Tag Archives: Restraints

Scrum 1/2

scrum

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.

 


Traffic 1/2

traf·fic

1 : the passage of people or vehicles along routes of transportation; traffic congestion

2 : dealings, business, or intercourse

3 : social or verbal exchange; communication

4 : buying and selling; barter; trade, sometimes of a wrong or illegal kind

5 : to carry on trade or business, especially of an illicit kind; human trafficking

The lock on the heavy jail cell door releases and the door slides open with mechanical precision, making a loud clunk which reverberates off of the austere concrete walls of the sally port (a double-door safety system that they have in prisons. From the outside, you go through one door, and when it closes and locks, the second door opens to let you into the interior). Standing in front of me is the fire captain who’s taking information from the jail’s processing officer – he looks up long enough to point us down a hall. We continue walking down the hallway of holding cells and I see freshly processed prisoners, still wearing their street clothes, sitting on benches in their cells watching the procession of uniforms glide past their limited view through the bars. In the open cell at the end of the hall I finally see my patient – a man in handcuffs, leg shackles, and an orange jump-suit – sitting on the bench with firefighters taking vitals and four very large officers keeping an eye on things.

Finally, I see a friendly face – the fire medic stands up to give me a quick report. “Hey KC, so it’s your basic incarceritis. Forty-eight year old male, chest pain by three hours, vitals normal, no primary symptoms. That’s about all we have unless you speak Mandarin.”

“Sweet! No problem.” I step around the medic and address the prisoner. “Ni hao ma?” In perfect intonation I ask him how he’s doing in a typical Mandarin greeting. Fortunately I grew up in the Chinese community of my home city and know enough Chinese to order dinner, get my face slapped, and yell like a drill sergeant at a class full of kung-fu students. Unfortunately, it’s all in Cantonese and I just exhausted my Mandarin repertoire.

The prisoner stands up with a hopeful look on his face and fires off an excited string of Mandarin. “好. 这些人不相信我. 我有胸部疼痛.”

In unison the firefighters and officers look at me to see if I can tell them what’s going on. “Sorry man, that’s all I got, let’s go to the hospital.” I motion to the gurney as he does the shackled penguin waddle out of the holding cell. Kevin and I put on the leather hand restraints as the officer takes off the handcuffs. I’ll need access to his arms to treat him, yet he’s still in custody.

As we’re walking past the rows of holding cells I’m asking one of the officers what’s going on. “Yeah, we used the translation service on the phone, he said he has chest pain and knows that no one will believe him so we called you guys.”

“What’s he in for?” I always ask as I want to get an idea of how dangerous someone is – it doesn’t affect my treatment but it’s nice to get a heads up if I’m going to be sitting in close proximity to a violent criminal.

“We picked him up yesterday on a sting-op. Busted about a dozen brothels in a couple different counties. These guys were trafficking young girls from Asia on container ships and forcing them into prostitution. This guy was pimping out girls as young as thirteen! I tell ya’, right now, I hope he is having a heart attack – he deserves it!” Damn!

 



 

Reckless Abandon

rude

1 : Relatively undeveloped; primitive: a rude and savage land

2 : Exhibiting a marked lack of skill or precision in work: rude crafts

3 : Lacking education or knowledge; unlearned

rec•less

1 : marked by lack of proper caution : careless of consequences

2 : utterly unconcerned about the consequences of some action

 

 a•ban•don

1 : to withdraw one’s support or help from, especially in spite of duty or responsibility; desert

2 : to give up to the control or influence of another person or agent

3 : to walk away from

Standing over the patient, who’s sprawled across the stoop of this shabby two story house in the impoverished urban sprawl neighborhood of the county, I kneel down to slide back his eyelids and expose pinpoint pupils. Pulling the stethoscope from around my neck and placing it in my ears (more to drown out the yelling of the family members on scene than to hear better) I place the bell on the side of my patients throat. The stethoscope can assist in hearing respirations when they’re shallow and far between. Tilting my head as I’m waiting an eternity for the next respiration I can see the fire engine that responded to this house light up down the block, siren doing the long slow whine, as it accelerates away from me towards a fire. My new patient has a respiratory rate of four per minute. I’m not happy.

I’ve been working in this new county for months now after getting signed off by my FTO to work as a Paramedic with an EMT partner. We were called to this house for one of the most ambiguous calls in EMS: “man down, unknown.” As we pulled up to the house with the BRT in front I see three firefighters carrying their gear back to the rig with a degree of haste. One of the firefighters looks at me as he’s storing the cardiac monitor into a sliding compartment of the rig. I see him through the windshield as our tires stop moving. He gives me the flat, thin lipped, look of angst. I’m still fairly new in this large county so I don’t know all of the firefighters yet — that will take years, much less do I know their personalities. Before I can contemplate the expression more he turns and climbs the fold out stairs into the rear passenger compartment of the engine.

Walking up to the house the fire lieutenant is walking out of the yard. He rips off the EMS copy of the fire sheet which should list the patient demographics, vitals, medical history, current medications, allergies, and treatment rendered. This fire sheet has two things filled out: a name and a birthday. As the lieutenant is passing me, headed towards the front seat of the BRT, I’m asking what’s going on with the patient. Looking over his shoulder, never missing a stride, “I don’t know, maybe an OD. We have a fire in our district, are you guys good?” I may be new but I can recognize a dismissal when I hear one. It’s obvious they are leaving regardless of my complaints. I’m just going to have to deal with what’s in front of me. No, I’m not good, I’m really god damn far from good!

Pinpoint pupils, decreased respirations, any new paramedic student knows the signs of a heroin overdose and how to fix it. That’s not the problem right now, the problem is he’s 220 pounds of weight that’s fixing to be dead weight if I don’t do something soon. The family is yelling at me. “Where the fuck did they go? Why ain’t you helping my boy?” The patient’s mother is understandably upset and getting all up in my face about it.

“I promise you I’m not going anywhere and I’m going to help him. But you’ve got to work with me so I can do that. Does he use drugs?” I’m still pretty new in county, I must sound like Mr. Rogers to her with my proper English and pronunciation. Can you say “white bread?”

“Hell no he don’t use drugs! He been clean for three year.” Okay, whatever! Regardless of her answer I know what needs to happen here.

“Okay, well, he’s looking pretty sick right now. Can I get you three to help us move him on the gurney?” It’s a beautiful day in the neighborhood, a beautiful day in the hood…

With the help of three family members and my partner we move him to the gurney. I get him strapped down and moved into the rig where it’s a better working environment, and safer. I tell my partner to leave the lights on and get us out of here, but not too far, and don’t tell dispatch we’re transporting. Kevin is an experienced EMT in the hood and knows what that means: put a little distance between us and a potentially dangerous situation, then pull over so I can do my on-scene treatment. He gets us maybe ten blocks away with a couple of turns and pulls over to the curb, jumps out and comes back to help me work this guy up in relative safety.

While Kevin was relocating our rig I was completing the first steps of an assessment that the fire medic should have done. Decreased respirations at four per minute, fast heart rate (trying to compensate for the lack of oxygen), blood pressure still okay (he’s in compensation mode for the moment). I administer 1 milligram of Narcan by way of a nasal atomizer. Narcan binds to the opiate receptors of the cells at 100 times the efficiency of opiates. Basically, it blocks the opiate from being able to effect the cells and completely reverses the effect in a matter of seconds.

The nasal atomizer is just a first step to bring his respirations up and buy me some time, I don’t expect that such a low dose will fix the situation, especially with the lower absorption rate from the nares. Kevin jumps in the back and helps me in getting an IV established.

“Damn, this dude is built, and freak’n heavy — he must spend a lot of time in the gym!. Check out this bicep, I’ll have no problem getting an IV with these veins.” A beautiful day in the hood…Kevin gives me a smirk.

“Do you want me to restrain him, he might come out of it combative?” Hank, my FTO, told me to listen to the experienced EMTs in the county. They may not have as much medical training as I do but they know the streets and the people who live there.

Using the leather restraints Kevin secures his hands while I finish setting up the Narcan for intravenous administration. Now that I have my monitor and oxygen set up I can track his respirations using a measurement of his exhaled CO2 levels. He’s breathing six times a minute with a shallow waveform on the monitor; the heroin is repressing his respiratory drive. The intranasal dose was just to buy me a little time for the intravenous dose that will reverse the condition.

The concern is that when someone’s high gets turned off they can get angry, combative, go into withdraw, or vomit. All of this could happen or none of it. It depends on their tolerance, level of addiction, and how fast I administer the Narcan. That’s why I’m sneaking up on the level needed to reverse the heroin by slowly injecting a half a milligram at a time and waiting for the effect.

After two milligrams of IV administration the man’s eyes pop open like a light being turned on and the monitor immediately shows an increase in respirations to 20. He looks down at his restrained hands, then around the ambulance and he finally starts to get his bearings. I look down at the pitiful example of a fire sheet to see his name.

“Antoine how do you feel?” Big round eyes staring at me, pupils dilated back to normal,  as he slowly gets up to speed with where he is and what’s going on.

“I’m a’rite, what the fuck happen, why the fuck my hans tied up, you a cop?” Kevin’s still with me in the back in case things get out of hand. I explain to Antoine that he passed out and his family called us and that I’m a paramedic not a cop. I get the cop thing a lot, even out of uniform — I think it’s the hair cut. Now that he’s starting to understand what’s going on he calms down, especially when I tell him we’re going to the hospital and not the jail.

I tell Kevin I’m good and we can start heading to the ED. He moves back up to the front of the rig and starts driving us to the closest ED, it’s maybe 10 minutes away so I’ve got a little time.

I recheck all of Antoine’s vitals — he checks out fine. The Narcan did its job — I just have to get him to the ED before it wears off. It has a fairly quick half-life, much faster than the heroin. Back in the rural county where I used to work that was a concern as we could have a thirty-minute transport time that would require re-administration to keep the effect. In this county it’s not too much of a concern as we’re always pretty close to a hospital.

Antoine is acting fine and seems to have a reasonable disposition so I offer to take off the restraints. “You gonna be cool if I take these things off you?”

“Yeah man, I cool.”

I take off the restraints and start working on my laptop to try to get some patient information before we get to the hospital, since he’s talking now. I ask him if he did his normal amount of heroin or if he overdid it today. He tells me it was a normal amount but he hasn’t had any for a while, he’s been in jail for three years. Duh, prison-ripped, I should have spotted it. That’s why Kevin smirked at me, this guy doesn’t exactly have a membership to 24-hour Fitness.

Looking at the fire sheet I recognize the date of birth. “Hey man, it’s your birthday today.”

“Yeah, see, I think thas what happen. I wen to the store an saw some my boys. They know I jus got out an is my birthday so they hook me up.”

It’s all starting to make sense now. He’s been away for three years; he’s got a clean system. There’s plenty of drugs in jail but it’s difficult to consistently do heroin intravenously in jail because it requires a syringe. He’s muscular because he works out all the time since there’s nothing else to occupy his time. The heroin hit him hard because of his level of fitness and clean system.

Antoine is quiet now and as I’m doing some paperwork I think about the deplorable actions of the fire crew. I get it; they’re firemen and firemen fight fires. This department jumped on the ALS (advanced life support – paramedic) band wagon kicking and screaming. They didn’t want to get involved in medical calls but they were forced into it by the county EMS agency. They still have the mindset and culture that their primary function is to go to fires even though ninety percent of their calls are medical. The paramedic on an engine is in a tough spot sometimes. That’s why he gave me a look of angst when they left.

Technically he’s the highest medically trained person on the engine and he makes all of the calls pertaining to patient care. But in reality he answers to the lieutenant. The lieutenant didn’t want an engine from outside of their response zone coming in to be be first at the fire. The first engine to arrive first runs the fire scene. So if they are late to the fire they could end up hosing off adjacent structures or setting up supply lines instead of kicking down doors and battling the beast. There’s also a rivalry between stations — if you can steal a fire from another crew in their zone then you get bragging rights.

