Tag Archives: Drugs

Simple Restraint

 

 

 

sim·ple

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

2 : lacking in knowledge or expertise

3 : mentally retarded, not socially or culturally sophisticated

re·straint

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.

Blunt Force Trauma

blunt

1: having an edge or point that is not sharp

3: slow in perception or understanding; obtuse

2: Slang: a cigar stuffed with marijuana.

 

force

1: cause of motion or change

2: an agency or influence that if applied to a free body results chiefly in an acceleration of the body and sometimes in elastic deformation

 

trauma

1: an injury (as a wound) to living tissue caused by an extrinsic agent

2: an agent, force, or mechanism that causes trauma

“Okay Ronald, you need to calm down and listen to me for a minute. Things are going to start happening very fast and I need you to focus. I know you can feel your heart beating way too fast and it hurts.” My cardiac monitor, sitting on the captain’s chair over Ronald’s shoulder, spits out a second 12-lead strip. Same interpretation as the first one: ***ACUTE MI SUSPECTED***
“I need you to chew up these aspirin while I explain what’s going on here. Whatever was in that blunt you smoked, maybe crack or meth, is making your heart beat too fast.”

He’s scared, staring at me with big, round, bloodshot eyes with that “doom” look that I’ve seen often with cardiac etiology. His heart is racing at 166 beats per minute, irregular, and his blood pressure is through the roof at 210 over 120. He smoked 20 minutes ago with some people he didn’t know and the weed came from an unknown source, so he has no idea what it was laced with.

When he told them he needed an ambulance they told him to “get the fuck out!” He called 911 from his cell phone a few blocks away.

Given the fact that he’s only 32 with no cardiac history it’s likely that his heart just can’t handle the fast rate and it’s causing some localized ischemia. Regardless of the etiology – whether it’s just the drugs or the unlikely occlusion of the coronary artery – I’ll activate him to the cardiac receiving center. They’ll have a cardiologist standing by when I get there to decide if he gets a trip to the cath lab or just monitoring until he calms down.

The siren starts to wail as we pull out of the parking lot where he sat waiting for us. I figure I’ve got maybe six minutes until we get there, just enough time to do what I can for him.

I hit transmit on the cardiac monitor and dial in the cardiac hospital. Bouncing down the road I place his hand on my knee and lift my heel up off the floor, making my leg an extra shock absorber so I can match the bouncing of the rig. As the needle finds a vein and gets a good blood flash I hear the monitor doing a modem handshake with the hospital to transmit my 12 lead.

Nitroglycerin and morphine are contra-indicated for his heart rate. It took a while to get used to that footnote in the protocols when I switched to working in this county because in my previous county it was part of our protocol. But so be it, I’ll play by the rules.

Fortunately we have decent sedation protocols for extreme anxiety, and I have just enough time to get two rounds of Versed on board before I get to the ED. Admittedly, I feel a bit strange treating a possible MI with a sedative but that’s what he needs right now. Ronald is really worked up, half from the unknown drug and half from the reality of the situation.

Versed is a decent drug – it’s used for procedural sedation in the hospital, like doing a reduction on a dislocated shoulder – give enough of it and you can put someone completely out, give just a little and it reduces anxiety. If you can titrate just right and walk the line between the two you can put someone in a very relaxed state yet they can still interact. It also has amnesia properties so people may not remember the pain they experience. That’s what I’m shooting for with Ronald but he’s a heavy guy so I don’t think I have enough time to get him there.

Backing into the ED another crew who heard us coming in code-3 opens the back doors and helps me unload the gurney. Walking into the critical care room the cardiologist comes in holding my transmitted 12 lead. I hand him the two follow up prints while I give a quick run down of the treatment I did and how Ronald responded.

They do a full cardiac work-up on him, and run their own 12 lead which comes out with the same interpretation. I always feel a little better when their machine and mine say the same thing.

They draw blood and send it to the lab to look for elevated troponin levels, the byproduct of distressed cardiac tissue. They’ll also run a tox screen to see what was in the blunt. Walking out, after giving a report to the staff I hear the cardiologist make an order for Ativan, another sedative. The ED has better drugs than I do but at least I got Ronald to the right place and started him in the right direction.

Off to the next call – my pager is buzzing on my belt and my dispatcher is chasing me out of the hospital for the calls that are stacking up.