A simple change in verbiage, in “definitions” can help providers AND patients be safer in emergency medicine. There is NO such thing as a combative patient.
Criminals assault. Patients do not.
With the high numbers of EMS/Fire and Healthcare providers assaulted on the job by what so many refer to as “patients” I would like to state I believe there is a distinct difference between a patient and an attacker. In order to better prepare for scene safety “tactics” the EMS/Fire or Healthcare Provider must have a clear separation between a uncooperative patient who is confused due to a true medical emergency and an aggressive-attacker who may be under the influence of drugs or alcohol trying to assault them.
The real skinny is this:
- Providers are getting assaulted by criminals and
- Patients are getting assaulted by staff. (Make sure to check out those links).
I believe in trying to remove the term “Combative Patient” from our EMS/Fire and Healthcare vocabulary. There is really no such person as a “combative patient”… when you look at the definitions of each word below, it becomes clear. Since the goal of DT4EMS is to prevent a person, patient or provider from becoming the victim of an assault, I believe a clear definition between patient and attacker must be understood. Without this clear understanding I believe that when a provider continues to call an aggressive attacking person a “patient ” (either in their head or out loud) it causes the provider to enter in or remain too long in a potentially violent situation or “connected” to an attacker.
Combative– eager or ready to fight, argue etc; aggressive.
Fight– a battle or combat
Aggressive– characterized by or tending toward unprovoked offensives, attacks
Attack– to set upon in a forceful , violent, hostile or aggressive way with or without a weapon; begin fighting with.
Patient– a person who is under medical care or treatment
Uncooperative– not cooperating (1)
Simply by definition, a “combative patient” cannot exist.
Change verbiage to encompass these examples:
Uncooperative Patient: A post-ictal seizure patient, a hypoglycemic patient, a hypoxic patient, a TBI/CVA patient -their movements don’t appear to the provider to be aggressive in nature. In short, they did not truly intend to injure the provider.
Aggressive Attacker: Usually an intoxicated/drugged individual who attempts to grab, strike, spit etc. on a provider, may use verbal threats. This person places the provider in apprehension/fear for their safety and uses a variety of verbal threats.
This brings me to a couple of staple DT4EMS statements: Voluntary intoxication is not a defense to criminal activity (like assault) and fleeing a violent encounter is NOT a patient abandonment.
When first trying to change your mindset about this concept of no longer using the words “combative patient” it will take a few times of actually looking at people you come in contact with.
Answering some simple questions will help the provider determine the difference.
In every situation where the provider is presented with a potentially violent encounter they must ask themselves several questions;
1) “Is this person trying to hurt me?” Seems like a simple question but all too often providers stay too close, too long with an aggressive attacker. Paying attention to the “gut feeling” will help keep a provider safe.
2) Is it the person’s intent to due you harm? (Intentional because of drugs, ETOH or is the person confused due to a true medical condition (IDDM,SZ, TBI, CVA etc.)
3) What is your perception of the movements directed at you? Are you afraid?
4) Why are they trying to hurt you? (Confusion or act of aggression?)
5) What are their spoken words in the process of their physical actions? When physical aggression is combined with verbal threats it is easier to perceive the intentions of an “attacker” vs. a “patient”.
So, what does this all mean?
If dealing with a “patient” cooperative or not, you would employ Good Customer Service, use good verbal skills, shoe a caring attitude… basically doing exactly what you signed up to do when you decided to join the medical community.
If dealing with an attacker– have your plan already in place on how to exit the area immediately. Don’t argue, don’t “order” them and for Jiminy Christmas…don’t try to restrain this person. If you feel this person needs medical attention and they don’t want to go with you…….. enlist the help of law enforcement to take custody of them, THEN you treat.
I believe having a clear understanding can reduce assaults on staff greatly. It can also remove some of the headlines of where staff have assaulted actual patients.
In a nutshell… you can have an “attacker” or an uncooperative patient…
This thought of staying too long thinking a person is a “patient” when they are truly an aggressor or and attacker is one many in the medical community wrestle with.
A simple change in verbiage can help:
1) Staff may find it easier to pursue charges on those who criminally assault staff.
2) More accurately document a violent encounter by labeling the person (an attacker) more accurately.
3) Have the media recognize the frequency of criminal assaults.
4) Assist staff in not treating patients like attacker
5) Have staff back away from someone who is not a patient, reducing the likelihood of a criminal assault.
6) Assist with administration understanding the difference and encouraging staff to report criminal assaults
7) Assist with law enforcement understanding the scope of the problem medical staff face regarding the use-of-force on the job ( both in application and defense of)
There are a myriad of things this simple understanding of patient vs attacker will help the provider with, but that is what EVE is for! See you soon!
Until next time…….
Saving Yours, While You Save Others!