The actions of the lieutenant put the patient at risk, put my safety at risk from the angry family, and put his paramedic’s license on the line. It’s called abandonment; you can’t just decide you have better things to do after you’ve started working with a patient, you have to follow it through. It’s the law. Now, technically, they could say they gave me a handoff; a fire sheet with a name and birthday. Yet had the patient coded I would have had to call in another crew to help me work it up. Fortunately everything worked out fine but that’s not always the case. Just when I think I have things figured out; EMS has a way of surprising me and challenging my belief structure.

As we’re pulling into the ED I’m thinking about my life four years ago and wondering if I made the right decision. I walked away from a successful career in an unrelated field to begin the process of becoming a paramedic. I had this crazy idea that I wanted to help people and make a difference in the world. I traded in my conservative casual office attire for a uniform and started working with people ten years younger than me for less than half the salary I was used to bringing home.

Since then I’ve delivered babies, watched people die, and found myself in the midst of gang violence, drug abuse, and so much more. Most times it’s rewarding, sometimes it’s astonishing, but every day brings something new. Many of the people from my old life thought I was insane for making the switch yet a few understood. Looking down at Antoine I know I made the right decision.

This is going to be an interesting journey…

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 : The act of awaking, or ceasing to sleep

2 : Rousing from sleep, in a natural or a figurative sense; rousing into activity; exciting

3 : to cause to be aware of

Is human life just a dream, from which we never really awake, as some great thinkers claim?

William Shakespeare –The Tempest

We arrive at the same time as the BRT which is taking an angled position across the street to block the intersection with their rig. This provides a degree of protection from traffic. We saw the patient laying in the crosswalk, flat on his back, not moving as we drove into the intersection. He looked like a GSW victim; bloody, laid out, no movement.

Jake, our ride-along EMT student, is excited as it’s the kind of bloody mess of a call that he was hoping to get today. EMT students are required to ride in an ambulance as part of their course completion. The majority of them are here to get their certificate so they can apply to fire departments. Maybe half will go on to be working EMTs, less than a quarter of them will become Paramedics. Along the way a few will get picked up by fire departments. It’s not uncommon in this area for 3000 people to apply for a 15-person academy in a fire department so the odds are definitely against them.

Throughout the morning Jake maintains a constant monologue about the fire departments he wants to apply to, where he wants to work, and the exciting things he did in the fire academy that he went to last year. We listen to him while suppressing smirks at his naivet. Jake quickly became disinterested in the mundane calls of the day; the old lady with weakness for three days, the Crohn’s disease patient with abdominal pain, the pregnant woman with abnormal discharge who is worried about her baby. All of them could have taken a cab to the ED, or made an appointment with their primary care physician, but that’s not what happens in this county. They call 911 because they feel entitled to immediate transport and evaluation at the ED. Anyone who doesn’t think we already have universal health care should spend a day with us and see the reality that we see every day.

My partner Brent and I exit the rig with Jake in tow and approach the patient as the fire medic is approaching from the other side. The patient seems to be a man in his thirties. I kneel down to listen for breath sounds while I’m feeling for a radial pulse; both are present but weak. The fire medic rubs up and down the patient’s sternum with his knuckles to see if he is responsive to painful stimulus; no reaction.

We start cutting off bloody clothing as one of the fire fighters is holding c-spine to prevent further injury to the neck and spine. Brent goes back to the rig to get the back board and straps. Jake is cutting up one of the pant legs. He’s never done this before and he takes slow deliberate cuts with the trauma shears. The fire medic and I strip the rest of the patient’s clothing in the time it takes Jake to do one leg.

Now that we have him stripped the injuries are obvious. Bilateral deformity to the knees, facial and head trauma in the front with matching trauma to the back of the head. The fire captain comes up after talking to some witnesses in the crowd that is growing on the sidewalk.

“Okay, per witnesses, this guy was crossing in the crosswalk when a car traveling at a high rate of speed did a hit and run. They said he went airborne and landed in the crosswalk.”

Looking down at the blood covering the white lines on the pavement I’m confused. “I don’t get it Cap, how did he get hit from the side and end up further down the same crosswalk?”

