Monday, January 24, 2011

Hands On

I didn't feel it. I didn't even know about it until I arrived at the E.R.

I parked the rig, pressed the magic numbers into the keypad (probably the same ones you do) and walked into the emergency department. I saw Billy, Fredo and the ambulance crew talking with someone at the doorway into one of the treatment rooms. As I peeked into the room, I saw that they were speaking with our patient. I was a little surprised, as the last time I saw him, he was being loaded into the ambulance and was fighting with us.

Our patient was now passive and was communicative. "There he is, hey Schmoe" Billy said. "Our patient said that next time bring six more of you and he'll take care of them too!"

"I don't doubt that" I replied. "He was a handful"

"I'm really sorry, I don't remember anything" our patient said.

"No worries pal, I'm just glad to see that you're doing better."

I stepped out of the treatment area and asked Billy if they had medicated the patient or if he had come out his altered state on his own. Billy said that the patient had come out of it just as they were pulling into the E.R.

Billy asked me "Didn't you feel him punch you in the head?"

"No" I replied, "He didn't connect - not enough for me to feel it anyway."

Billy laughed as he told me that he had looked up and saw out patient's fist fly by the side of my head and saw my hair fly as if I had been smacked. In reality his fist had probably just grazed my hair as it whizzed by. I was busy dodging kicks as I and one of the guys on the ambu were trying to restrain his legs.

It had taken five of us to restrain our patient and secure him to the gurney using "soft" restraints. It might have been easier for us if we had suspected that our patient was being deliberately abusive rather than suffering some sort of neurological issue. We might have used some more aggressive and painful restraining techniques.

In the old days, before the Great Big Ambulance Company provided soft restraints, we would have used cling to tie his extremities to the gurney. A use which cling was not designed for. Before that, we would have sandwiched him between two backboards, then wrapped the whole thing in cling. I think the soft restraints are the best, both for us and our patients.

The call had been for a 32 yr. old male suffering a seizure. While his seizure wasn't the traditional Clonic-tonic seizure, it was convulsive and it did produce a post-ictal phase, one which we found to be a bit physical in nature. As the patient had no history of seizures and had suffered a few episodes of neurological dysfunction in the weeks prior to this call, it is highly likely that he has an internal issue in his brain. Sadly, his immediate future is one of testing and more testing. Hopefully, his situation is treatable. Regardless, at least for the short term, his life will be turned upside down.

  As for my close call with the patient's fist, that is notable in that it even occurred. Ten years ago, me going hands on with unruly patients was pretty common. The area where I worked was one where violence was a common occurrence and I was savvy enough to know when and where punches were coming from. Now, incidents like this are so rare that I didn't see this one coming. Had it connected, it would of hurt. Even so, my pain would have been nothing compared to that which our patient is likely to feel in the coming months. I wish him well.

Thanks for reading,

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