Tag Archives: 5150

Scrum 1/2


1 – rugby – the method of beginning play in which the forwards of each team crouch side by side with locked arms; play starts when the ball is thrown in between them and the two sides compete for possession

2 – a confused crowd of people pressed close together and trying to get something or speak to someone

3 – a brief and disorderly struggle or fight

The limitation of riots, moral questions aside, is that they cannot win and their participants know it. Hence, rioting is not revolutionary but reactionary because it invites defeat. It involves an emotional catharsis, but it must be followed by a sense of futility.

Martin Luther King, Jr.

The high intensity LED strobes on the rig are lighting up the dark concrete canyons of empty streets in my urban workplace as I get closer to the call location. Sirens and the occasional air horn reverberate from the buildings as I creep through intersections and accelerate down the open streets. I pass City Hall and point out the tent city that was resurrected after a somewhat violent clash between the city police and members of the Occupy movement.

My EMT partner is helping to cover shifts in this county and is far from his normal surroundings of rural EMS calls. John is a part time EMT in one of the rural counties that surrounds my mostly urban county. He picked up this shift to get some overtime,  and being new in the EMS community, he wanted to come here to get some “action.” He’s about to get more than he bargained for as we get closer to the call location.

I round the corner just two blocks from my destination when I’m met with a SWAT skirmish line slowly backing towards my flashing rig. Thirty officers in full riot gear – extra padding in the uniform, full helmets with gas masks on, and plastic shields – are holding off a mob of four hundred angry people in dark clothing. The occasional bottle is lobbed from the crowd and breaks on the asphalt near their feet. The officer in charge whirls around to face me and a single motion from his baton-wielding arm is enough to convince me that I need to find another route to my destination. No arguments from me – this is the last place I want to be right now!

I pick up the mic as I point the rig up a one-way downtown street with headlights coming at me in all lanes. “Medic-40, we’re re-routing, we got blocked by protesters at Main street.” Driving the wrong way, up a one-way street, I’m giving an update to dispatch while pulling my ballistic vest from my bag and trying not to have an accident while I dodge oncoming traffic. I don’t remember this lesson being in my Emergency Vehicle Operation Course!

“You green-eyed mutha’ fucka’! I’m gon’ whoop yo ass like on Jerry Springer!” She’s screaming insults at me and balling up her fist as I escort her to the rig.

“Okay, you can whoop my ass later, let me check you out first.” Placating the psychotic patient has become something of an acquired skill in this county.

She called 911 saying that she needed an ambulance and then hung up. My dispatcher was unable to get her on repeated call backs so they sent us and a fire crew to see what’s going on. Seeing all of that in the call notes of the MDT I requested a PD back-up before we even got on scene. It’s just safer to have the guys with guns on scene when you don’t know what you’re getting into.

“Don’t you take me to no county hospital! I know my rights. You have to take me to EPS!” I’m taking a blood pressure as she yells at me. Just as I thought – way too hypertensive – she’ll need medical clearance before going to EPS (emergency psych services). She’s not going to like this because I’m now obligated to take her to the county hospital.

“Okay, here’s the thing. I need to put these restraints on you because you’re threatening me.” She struggles a little but lets me put the substantial leather wrist restraints on her – thereby greatly decreasing the chance that she can follow through with her threats to whoop my ass.

The city PD officers must be a little busy because they’re taking an eternity to get here. The fire crew simply escorted the screaming woman to the back of my rig and told me she wants to go to EPS. Before I even had her situated on the gurney the fire engine was driving away. Thanks a lot, guys!

“Why aren’t you taking your Seroquel?”

“I don’t like the way it make me feel! It make me all sleepy! Fuck you! Take me to EPS you green-eyed mutha’ fucka’!” Classic; the crazy person doesn’t like feeling normal so they stop taking their anti-psychotic medication. I’m about to make you feel VERY sleepy!

I’m drawing up a sedative in a syringe as the officers finally arrive and walk up to the back of my rig to face my not-so-pleasant patient. “I hear you want a green sheet, what’s going on?”

My patient seals the deal with her next outburst. “Fuck you! I’ll put you on a green sheet you bald-ass mutha’ fucka’. Let me up! I gon’ whoop his ass too!”

“Good enough for me. I’ll be back in a minute.” The officer walks back to his car to write up a 5150 form – a 72-hour hold for psychiatric evaluation – as his partner stands by in case we need any help.