“No, he was in the other crosswalk, went airborne, and landed in this crosswalk.” Damn, that’s big air!

I stand up to see the street better; two lanes each way with a turn lane in-between. It’s at least 100 feet from crosswalk to crosswalk. That gives me an idea of the speed of the car and level of trauma that was inflicted on this guy. Given the wound pattern it appears he turned to face the car as most people do, and the bumper broke both legs. He folded face first into the hood causing the facial trauma, then was launched across the street landing on his back and causing the trauma to the back of the head on the concrete.

We get him secured to the back board and loaded into the rig. Throughout the process he hasn’t moved or reacted to anything we did — he’s completely out. We’re conscious of the time spent on scene – as this is a code-3 trauma activation we want to hold our scene time to under 10 minutes.

The fire medic looks up at me from outside the rig. “You want a rider?” I tell him yes; I have Jake in the back with me but he really can’t do much to help. I can use another medic with me. He jumps in and I tell Brent to get us out of here.

As we’re rolling towards the freeway I’m setting up my intubation kit while the fire medic is working on an IV and Jake is trying to take a blood pressure. He’s never taken a blood pressure in a moving ambulance with road and siren noise – it’s an acquired skill and he’s got to start somewhere. There’s blood in the mouth, I suction it away and insert my laryngoscope. Visualizing the vocal cords, I pass the tube into his trachea. I inflate the cuff, which secures the tube in the trachea, and attach a bag to squeeze some air in to confirm placement.

The patient, still a John Doe (JD) to us, suddenly starts moving all extremities at once and shaking his head. He’s trying to scream but there’s a tube in his throat so all that comes out is air with a fine mist of blood. I’m trying to hold his bloody head steady with one hand while holding the tube with the other hand to stop it from getting dislodged. Jake and the fire medic have their hands full holding arms and legs. It’s not a seizure – the movements are purposeful, yet unorganized. It’s the flight or fight response of an injured brain manifesting in a combative outburst. JD doesn’t mean to be combative – heck JD isn’t home right now – it’s just the autonomic part of his brain trying to do something, anything, to protect from further damage.

It takes all three of us to subdue him. I’m holding the head and tube, trying to preserve some semblance of c-spine precautions and stop the tube from being dislodged. Jake is holding his legs which are kicking even with bilateral fractures at the knees. The fire medic is using leather restraints to secure JD’s hands to the backboard.

As we’re pulling into the ED I decide to remove the tube. If JD’s moving enough air to be combative then he can breathe on his own – the ED may well re-tube him but that’s up to them. I might have sedated him but that’s contra-indicated for traumatic head injuries, not to mention I couldn’t reach the drugs while all three of us were holding him down.

We roll him into the trauma room where a team of 15 nurses and doctors is already waiting for us. It’s a teaching hospital – one of the best – so a brand new resident gets my attention and says, “You can talk to me.” I’m sure they teach the “baby docs” to say that every time. It always kind of makes me chuckle.

I give the baby doc a full report on my treatment and JD’s condition. All the while JD is screaming and flopping bloody appendages around as they pull him off the board and baby doc orders the RSI kit (rapid sequence intubation – sedate him, paralyze him, and tube him). That’s one that’s not in our protocols but it’s the only way to handle JD right now.

As I walk out to the ambulance bay I encounter a dirty look from Brent as he’s scrubbing the cabinets of the rig to get the blood off. “Sorry dude, we tried to keep it clean.” I’ll do my paperwork fast so I can get back and help with the decontamination of the rig.

While doing my paperwork I’m explaining to Jake the pathophysiology of coup-countrecoup traumatic brain injuries. He’s using some wipes to to try to get the blood out of his white polo shirt. He’s not as talkative as before; the constant diatribe of his accomplishments have dwindled to a morose silence. I don’t think he’ll be one to work as an EMT or go on to be a Paramedic. The reality of our mundane calls interspersed with the insane call isn’t for everyone. I suspect he’ll continue testing for the Fire Department and given the odds that may not work out the way he expects.

I finish my paperwork and head back to the rig to help with the decontamination.

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.