This is the first of a series of opinion articles on dealing with violent patients and situations.
These blog posts are the sole opinion of the author and do not represent the opinion of Canadian Paramedicine or its affiliates.
Paramedics are assaulted by patients, their family members and even other first responders. They also often have to deal with frustrated motorists who refuse to obey traffic laws or cooperate with emergency personnel on the scene of an accident. This article will deal with some of the issues we encounter, safety-wise, as “street paramedics”.
Entering the unknown
As paramedics, we are often sent to situations with very little information. We are taught to dissect what little data is given to us and create a whole myriad of scenarios in our heads before we arrive at the location. How many times have you been called to a stab victim and no information about the aggressor is given? Are they still at large or has the police arrested them?
Paramedics can be put in a very dangerous situation where they are not prepared for what may be on the other side of that door. Paramedic shifts have turned from routine transport to life-threatening situations before our eyes. We are victims of violence or aggression on a regular basis, rarely knowing what is waiting for us when we arrive.
Let me take you back to 2009 in Mexico City. We were called to a home in a very dangerous neighbourhood for a pregnant patient with abdominal pain. As soon as we arrived we noticed that there was no police unit outside the house but there was a man standing there who flagged us down. It was around 3 in the morning and the man had a cigarette on one hand and a beer on the other.
With only that information, we are expected to make a decision on whether we should go inside or call and wait for a police unit (in that area they could take up to an hour to arrive). This is something that we all have had to experience and something that, unfortunately, we will continue to deal with on a routine basis.
This isn’t something that is isolated to big cities or dodgy neighbourhoods… The truth is that we as paramedics are usually involved in moments when our patients’ cognitive response is impaired by their current situation. This is to say when under stress, people lash out (1,2).
Dealing with violent patients as a paramedic
There are many suggestions on how to deal with violent patients. My academy instructors would say that the first is “Don’t!” However, this advice can rarely be applied to the everyday situations that we deal with in EMS.
Before we continue, remember that this is my own opinion and though I may cite references that support it, please always stick to your provincial/regional protocols for safety and patient treatment.
Patients that are not under the influence of drugs or alcohol and have no prior psychological disorders will usually respond well to empathy. Being friendly and listening to them will help in establishing trust between the patient and yourself. Explaining to them what is happening and what you and your team are doing will help establish authority and trust with the patient. You don’t need much time for you or your team to do this; it all starts the moment you walk into the scene and introduce yourself to the patient (3). Also, remember what we were saying that we need to imagine a million scenarios for each call? Do the same with what you find on the scene. Are there guitars lying around? Then maybe throw in a musical quote or two. Is the patient a history professor? A few random pieces of historical information may help you calm them down.
I will not get into my opinion on how to deal with patients under drugs and alcohol or with psychological disorders as these have very strict protocols in each country and/or region. Just remember that it’s very important to keep up to date with psychological disorders and new drugs and their effects.
Conclusion (for now)
Violence against paramedics is an epidemic that needs to be addressed. It’s important for hospitals and EMS providers alike, to train their staff on how to handle violence or aggression from patients. Paramedics should always use empathy when dealing with a violent patient-listening, explaining care procedures, and establishing trust will help them in these situations. You can also take preventive measures by educating yourself about the drugs your patients may have taken before arriving at the hospital or emergency medical services scene. This way you’ll know what sort of anger management techniques are needed if they behave violently because of drug usage (1). If all else fails, remember that it’s usually best not to engage with a violent person unless there are extenuating circumstances.
1. Fuller K. When Anxiety Turns to Anger: Relationship of Anxiety and Anger [Internet]. Discovery Mood & Anxiety Program. [cited 29 July 2021]. Available from: https://discoverymood.com/blog/anxiety-and-anger/
2. Wofford J. Cognitive–Affective Stress Response: Effects of Individual Stress Propensity on Physiological and Psychological Indicators of Strain. Psychological Reports. 2001;88(3):768-784.
3. Pease A, Pease B. The definitive book of body language.