As my patient is distracted by slinging insults at the officer I inject a sedative into her arm. With a green sheet in hand I have a pleasant drive to the county hospital and get a chance to do my paperwork while my patient snores like a chainsaw on the gurney.


Gangsta Rap 2/3

Kevin and I are dumb-founded. It was actually a good rap, despite the disturbing subject matter, and Lil’G seems to have some talent. I’d much rather listen to him rhyme than watch him tear the place apart.

“Lil’G man, you got some talent, you write that when you’re in prison?” I’m honestly curious.

“Nah man, I gots too much to do when I’m in the joint.” He’s dismissive with a wave of his hand.

“Too much to do? What, you working out all the time? Gotta build up those guns?” Referring to his biceps. Yet a tickling on the back of my neck reminds me that we didn’t exactly search him before he got in the ambulance with chest pain a few minutes ago. I hope Kevin did the “EMS pat down” as he put the monitor leads on him.

“Nah, I don’t work out in the joint. I’m too busy keepin’ an eye on all those niggas. Don’t never know when some fool’s gonna come up and try to stick me. Gotta be ready for a smack down, you know?”

After what seemed like an eternity PD shows up. Fortunately they pulled up to the front of the rig and I’m able to brief them before Lil’G notices they are here. The officers walk around the back of the rig so Lil’G can see them and it’s obvious by his expression that he’s not surprised. He knew this was happening all along. He’s been in this situation before and knows the drill just about as well as we do.

After a quick conversation and some paperwork the green sheet is finished and we can start to transport to the Emergency Psychological Services (EPS). Lil’G will get a psych evaluation and maybe stay a day or two for observation. It all depends on how he answers the questions.

It’s Kevin’s tech so I’m up front driving to EPS while Kevin finishes off the paper work. It turns out that no restraints or sedatives were necessary as Lil’G seems to want to go to the EPS. I can only imagine the life he’s led up to this point and how it may actually be comforting for him to rest in a relatively safe institution for a few days.

Growing up in the hood he presumably had few positive role models. He must have been in harm’s way often and exposed to some traumatic events. Just as a soldier comes back from a war with PTSD, I can imagine that life in the hood can create the same effect. Then at a formative age he’s placed in prison with its strict routine and lack of freedom accompanied by the ever-present danger of prison violence. Past traumatic experiences have created at least as many mental/emotional scars as physical ones.

Yet even with these obstacles this man has made it to his forth decade of life, which is rare for people in his situation. He seems to focus his energy on his rhymes, which he presents in all modalities of communication, with a harmony of visual/kinesthetic/auditory artistry. A man with limited education and vocabulary is able to access his inner emotions and express his feelings, dark and violent as they may be, to others and himself.

Pulling into EPS I hear the disturbing rhymes from the back of the rig.

I chop your head off… let it roll in a buck-et.

I punch your eyes out… so I can skull fuck-it.


But I aint trippin’ nigga… I won’t beg.

I drink the blood… from a bull dog’s left leg.


I told you once nigga… I ain’t even trippin’.

You get found nigga… by three old men fishin’.


We can do some shit… I might bust your brain.

But on the tip of my shoes… I’m leavin’ doo-stains.

Gangsta Rap 1/3


1  :  black slang; a gang member

2  :  a type of rap music featuring aggressive misogynistic lyrics, often with reference to gang violence and urban street life


1  :  to hit sharply and swiftly; strike

2  :  a criminal charge; a prison sentence

3  :  music; to talk using rhythm and rhyme, usually over a strong musical beat

4  :  to have a long informal conversation with friends

Violence is a part of America. I don’t want to single out rap music. Let’s be honest. America’s the most violent country in the history of the world, that’s just the way it is. We’re all affected by it. That’s one of the frailties of the human condition; people fear that which is not familiar.

Spike Lee

“Ya’ see, I didn’t really call you here because I was havin’ chest pain. It nothin’ like that at all. Ya see, I thinkin’ about killin’ myself.” As the fire engine accelerates away from us Kevin and I have a very different call on our hands than the one we thought it was going to be just a few seconds ago.

Getting called to the middle of the hood for chest pain is a common enough thing and we answer these calls on a daily basis. Today we happened to be just a few blocks away when the call information arrived on the Mobile Data Terminal (MDT). I turned the ambulance around and we were on scene in less than two minutes.

