The EMS call for one down can result in any number of possibilities. When the person down is a psychiatric patient, a major unknown factor is inserted into the equation. The psychiatric patient’s unpredictable behavior puts all emergency responders at risk. Protecting all responders at the primal level involves all responders taking basic protection first. This week’s featured firefighter near-miss reportdescribes an event that starts out innocent enough, but escalates quickly to a point that has the reporting officer wishing he had a “do over.”
“…the Communications Center received a call from a well-intentioned passerby for a man down. Upon arrival, he was difficult to find, so I had the crew wait in the engine while I looked for him on foot. Eventually, I found a person sleeping peacefully under a tree…I woke him up and started asking questions to confirm he was OK. As the captain, I knew I was not going to have any physical contact with this person as the medics were right behind me. All I needed to do was stand back, document, and explain what was going on to the EMT ride-a-long. I was in my T-shirt, without gloves, EMS coat, or eye protection. His responses were bizarre and unrelated to the questions he was being asked…Because he was refusing transport, the police department was requested to issue an involuntary hold on him…Three officers were not enough to subdue this scrappy, wiry man. Three officers, my two firefighters, and the two ambulance personnel were still not enough…he bent his head down and attempted to bite my forearm. I felt his teeth graze across my skin as he got a mouth full of arm hair. Immediately, he made a loud slurping sound as if preparing to spit at me. My face was one foot from his and he had a clear shot…”
Once the psychiatric patient feels threatened, he becomes resistant, and then escalates to combative. When an incident accelerates to a physical level, there is no time for emergency responders to ask for a time out to don basic protective equipment. The medical history of the psychiatric patient is difficult to obtain or verify, therefore, being proactive on all EMS runs is necessary. Consider the following:
- What self-defense and physical restraint training have you taken?
- If the patient in this incident suffers physical injuries at the hands of fire or EMS personnel, is the department and/or the personnel personally liable for the injuries?
- List the number of infections an emergency worker could incur from a human bite that breaks the emergency worker’s skin.
- Describe the disinfection procedures you would take after returning from this run.
- What are the critical decision points the officer in this near miss faces? How would your decision-making process compare to the decisions this officer made?
The need for proper PPE on an EMS call is every bit as critical as a structure fire, vehicle entrapment, technical rescue, or hazardous materials call. The time to “dress out” for the run is before you arrive. Donning a pair of medical gloves and eye protection prior to encountering a seemingly harmless patient is an essential component of being prepared for the unexpected.
Have you averted an injury or exposure because you were wearing the right BSI/PPE? Submit your report towww.firefighternearmiss.comtoday to reinforce the practice tomorrow. For more on the value offirefighternear-miss reporting,CLICK HERE.
Note: The questions posed by the reviewers are designed to generate discussion and thought in the name of promoting firefighter safety. They are not intended to pass judgment on the actions and performance of individuals in the reports.
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