Health lists only one required hour of "Abuse and Assault" information.

Current practices

The usual guidance is simply to not approach an unsafe scene, according to Bigg, chief of the New Windsor Volunteer Ambulance Corps.

"Usually, law enforcement puts us on stand-by until the scene is safe," he said.

This is usually the case, but not every dangerous situation can be avoided, Muellerleile said.

Sometimes, the trip to the hospital becomes unsafe.

"You do have people who just snap," Lenahan said. "They're fine one second, and the next, they're a completely different person."

Bigg said the only option is to defend themselves.

An EMT or paramedic cannot legally restrain a patient. Only a law enforcement official can do that, Bigg said.

They can always ask a patient if they have weapons but cannot search a person, Bigg said.

The only true course of action is requesting law enforcement assistance, Muellerleile said.

"Obviously, if there's any issue that can potentially escalate, involve the police department," he said. "If you have any iota of doubt."

Intuition

The complete lack of standard protocol for dealing with an assault means the technicians must rely on their own intuition, Lenahan said.

However, a standard protocol might not be appropriate, according to Dawn Marshall, a life-member EMT with the New Windsor Volunteer Ambulance Corps.

"You have to take each situation as an individual one and manage it from there," she said.

Bigg uses humor. Marshall tries to talk a person down when she notices the first signs of agitation. Hubel tries to have the responding EMT whom the patient seems most comfortable with ride in the back rather than drive.

It's all about reading the situation, according to Bigg.

"If someone is having a psychological breakdown, you can't fix it the same way every time," he said.

While paramedics are able to give a sedative to a patient, that rarely happens.

Approaching an already angry person with a needle in hand usually only makes things worse, Bigg said.

Moving forward

Bigg said New Windsor's ambulance service is now working with the town's Police Department to develop new protocols for treatment.

Admittedly, there cannot be a "blanket policy," he said. But it will address how to gauge a patient and decide when EMTs or the police should transport the person.

Bigg also hopes to do more training on identifying and de-escalating various types of crises, but that is often an issue of funding.

Instead of formal trainings, some ambulance corps do situational awareness scenarios every so often to practice handling an aggressive or violent patient, Lenahan said.

He hopes there will be significant improvements to the standard national curriculum - but he's not holding his breath, he said.

Muellerleile said his ultimate goal on any call is to get everybody home safely.

"When I go to work, I kiss my wife goodbye, I kiss my kids goodbye, and there's an expectation that I'm going to be home 24 hours later at the end of my shift," he said.

"But in the back of my wife's mind, there's a chance that I might not be coming back."

The unfortunate truth is because of the nature of the job, some people won't come home, he said.

aspadaro@th-record.com

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©2017 The Times Herald-Record, Middletown, N.Y.

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