Dog In The Road

In my first EMT class, I learned about a code phrase: Dog In The Road. The idea is that the provider in the back of the ambulance can shout “Dog in the road!” when confronted with a very dangerous situation, such as when a violent patient escapes their restraints. What do you do when you're behind the wheel and a dog is in the road? Brake, I hope. Rather than the attendant quietly taking a whuppin’, the phrase causes the driver to immediately slam the brakes as hard as s/he can – both feet on the brake pedal and strain until the ambulance is stopped. The driver comes as close to simulating a wall impact with the brakes. Sixty-to-zero as fast as possible. The idea is that the provider in the back of the ambulance is prepared for the sudden stop, but the dangerous patient isn’t ready.

You know what I can’t remember ever saying in 20 years of EMSing? "Dog in the road!"

When I learned about the phrase, I figured it would be something that everyone knew about and that was used fairly often. Not daily, or anything, but at least once or twice per year. The first time I had the opportunity to use the Dog In The Road phrase, I didn’t remember to use it. The code phrase I used to ask for help: “Hey! Don’t undo those! Leave your seatbelt on! No! Sit down! Sit down! Sit down! Greg!” Greg pulled over and we put the patient back in the bed.

The most recent time I needed my partner to help me in the back with a dangerous patient began with a deep, exasperated sigh: “Dude, give me a hand back here, will ya?” It is similar to climbing commands - when the climber is falling, s/he is supposed to call "Falling!" to the belayer. What is usually called out is either a scream or profane cursing. I think I've heard "Falling!" called out as much as I've heard "Dog in the road!" shouted.

I have a problem with code phrases. Not everyone is on the same page and people under stress forget the phrase. If I asked to take my lunch break over the radio, what action do you think should occur? How about if I hit my panic button and then told dispatch: “We’re all good here. Everything is Code 5. No problems…”?

What I have learned over time is to avoid even approaching a situation where a dangerous patient can harm me. I try hard to not let things escalate to Dog In The Road levels. Patients are restrained, and are not allowed to touch the seatbelts. Seatbelts are inverted, by the way, making it harder for them to quickly click the belt off. Patients are not allowed to remove safety restraints in a moving ambulance, ever. A patient might get one command to leave the belt alone, followed by immediate wrist restraint. A patient might be able to slip out of wrist restraints, but they get immediately re-restrained (I don’t ask them to sit down and call for my partner nowadays). A patient struggling against physical restraints needs the addition of chemical restraints. As a matter of fact, chemical restraint is used early and often in my ambulance. Some Haldol or Versed is a lot safer and more dignified than being thrown forward during aggressive braking, or a wrestling match, or a full-on donnybrook.

Listen, if I am transporting Officer Jim Pembry and he sits up and removes his face skin
to reveal a cannibal serial killer, "Dog In The Road" is warranted.
But rather than calling out "Dog in the road," what would probably come out
would be a significant amount of urine and a high-pitched shriek of terror...

(Via YouTube; Silence of the Lambs, 1991)

It is safer for everyone to be properly restrained. Sudden braking to throw escaped patients around is usually a failure on the part of EMS.