Sitting on a chair in front of an urban church outreach center was a man in his early forties. The pastor and church volunteers are comforting him as we walk up to see what’s going on. Holding his chest he tells us of the pain he’s feeling and how he wants to get checked out at the hospital. It’s an easy call and the assessment and treatment are so rote that we fall into auto pilot as we go through the motions.

Seeing the fire engine approaching from down the street I write the man’s name and birthday on my glove and hold my hand up high so the fire lieutenant can copy it down for his records without having to exit the engine. In seconds they are off to the next call and we are alone with the patient. Of course, that was before I knew the true nature of the call.

After our patient drops the bombshell on us, Kevin and I take a collective deep breath and one look between us confirms the sudden detour this call has taken. In our business suicidal ideation is taken very seriously. A person who is truly suicidal, who has ceased to care about their own life, may not care about other people’s lives. Therefore, we can be in danger when dealing with these people.

Our new patient, Lil’G, is quite a formidable man. He has scars on his face, one of which is consistent with a knife wound. He’s 240 pounds of compact, short, boxer’s build with huge upper body development. He’s seriously built like a smaller Mike Tyson. He jokes with Kevin because he had to pull out the fat person blood pressure cuff just to fit around his huge biceps. He does a muscle man flex and smiles showing me a gold tooth. I’m feeling very uneasy about this. I give Kevin a look that he understands. “I’ll be back in a second.”

“Hey, where you goin’?” He’s quick with predatory instincts, watching every movement – nothing escapes him.

“I just have to get the computer from the front.” It’s a half truth which I hope he doesn’t see through.

Walking up to the front of the rig I turn on the portable radio on my belt. Opening the front door I grab the computer and turn off the rig radio which can be heard from the patient area in the back. I stand in front of the engine compartment so I can keep an eye on Kevin through the windshield as I call in to dispatch on my portable.

“Medic-40 go ahead.” The radio crackles back to me.

“Medic-40, please send PD to our location, code-2, our chest pain call just turned into a 5150 with suicidal ideation. We’re code-4, for now.” The code-4 tells my dispatcher that we are not currently in danger. The ‘for now’ tells her that I don’t know how long that’s going to last.

I’m standing outside of the back doors as Kevin is doing further assessments on Lil’G. Kevin knows the drill: we have to stall as long as possible so PD can get here to write up the green sheet (5150). Without it we have fewer of the options we may well need in this case, like restraints and chemical sedation.

I’m watching Lil’G as Kevin continues with the 12-lead EKG. Lifting up his shirt I see the multiple GSW (gun shot wound) scars.

“Lil’G, how many times you been shot?” Anything to distract him and buy us some time.

“Yo, I been shot four times, stabbed two, and sliced up a couple. It’s hard man, growin’ up in the 70s.” He’s not referring to the decade – to him the 70s are the street numbers in his corner of the hood.

“You ever do time?” I’m thinking prison ripped could explain the boxer physique.

“Yeah, I did six year, fo’ bangin’. You know; sellin’ a little, had sum ho’s, and a little bit a shootn’.” He’s not talking about shooting up with heroin. “Yeah, I got a strike on me.” In this state it’s three strikes for felony convictions and you’re in prison for good.

Kevin’s still trying to stretch out the assessment as I’m typing on the computer. “You got any medical problems?”

“Yeah, I got PTSD, bipolar, paranoid schizophrenia, and depression, but I ain’t takin’ no meds for it.” FUCK ME!!! I’ve got a bipolar psych patient who’s off his meds, built like Tyson, and thinking about killing himself. I really need a raise.

Lil’G could shred both Kevin and I if he put his mind to it. Not to mention tear the ambulance apart. We’re walking a fine line here and we have to keep him on the good side of his bipolar disorder. I’ve watched manic bipolar patients cycle from happy to violent a dozen times in the course of a single transport. If this guy cycles on us we’re fucked.

Despite the lethal potential of Lil’G he’s actually pretty engaging. He has a fast wit and keen observation skills. He decides I look like the silver terminator from Judgment Day, in reference to my hair style and clean cut white boy appearance. Seeing as the terminator impersonated a cop through most of the movie I’m not sure I like the reference.

“Yo man, that’s your new name, I’m gonna call you T2.” He has a full bodied laugh with muscles rippling to the diaphragmatic contractions. Great, I have a street name.

