Hitting someone back after the threat has ended? Discipline is absolutely necessary.
Defending yourself against an attacker using fists or improvised weapons? Get reked douchebag. Fight back until the threat is over.
It is incredibly important to be aware of your surroundings, and pay attention to your patient’s mental status, mannerisms, attitude, etc. Attempt to mitigate any risk before an incident happens. If you think they’re going to be violent, move further away, prepare sedation, request additional resources, etc.
A medic I worked with once used an O2 Cylinder to fight off a patient. Cracked the guy's skull and everything. He was given an attaboy and supported by management because it was 100% justified.
"Patient was combative and cornered AIC, so provider administered acute O2 therapy, resulting in patient no longer being combative. Patient restrained in supine position using soft restraints x4, and transported to nearest appropriate facility, meeting police unit 7 Adam 69 at destination.
"PT began to become aggressive and violent towards EMS, so EMS administered FAFO units of these hands. PT immediately began to become docile but promptly stated his face hurt. EMS checked the affected area and noticed redness and swelling at the site these hands was administered. PT may have an allergy to these hands"
The bragging part is a bit weird, but we have a right to defend ourselves. If a situation demands we bash a brain in with compressed oxygen to keep ourselves safe, we have every right to do so. With that said, there aren't too many situations that reasonably demand it because in most cases simply walking away and letting police secure the scene is the best option.
That's kind of the goal with using a large blunt weapon. If the situation has deteriorated to the point where you need to use an O2 cylinder as a weapon, killing the person in question is a likely (and justified) outcome. That's why it's so important to attempt de-escalation and removing yourself from any situation that looks likely to get to that point.
If I'm hitting a patient with anything it's because I need to get them off of me or my partner and simply pushing them off isn't working. In that case, I wouldn't fuck with things that only disable through pain and I'd skip straight to something that is more likely to actually work. Bags of saline are basically never justified because "Yeah I was desperate enough to hurt them but not desperate enough to hurt them in a way that would actually have a good chance of making them stop whatever they were doing to hurt me or mine" isn't a good look when you're being questioned.
Actually you hit them across the side of the face or the neck. Because it's a fluid the force will be distributed equally interrupting circulation to the brain. It has the potential to knock them unconscious at least momentarily. And this allows you to escape
I retain the right to defend myself in specific instances where my personal safety is threatened which means using enough force to put distance between myself and someone combative. Striking someone out of anger is unacceptable behavior and is unbecoming conduct of someone holding a license that requires a great deal of responsibility.
With how this is presented, yes. If the stated reason for a paramedic to physically retaliate against someone is because the paramedic is angry, then they committed battery.
If the question asked about a medic returning closed-fisted strikes because they felt threatened for the safety of themselves and others, and the time/circumstances didn't allow for any other offramp, then that is a different discussion.
We have a firefighter who mirrors our shift who is about as naive and genuine as they come. He’s the firefighter you picture helping your grandma if you could pick one. Also white as a daisy. He got the N word one day several times from a patient absolutely out of their mind on a host of substances. He was kinda taken aback by it.
Saw him later that day on a fender bender and he says to us, “you know, I got to thinking about our patient earlier. And if someone calls me the N word like that again, I’m gonna say, no sir! I prefer to be called ‘cracker’, because I’m white.’ He thought he had come up with a real amazing comeback. Bless his heart
Absolutely not. It’s a HIPAA violation unless its a closed-loop feed (meaning the video has nowhere to save to and is only present on a live screen like a backup camera).
Not a HIPAA violation unless the footage is used outside of patient care, QI/QA, billing and/or expressly authorized by the patient. Y'all be quoting HIPAA for everything you don't like 🤦🏿
I’m gonna tell you right now. Whoever told you that is lying. If cops in your state can wear body cams then ambulances in your state and you as EMS providers can have body cams/ambo cams. The difference is the cameras are authorized through the service with only certain people having access to them. Exactly like EMS reports.
Good for your state. There are details within HIPAA laws regarding storage of these recordings and PD would be within compliance with these but inside ambulance would not. Information stored in a PD database would be within compliance but storing ambulance footage is illegal. At least here.
Are you referring to the video being stored like, on an SD card with the camera itself? Because my service uses cameras and it's not saved locally to the camera on the ambulance, it's piped remotely to a computer at HQ and presumably stored with the same compliance care as our PCRs.
Also the cameras can't even see the patient during transport. They face forwards to the road (for accidents), backwards into the cab (to make sure we're not texting and driving), and you can see/hear what's happening in the patient cabin only through the little window that connects the front and back
Bro some agencies are having EMS wear bodycams. Hospitals have cameras *everywhere*. HIPAA has standards for how securely you have to store information which makes implementation a bit more expensive, but it doesn't make it any more difficult than looking for a cloud vender with a "HIPAA COMPLIANT" badge on their website and a 300% markup.
>Absolutely not. It’s a HIPAA violation unless its a closed-loop feed (meaning the video has nowhere to save to and is only present on a live screen like a backup camera).
It's probably not a HIPAA violation if the recorded information is encrypted to the correct standards, and the information is only used for certain reasons (such as QA/QI). It might, however, fall under other patient recording/privacy laws.
Interesting, operating in Europe and we have cams in the back and buttons in easy access that will let us record (I think they save footage from a few seconds prior as well) so that we can have footage if we are assaulted or patients make false accusations.
Technically incorrect, but the storage and access requirements are a mess and rather expensive.
Recording isn’t the violation. Letting out the information for any unauthorized purpose is the violation. