Not all want to be helped

The house wreaked of urine, faeces and body odour. We wound our way in stepping over dog poo and holes in the floor, past a door barricaded to knee height, behind which two naked toddlers peered out curiously. This house was filthy. I’ve seen some pretty bad places as a paramedic but this one was one of the worst.

Lying face down on the bed, drool flowing from his mouth, was our patient. 23, seizing. His mother panicking “he’s never been this bad before, his blood sugars are 1.9”.

We got to work pretty quick; put a line in, started squeezing in a bag of 10% dextrose, put O2 and the monitor on, took a reading with our device which came back at 0.8 (should normally be around 7, anything less than 3.5 is bad).

The patient started to come around. He was a bit agitated which is to be expected. When starved of sugar or oxygen brain jumps back to primal mode.

But then he stayed agitated. “F*** off!” He yelled. At first it didn’t bother us. But then we noticed unlike normal patients the abuse wasn’t generalised, it was specifically aimed at us.

“I’m gonna punch you in the f*#$ing face!” He raised his fist.

My partner responded.

Abuse towards healthcare workers is fairly common. Each person manages it in a different way.

Most good practitioners have the common theme of not giving control to the patient. If you do this, that patient instead of following your advice as a professional, is now much more likely to ignore you, make additional demands and try to make you do what they want.

It will complicate your interactions immensely.

We can give our patients choices. We should do our best to help them feel calm and cared for. But in prehospital care especially we need to be the one in charge. 80 year old lovely little Mrs Jones who is polite and predictable gets lots of options. The drunken 20something gets very few.

See there’s a reason nurses, paramedics, doctors, physios have a reputation for being bossy. We have to be.

For our safety, for our colleagues and for our patients.

Or our patients won’t follow their treatment regime. They will stop for one more smoke… and then they have to grab a bag… and before you know it you can’t make them get in the ambulance any more.  They will take a swing at you. They can bully other patients. They can intimidate healthworkers at will. It may be subtle, but some patients will push the boundaries as far as they can.

Paramedics like my partner that day simply out do the aggression: “You hit me, I’ll F*#@ing hit you right back and then you’ll spend 6 months in prison for assault” The patient was still a git, but he didn’t threaten any more.

A few use a diversion technique.

Other practitioners blow it off and completely ignore it.

Better still, I watched one mental health nurse reply to a knife threat with a cold even voice state: “never threaten healthcare staff Steven….. it will not end well for you”

If you don’t have a plan for what to do when someone threatens you, you need to make one. Trial and error will help you find the one that works for you. But before you even meet the patient, you need to be the one in control, for everyone’s safety. Unstable patients don’t make good decisions.

How do you manage patients?

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