I remember a call from a couple of years ago where I blasted
a 12-year-old female with Haldol. At the time, it felt wrong. In hindsight, I
should have given it sooner.
My partner and I went to a junior high school for an
“Unknown Medical.” I arrived to find the school security guard with a story: A
student walked past one of the security guards smelling of weed, so the
guard stopped her and attempted to search the kid’s backpack. The student was
resistant to that plan, so she was taken down. But she was, you know, taken
down all gentle-like. So they didn’t think she was hurt. But they would like me to
“just check her out.”*
The sixth grader was covered in the smell of marijuana like
Pigpen is covered in dirt in the Peanuts comics. She was making my eyes water
and my mouth dry out, just being near her. Her secondary exam and vitals were
fine. The school had attempted to contact her parent or guardian listed in her
records, but there was no answer. The funny part of the call was when the
security guards were surprised that I was going to transport the student.
"Wait. What? You need to transport her? She isn't hurt!" (Then why did you call me?!?)
Just check her out, my ass. A minor, without parental
contact, in a still-ongoing cloud of marijuana, and with a report of trauma (however minor) is
going to the hospital. I don’t know what they expected to happen. Anyway, we
went to the ambulance and that’s where the brawl started.
See, the kid agreed with the school security guard, at least in this case. She did not want to go to the hospital. Just
getting her in the side door of the ambulance was like getting a cat into a
bath. All four limbs locked with hands and feet on the door. We’d break down
one limb, only to find another locked out. Eventually we got her onto the bed, put
the seatbelts in place, and restrained her wrists with Velcro restraints on the
pram.
One EMS secret I have learned in my time on the street is
that there is no patient more impossible to restrain than an enraged
13-year-old female. The only way to make it worse is to find an enraged, drunk, 13-year-old female. Twelve is
close enough. No f**ks are given, no joints are undoubled, no pain is felt, no
logic can reach them, and no restraint shall hold them. I have a theory – the
problem is that medics don’t want to hurt 13-year-old girls. If it were a drunk
22-year-old male, dude would be restrained. Thirteen year olds present a problem.
And they are angry, flexible, and surprisingly strong. Restraints pose no problem.
 |
| Maybe I could transport them safely in this 19th Century mess... Source |
Eventually, I had to administer some IM haloperidol.
What kind of jerk gives chemical restraint to a thirteen-year-old
girl? Me, that’s who. In hindsight, I spent too much time and energy
negotiating, begging, and cajoling the patient into holding still and
submitting herself to transport.
I could have maintained her to the hospital on the pram with
physical work and physical restraints. I know how to cowboy up and get someone to the hospital. But fighting and escaping in a moving
vehicle is dangerous. Dangerous and exhausting.
I need to lower my threshold for chemical sedation of
angry/violent/confused patients. I am a reasonable person. If your behavior is
such that it is pissing me off, your behavior is outlandish. You should be
sedated. In addition, it is dangerous to
fight and escape in a moving vehicle. Flight nurses and medics friggin' paralyze
people to avoid combativeness in their moving vehicle. And here I am, counting
on Velcro or kerlix restraints, negotiation, and physical holds.
It is dumb. It is too much work. It leads to people being
inadvertently hurt. It leads to people escaping. It leads to medics and EMTs being hurt. It leads to a loss of dignity for people who need our help.
So I am lowering my threshold for administering chemical
restraint.
I’m not saying that everyone needs Ketamine. Appropriate force
escalation and medication choices are still important. Physical restraints and
negotiation are fine in some cases. I find that Haldol works fine on
psychiatric- and alcohol-related combativeness. Versed works fine on
sympathomimetic combativeness. Ketamine is fine for excited delirium.
But I think I should use each of them more often.
 |
| As an aside, this is a psychiatric hospital with patients restrained with wet blankets. Wet. Blankets. Source |
*Future blog post rant about “just check her out” to
be published soon…
No comments:
Post a Comment