And just like that Lil’G cycles on us. Yet not to a violent nature – quite the contrary. Right there in the back of the ambulance he starts rapping. With perfect tempo and surprisingly colorful depictions he tells us what’s on his mind in the only way he knows how.

I’m on the microphone… gotta do it quick.

But never give a care… I ain’t scared to hit a bitch.

Gotta hit her from the back… nigga back side.

I don’t give a fuck nigga… it’s time for a wild ride.


Call me Lil’G… when you see me.

I see niggas on the street… trying to be me.

I got these knuckles man… I make ‘em laugh man.

Never give a care… put ‘em in a bath man.


Gotta do it good… cuz you know what’s right.

I never give a care nigga… cuz I’m hell’a tight.

I come from 69ville… nigga eight-five.

Never give a care… boy I don’t duck and hide.


I’m born on the east side… I’m going east bound.

You a block head… whose name is Charlie Brown.

Suicidal Ideation 3/3

“Medic-40 copy code three.” The dispatcher’s abrupt call snaps me out of my otherwise boring day surfing the web on my iPad. It’s been quiet today – not too many calls have been getting sent out. Crews across the county have been sitting idle for the last few hours. Scottie is off today so I got assigned one of the float EMTs – we call that “mystery meat.” This is the first time I’ve worked with him and I got tired of listening to his diatribe six hours ago – so I’m happy to have a call.

“Medic-40 go.”

“Medic-40, code three for you. 1055 Vincent St. for the 22 year old male with a noose around his neck. You’ll need to stage for this please. PD is en route.”

“Medic-40, ten-eight” (we’re en route). Plugging the address into my iPad I see that we’re only ten blocks away from the call. We’ll be there in just a minute.

Almost immediately the radio crackles again. “Medic-22, we’d like to jump that call for 40.” Finally something interesting to relieve the boredom of the day and everyone else wants a piece of it. I’m not sure where 22 is but we’re close enough to make it in stellar time and I really want something to break the monotony of the day. Not today guys.

“Medic-40, we’re pretty much on top of it, we’ll take the call. Thanks Medic-22.”

As we pull out of the parking lot where we have been sitting for the last few hours a fire engine screams past us headed towards the call – we pull in behind them with our lights and siren singing a duet. I like going to calls with the fire engine clearing traffic for us. People tend to clear out of the way a lot faster for the BRT than they do for a little ambulance. It’s like having a big brother who’s a linebacker clearing the hallway between classes in high school – we just follow along in the wake.

Two police cars pass us as we turn into the residential neighborhood and the BRT follows them straight to the house. So much for staging and waiting for police to secure the scene. I’m usually happy to stage and wait for police to call us into the scene – it’s safer. But in this case there are only a few possible outcomes; the person is dead and has been for a while, he just hung himself and cutting him down now could save his life, or it’s complete BS.

As we get out of the rig the firefighters are headed into the house with their bags. We decide to just walk up and see what’s going on before pulling the gurney and equipment out. Walking to the front door a woman exits the house with her hands covering her face, crying. I step through the front door and into the living room to an officer coming down the stairs with a young man in handcuffs.

The officer comes over to us. “He wasn’t hanging; just lying on the bed with a noose around his neck. He said he wanted to hang himself but couldn’t find anything to tie the other end of the rope to. We’ll have a green sheet for you in a few.”

According to the American Foundation for Suicide Prevention:

  • Over 34,000 people in the United States die by suicide every year.
  • In 2007 (latest available data), there were 34,598 reported suicide deaths.
  • Suicide is the fourth leading cause of death for adults between the ages of 18 and 65 years in the United States (28,628 suicides).
  • Currently, suicide is the 11th leading cause of death in the United States.
  • A person dies by suicide about every 15 minutes in the United States.
  • Every day, approximately 90 Americans take their own life.
  • Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death.
  • There are four male suicides for every female suicide, but three times as many females as males attempt suicide.
  • There are an estimated 8-25 attempted suicides for every suicide death.

Suicidal Ideation 2/3

An officer meets us as we walk up to the apartment building. “She’s in that apartment. Watch your step as you go in, there’s blood all over the place. Looks like she bit her tongue. We’ll have a green sheet for you in a few.”

We were called here for a 5150 but it’s looking like there’s more going on than someone who voiced suicidal thoughts. Once an officer hears a person say they want to kill themself, they have to write up a Form 5150 – it’s on green paper so we just call it a green sheet. Basically the 5150 is a tool used by law enforcement to hold an unstable person for 72 hours during which time they are psychologically evaluated. More often than not they are not “suicidal” – they just said the wrong thing at the wrong time or PD has nothing else to hold them on so they get the person off the street using the 5150 because it’s less paperwork for them.

