(Cooperative, inter-agency communication and training can solve a lot of these issues)
“You can either go with them to the hospital or go with me to jail”.
The phrase every provider dreads hearing.
The danger of this phrase is it can give the perception of “custody”. Not only to the person being transported and bystanders but the provider as well.
The person transported may believe the provider is an extension of law enforcement and the provider may believe that they must maintain custody of a person who wishes to break free.
This is directly related to Soft Restraints = Hard Times for Healthcare!
Below is an actual situation:
“EMS personnel eventually convinced him to enter an ambulance for transport to the hospital, but he grew combative again, prompting the personnel to request officer assistance in the vehicle. He was warned that he could go to the hospital for treatment or face arrest, at which time he started making threats against officers and personnel, including threatening gestures, before relenting when warned with a taser.
Lapin acted calm and took off his jacket, then lunged at the EMT, punching him in the face. He was promptly handcuffed and removed from the ambulance, and he began kicking windows when placed in the rear of the cruiser. At the Salem hospital he again became belligerent and had to be physically restrained to a bed by hospital staff.” READ THE REST AT THE SOURCE
At first, I thought it was a phrase unique to an area, because I first heard it as an EMT in South Florida. Later after becoming a medic and moving to Missouri I heard it there as well. Then in 1995 when I went to the police academy I heard the phrase taught to law enforcement and its appropriate context. Now that I get to travel the country and speak to EMS/Fire and nursing staff, I have heard that nearly every service area, urban or rural, has the same problem with this phrase/statement.
In the police academy the context of the phrase “You can either go to the hospital with them, or go to jail with me” was supposed to be used when the officer felt the person needed medical treatment but had not committed a crime, and the officer was trying to convince the person to seek medical care. The supposed “teeth” behind the warning was the officer could use some sort of a law (in Missouri is commonly known as the “12-Hour Safe-Keep”) where an officer could take temporary, protective custody of a person, but no criminal charges would be filed. The problem now is, in many areas this phrase has become the proverbial way to “pass the buck” so to speak.
It seems that when a person is under the influence of intoxicants or drugs, but has not committed an actual crime, many times an officer uses the phrase as a temporary means to get the person “off-the-street”. Having been an officer for as long as I have, I understand an officers intent. The officer feels as though their hands are tied due to liability. The fear the drunk or drugged individual may slip and fall, step out into traffic, get injured and sue the department. I get it. However, the method/statement/tactics used to get the person ‘off-the-street” must be changed. Because now in these situations, the medic feels compelled to maintain “custody” of a person placed in the back of the ambulance. What happens when the intoxicated individual decided they no longer wish to remain in the ambulance? Simply put, Drunk is not sick, sick is sick (or injured). But that is a different topic all together.
This phrase of hospital with them or jail with us, while not intentional, many times has the officer(s) unknowingly placing the EMS provider in potential danger. The danger arises when the person gets in the back of the ambulance and the doors shut. What sometimes happens is the now so called “patient” perceives the EMS provider as an extension of law enforcement………..except, without all of the tools/tactics/training and ability to control or keep them against their will.
So the ambulance begins to roll down the street and the “patient” (refer to our blog post on Combative Patient and how there is no such thing) becomes aggressive verbally and or physically. The person begins to tell the provider, usually using expletives, on how they are going to get out of the ambulance and what acts, usually a very descriptive depiction of their physical assault, they will do to the provider in the process. Then because of the false sense of “Duty to Act” and the confusion patient vs. attacker, the provider feels compelled to try and restrain the person on the stretcher. Remember this person had no real medical emergency aside the fact they were high or drunk. Add the fact that according to the NAEMSP it takes five people to medically restrain a “patient” and the lack of training on how to handle such a situation a whole new set of situational and legal problems arise.
So what do we do to fix this situation? First we try to never let it happen to begin with. We accomplish this by education. We educate law enforcement on what EMS can and can’t do both legally and physically in the back of an ambulance and educate EMS what THEY can do both legally and physically in the back of an ambulance. See EMS/Fire have been learning via osmosis when it comes to scene tactics. The only problem is EMS/Fire have no authority or training when it comes to many instances for the use-of-force. So instead they see an officer do something and they figure…. well “I guess that’s what I’m supposed do…”.
Realizing this will take time to change, the company stance of DT4EMS, LLC and the way we have been educating EMS/Fire and nursing staff across the country is this:
If presented with the situation where a person is told “You can either go to the hospital with them or to jail with me” and the person has no other emergent medical problems and law enforcement is not riding with EMS to the hospital- First, try to express your safety concern to the officer on scene. If that does not work, we recommend consider stating something like this to the person in the back of the ambulance “We are not the police, we are just trying to help. We are simply wanting to get you to the hospital to get checked out. If at any point you don’t want to go, just let us know and we will let you out. Just let us pull over somewhere safe”. Now you can come up with your own way to say it, so long as the message is clear- an conveys you do not have the authority to hold the person against their will and you will not use force to do so.
After the call is complete, not on scene or at the ED, you discuss the situation with your administration (not the officer directly involved) and have your administration meet with local law enforcement administration to discuss the need to address “when” that statement should be used. This meeting could also be a prime time for administrations to educate one another on the capabilities each agency may possess in dealing with the intoxicated individual.
Too many assaults leading to injury, have occurred on staff trying to restrain a person who was an attacker, not a patient.
Through education we can make our job safer. We do tons of training to save everyone else, now it is time to start learning “Saving Yours, While You Save Others”.