Success on the Street (SOS) Report from an ED

It started with a text message in which I could tell this nurse was excited about the SOS she was just a part of. I was uber excited to find out what had happened. Both the text and the email were unsolicited. It makes my heart so very happy to hear how someone was able to practice SYWYSO.

Below is the exact email as I received it, with identifiers removed to protect some anonymity. 


Hello Kip—


*Edited Location* is better because of you and your training.  I was witness today—(just a within the hour)—to the training in action, and it was amazing.  We had a DKA *Edited*.  Patient but he was NOT confused, he was awake alert and completely oriented.  But he was angry and violent—he did not want to be in our ER.  He needed our care but didn’t want it.  And he is known to us—non-compliant, violent, positive for drugs, etc.  I don’t mean to be disrespectful but just so you get the pic, he is tatted up head to toe, a Mohawk haircut, unkept, and with an extremely foul mouth.   


The patient wanted some water, the nurse, who had not had the training said “No, because I do not want to clean it up.”  That nurse left the room.  *Edited Name*,  who had the full week instructor training *Edited Name* came in the room right after that and the patient asked for water, she was not privy to the conversation that had just taken place and told the patient that we could not give him water right now.  Because of the comment that was made just before, the patient lost it at that point.  He was f’ing leaving and we needed to leave him the f alone.  He was getting these f’ing IV’s out and on and on.  That is when I entered the scene, because I heard the commotion.  It was amazing to watch—*Edited Name*  IMMEDIATELY took her defensive stance, hands up instinctively and backed away—spoke softly to him, telling him, “Hey man, I know you are thirsty, we are going to take care of you, we just need to do a few things to check you out and we are going to take good care of you.  Can you help us with that?”  Validate, explain, request!!!  She ROCKED IT!


About that time, the first nurse walked back in and the difference was night and day—again, this nurse HAS NOT been through the training and was not doing anything EVERY SINGLE one of us would not have done prior to the training. The patient was picking at his IV’s, at this point saying he was getting these F’ing IV’s out and leaving this F’ing place and we needed to get him a phone to call a ride, we better not try to stop him or someone would get hurt.  The nurse physically pushed his wrists down and told him “No you are not pulling these IV’s out because I will have to restart them.”  She had an aggressive stance, leaning in almost face to face.  The guy was furious, jugular veins bulging, face red, breathing hard—the fight was on.  I told my nurse, back up—give him some space.  She looked at me, still holding his hands down and said, “He will pull these IV’s out.”  I said, “It’s OK, let him.”  The room was full of staff and nursing students all ready and willing to hold him down.   I told them to clear the room, I was talking softly to the patient but in defensive stance, with plenty of space.  The physician was called to the room.  He told us to restrain the patient immediately.  I looked at him and said, “No sir, we need to get PD here” and told the nurse to call PD.  I was in the hall by this time, not in the patients room.  I told the nurse, “Do NOT attempt to restrain that patient, get PD here.”


The PD arrived within minutes and the guy was completely different the moment the cops showed up.  Still mad, but he agreed to treatment. We gave him meds to calm him down—with his permission—-and appropriate care was rendered, prior to us transferring the guy out.


Two things—-

  1. I am amazed at the different interaction between the patient and *Edited Name*, who has had the training—- and the patient and the other nurse, who had not had the training. BLACK AND WHITE difference and could not have been more obvious to me now that I have had the training.


  1. Given the feel of the room and what was going on in the room when I arrived, the potential for someone to end up hurt in that room today was off the charts, if we had not of been able to intervene with de-escalation techniques taught to us in the class. The stuff we learned in DT4EMS saved another nurse from another potentially violent episode today—I am convinced of it and so proud to watch *Edited Name*  put into play what she learned with you * Time Frame Edited*.  She really did rock it!!!!


Thanks Kip—I wish I could express it more in an email, but I know the words fall short—I was amazed!!    

 I will use the very episode to assist in training but right now want to be VERY careful with the story because I do not want to make the nurse who was in the ER feel bad—she did what she knew to do, what we have always done—EVERY ONE OF US.  Now I can see clearly that is not working for us!  I feel so strongly the need to get the training out to our staff ASAP!  I want to get going with it.  We have to change the culture.

 And by the way—just for the record that nurse is incredible—she is one of our VERY BEST ER nurses.  She was just doing what she knows to do and that was use force in that situation.   


First of all, I want to make sure everyone is aware, I do not blame staff members for acting in a way according to what “culture” has taught them. Matter of fact, I have said “If you don’t train them, how can you blame them?” I would also like to thank the nurse who wrote the email to me. Oftentimes we hear success stories, but in anecdotal form. So many people assume to know what we teach, without ever actually attending our course. an SOS report like the one here allows others to make a more informed decision about training their staff for reasonably dealing with violent encounters.



sos success on street