Walking into the apartment I see two more officers standing in front of a slim woman in her forties. She’s sitting on a chair in front of a closet with blood dripping down her chin –  enough to saturate her shirt. She has ligature marks around her neck which are consistent with the belt that is sitting next to her. Looking in the closet I see the closet rod is broken in the middle.

The officer lets me take it in before he gives me the update. “Hey guys, this is Sandy. She’s been going through some pretty rough times and she tried to kill herself today. She drank a bottle of wine and put a belt around her neck and tied it to the closet rod. She hung there for maybe ten seconds before the rod broke. When she hit the ground she bit her tongue pretty bad. The blood freaked her out so she called 911.”

As I kneel down to examine Sandy I see the bottle of wine on the side table – it’s a Mondavi Pino Noir; not the usual crappy two-buck-chuck that they sell in the local liquor stores. Sitting next to the bottle is a Riedel Vinum wine glass. Riedel is known for being shaped so that the wine lands on your palate just so, and you pay for the privilege – a single glass can cost $25 or more. Well, she gets points for taste even if she can’t calculate load bearing stability very well.

“Hi Sandy, I’m going to be taking you to the hospital to get you checked out. Can you open your mouth so I can see what’s going on?” Sandy nods her head and opens her mouth. Pulling out my flashlight I see that she’s nearly severed the end of her tongue – it’s being held on by less than a half inch, yet the bleeding has slowed to a small trickle. I pull out a sterile piece of gauze and tell Sandy to pinch her tongue with her fingers as we walk out to the ambulance.

Once in the rig I can assess Sandy a little better. She checks out fine aside from the tongue and a minor abrasion to the chin. My only real concern is if the attempted hanging caused any damage to the throat that could cause airway obstruction issues or if her tongue were to swell to the point that it blocked her airway. Admittedly these are big concerns, yet I don’t find anything that would make me light up the rig and drive fast.

Sandy’s not much for conversation – partially because she’s holding her tongue (literally) and the reality that if not for the closet rod breaking she would be dead right now. We start driving towards the trauma center – I don’t plan to trauma activate her but I want her in the trauma center where they are prepared – in case the swelling causes any issues over the next hour or so.

I dim the lights in the back and tap away on my laptop as we take a quiet drive to the ED. I’ve watched partners in the past who will talk to people on a 5150 to try and figure out where they went wrong and offer advice. I have mixed feelings about that as it’s not necessarily our function in the medical community. Although I’ve probably taken more psych classes than my peers I feel it’s my job to treat the physical condition and understand the mechanism that led to the injury – so as to give as much information to the nurses and doctors that will continue to care for the patient. I feel it’s inappropriate to play Paramedic Psychoanalyst.

I’ve transported more people on 5150s for voicing suicidal ideation than I can even count – one man was even placed on a hold for texting it. But this is a different presentation. Sandy wanted to end her life so desperately that she put together a plan and acted on it. The carpenter that installed the closet will never know that had he put a third closet rod support in the middle, as he should have, a woman would be dead right now.

Suicidal Ideation 1/3


1  :  intending or wishing to commit suicide

2  :  likely to lead to death, destruction, ruin, or very much against somebody’s best interest.



1  : The faculty or capacity of the mind for forming ideas; the exercise of this capacity; the act of the mind by which objects of sense are apprehended and retained as objects of thought.

Sick of trying – what’s the point

Sick of talking – no one listens

Sick of listening – it’s all lies

Sick of thinking – just end up confused

Sick of moving – never get nowhere

Sick of myself – don’t wanna live

Sick and tired – and no one cares

Sick of life – it sucks

Suicide is an alternative


Suicidal Tendencies – “Suicide is an Alternative

(80’s punk rock/crossover band)

We’ve been standing in front of the house for maybe ten minutes and police cars keep arriving: plainclothes detectives, gang unit, even the brass – I’ve never seen this level of response to an active case. All of the officers on scene are quite emotional and that’s not normal for this group – they rarely get broken up on scene and they see some of the worst things humanity can dish out. Something is definitely wrong but no one is talking to us.

It’s nearing dusk and the fog has started to build in the city next to the water. All members of the light bar fraternity (Police, Fire, EMS) are represented here with their strobe lights cutting rays into the fog as the city gets colder from the encroaching marine layer.

Every type of call in EMS has a vibe and all of the responders seem to pick up on the collective unconscious signals. Some are humorous to the responders – like when a gang banger shoots himself in the groin while stuffing his Glock-19 into his pants. Some are all business – like when a child is having a severe asthma exacerbation. Some are just sad – like when an elderly person dies in their sleep. Yet this is a vibe I’ve never felt before – I just can’t quite put my finger on what’s going on and the officers aren’t talking to us or letting us into the house. They just talk quietly on radios and phones as more police cruisers keep arriving.

Another five minutes and an officer comes out of the house – I can’t even count how many stripes he has on his sleeve but it’s obvious this is his crime scene. He’s emotional but he’s stuffed it down into the closed recesses of his mind so that his professional side can run the show. He’s all business as he fills us in.

“Thanks for standing by so long. We had to do a thorough search of the residence before letting anyone inside. We’ve got a fifty-two year old male in the garage; apparent suicide, GSW to the head. It’s obvious he’s dead but I need you to pronounce so we can get on with the investigation. When you go inside don’t touch anything – just get in, pronounce, and get out. It looks like he fell on the gun and we can’t get to it so don’t move the body at all; he may still have a finger on the trigger. And guys, one more thing – he’s one of us.”

My heart just dropped into my stomach and I’m having a hard time breathing. Now the collective vibe of the scene is hitting me full force – an officer just committed suicide.

I follow the officer with all the stripes on his sleeve through the back door of the garage, carrying just the ECG monitor and my stethoscope. The officer stands aside so I can do my assessment.

Crumpled face forward in the middle of the garage is a body in dark clothing. There’s a small pool of blood near his head and blood splatter on the ceiling of the garage. I’m being careful not to step on anything as I kneel behind him and see a forty caliber shell casing on the floor to the right. I smell the metallic scent of fresh blood from the pool that is slowly coagulating as I put my fingers to his neck to feel a warm body without a pulse. A single slice with my trauma sheers up the back of his thin shirt exposes his back to me. As I’m listening on the back for any breath or heart tones I see the exit wound the bullet made as it went through the back of his head. Without moving the body I place my electrodes on his back in the same configuration I usually use on a person’s chest. I don’t want to roll him over since I don’t know where that gun is pointing right now. The monitor shows the flat line of asystole that I expected to see. I print out six seconds of flat line and rip the strip off the monitor and put it in my pocket. I disconnect the monitor and retrace my steps out of the garage without disturbing anything.

The officer with the stripes was watching me the whole time from the doorway. I tell him what he already knows. “Yeah, he’s gone.” Looking down at my watch, “We’ll call it confirmed at 1855.” He nods his head and writes a note in his little book.

I walk back to the rig to start my paperwork. Sitting in the passenger seat with the laptop open on my knees, I’m typing as my partner comes back from talking with the fire crew that’s packing up to head back to the station.

He gets in the driver’s side. “So, I was just talking to fire and I got the story. He was a detective on the force for fifteen years but he’s been on administrative leave for the last couple of months. He’s got some alcoholism issues and his unit commander was on his way here today to drive him to get checked in for detox. The commander is the one with all the stripes. He got here an hour late because of a case and found the guy in the garage…”


Simple Restraint





1 : of humble origin or modest position <a simple farmer>

2 : lacking in knowledge or expertise

3 : mentally retarded, not socially or culturally sophisticated


1 : a restraining force or influence

2 : something that is fastened to limit somebody’s freedom of movement

3 : restraint is calm, unemotional, behavior that does not provoke

As we round the corner there are three police cruisers pulled over with officers standing around. There’s a man cuffed in the back of one car with an officer doing some paperwork using the trunk as a desk.

It’s evening in the big city of my mostly urban county. The city police are on full deployment; everyone in the department is doing 12 on 12 off shifts. With PD layoffs on the horizon due to a city budget deficit and impending civil unrest due to a trial of a former police officer, the tension in the city is palpable. The police are backing each other up on every call with a show of numbers on the street.

They called EMS for an individual on a 5150. This refers to article 5150 of the state health and welfare code that states an officer may detain someone for 72 hours for psychiatric evaluation if they are deemed to be a danger to self or others. 5150s are theoretically used when a person threatens suicide or has some sort of behavioral crisis of a psychiatric nature. In practice, it tends to be used when PD can’t find grounds to arrest someone but wants them off the street.

Walking up to the police car I see a man in his twenties cuffed in the back seat. One of the officers sees me and gives a quick report. He says that this man’s mother and aunt called because he was emotionally disturbed about the situation in the city. He kept going on about wanting to kill some cops and shoot up the nearby police sub-station and he’s off his psych meds. Given what’s going on right now I can see the logic in getting this guy off the street for a while before he does something really stupid and gets himself killed in the process.

I open the door to the cruiser to get a read on the guy. The smell of alcohol flows out as the door opens. Great! Drunk cop killer in the making and off his meds. He’s taller than me and has great muscle tone – maybe prison ripped (prisoners have nothing better to do than work out, so when they’re released they’re amazingly well-built). He also has good veins. Not a junky; could be a fighter.

“Hey Lawrence, how ya feeling today?” This 20 second introduction is my chance to get an idea of how I’m going to be treating him over the next half hour. Do we have a nice conversation on the way to the hospital, do I have 5 cops hold him down while I sedate him for my safety, or something in-between?

“Yo! Why they do me like dis? I ain’t done nutt’n man…”

“Hold up, hold up, I gotta axe you sum questins man.” I match his street vernacular. I’ve got to cut him off quickly before he spirals out on me. Some may see that as insulting but it honestly speeds communication and builds rapport in the hood as long as you can do it well and with sincerity. All of the medics in county can speak street. My wife thinks it’s a riot and tries to get me to do it for friends. Something about an Irish/Scottish guy speaking street is a bizarre juxtaposition.

“Yo! Lawrence how much you drink today?”

“Man, I dun know, jus a couple, shit man why they do dis to me, man I din do nutt’n…”

I cut him off again, louder: “Lawrence! Chill man, chill. Couple a what? When you get your drink on man, what you drink?”

“Pints, jus a couple pints man. Vodka man das what I always drink.” Well, at least we’re communicating now and not yelling at cops. I’ve seen what I need to see. “Aw-rite, Lawrence, yo sit tight man, I’ll be back min’it.” Like he’s going to sit any other way in cuffs.

I close the door and tell my partner that we’ll need restraints for the gurney and tell the officer that we’ll be going to the hospital for medical evaluation prior to getting him transferred to the county emergency psych services. They’ll need to draw some blood to get a blood alcohol level and tox-screen on him. His speech is a little slurred, he ramps up pretty quick, and he had twitchy eye movements. Maybe he’s just a scared guy in a bad situation or maybe he’s a bipolar/schizophrenic who will cycle faster than I can keep up. Either way I want him strapped to the gurney for my protection.

My partner comes back with a big round-eyed look. Oh shit! “Dude, someone snagged our restraints, I checked the rig, we don’t have any stashed.” CRAP! We have the same rig every day, we used the leather restraints yesterday. Unfortunately it happens often that another crew will take equipment from a rig while it’s parked at deployment. Then it becomes a domino effect and you have to see what was removed every morning. It’s my fault – the restraints are in a fairly hidden place so I didn’t think to check to make sure they were still there this morning.

There’s no way I’m transporting this guy without restraints. Fine, we go old school. I go back to the rig and pull two triangle bandages, which are usually used to make a sling for a broken arm. Today they get used for restraints. My preceptor back in the rural county where I interned showed me how to use triangle bandages to make back-up restraints by tying interlacing lark’s head knots. This technique doesn’t cut off circulation but if the patient struggles it cinches down – the more they pull, the tighter it gets. In that county we had a state penitentiary and sometimes had to transfer prisoners more than 30 minutes to the nearest hospital. Being in such close quarters with a guy that’s doing 25 to life for murder, redundancy of restraints becomes a priority.

I have the officers help us to put Lawrence on the gurney, take off the cuffs, and tie his wrists to the rails using my modified restraints. All the while Lawrence is complaining about the injustice how his rights are being violated.

Now that he’s out of the police cruiser I see just how big he is. If I have to overpower this guy it’s going to be hard to do without hurting him. I don’t want to use drugs to knock him out; he’s been drinking and  may have other drugs on board which could interact with my sedative. It’s embarrassing to bring a patient into the ED while bagging them because you knocked out their respiratory drive. I better play this soft, I don’t want him ramping up on me.

I get him loaded into the rig and jump in on the bench seat next to the gurney and tell my partner to just drive. I want this over fast. I take a set of vitals. He’s within normal limits on everything. Well, at least that’s good; no crack or meth.

As I’m talking to him I start to realize his slurred speech isn’t the normal alcoholic slur and his mental associations aren’t the angry disenfranchised minority gang banger rhetoric. He’s actually inquisitive and asks questions about things with genuine simplistic curiosity.

“You got kids man?” Laying on the gurney with wrists tied down. I have the strangest conversations in EMS.

“Nah, no kids man, I got dogs. Dogs are betta.”

“What kine a dogs you got? You got any pit bous man? I love them pit bous!”

“Nah, I got a hound dog and two small dogs. My wife wans a pit bou though.”

“They took away my pit bous man, I love thos dogs man, how can they jus take a man’s dogs away, I love thos dogs.” He’s getting upset, starting to cycle, I’ve got to steer this in a good direction quick.

“I hear ya. Pit bous are good dogs man. I see ‘em all the time at the shelter. I volunteer to wash them at the shelter, give em a bath, man they so happy when they clean. That way they smell good and get adopted faster.”

“Nah man, you lie’n to me. You no volunteer and shit.”

“Hell yes I volunteer, couple times a month. I just go down an wash dogs all day. You wanna see some dogs you go down an’ do it too. You get to play with dogs an make ‘em happy and clean so they get adopted sooner.”

“Nah man, I jus wanna take ‘em home wit me.”

“Nah man, check it – you take one dog home and you jus gave a home to one dog. You get 100 dogs clean and happy so they get adopted, you jus gave a home to 100 dogs. How you think you gonna feel then?” He thinks about it for a while, a little too long of a while, and then his whole face lights up. He tells me how happy that would make him feel to help 100 dogs.

Laying in front of me is not a violent gang banger who wants to kill cops. He’s a seven year old in twenty-something body. The slightly slurred speech, the simple questions, the delayed comprehension – he’s developmentally challenged.

I pull the trauma shears off the wall and make a show of cutting his modified restraints off. He seems like he’s calm now – no cops around making him jumpy – and we both like “pit bous.” Besides, I don’t want the other crews at the ED seeing my restraint method and giving me shit for not checking out my rig this morning.

As soon as I cut the hands free his arms come up towards me. Damn those are big arms. Fuck, no not that, anything but that! He gives me a hug.

We finish the ride to the hospital with more talk of dogs while I finish off some patient information on the laptop. While pushing the gurney into the ED he’s hanging on my shoulder, worried that I’m going to leave him.

“Nah unkol, you cain’t leave me man! Why you gotta go unkol? Thas what they all do. Who’s gonna take care of me man?”

I can only imagine the life he’s led. Growing up in the hood with a disability must be horrible. No men in his life, raised by Moms and Auntie, with three generations of women living in the same house. He’s an easy target for the predatory behavior of his peers. He quickly tries to mimic them in dress, attitude, language, and drug and alcohol use to attempt to fit in or at least stay out of the cross hairs of the more malicious predators. He’s an innocent mirror; reflecting the attitudes of the people around him. They’re angry at the cops so he’s angry at the cops.

“Nah, Lawrence, check it man. These people can take better care of you than I can. They hep you man, I promise. It’s like the pit bous man. If I take you home I only help one person. If I stay on the street an meet 100 people like you, I help 100 people. You get me man?”

He gets it – he’s not happy about it, but he gets it. I give the report to Katie, his nurse. I’m glad she’s here today, she’s the perfect personality to at least make sure he’s looked after while in the hospital. They call a security guard and he takes up a post outside of a room. Lawrence will have to be within sight of him until he’s transferred out. I get Lawrence moved over to the bed. He’s sad and doesn’t want to talk to me any more. He closes his eyes and pouts. I look at the 5150 form written by the officer and take another look at Lawrence to burn the image into memory making the visual association of name to face.

I’ll see him again, if not on the streets then in the news. Someone will convince him to do something stupid and he’ll do it just to please a male father figure. He’s a big intimidating guy at first glance and but he’s simple-minded. The police will be inclined to tase him or shoot him than fight with him or talk to him.

I walk out of the room and the rest of the nursing staff gives me shit for adopting a gang banger. I’m glad this is the last call of the day. My uniform smells like Lawrence, I’m tired, and I’m running low on triangle bandages.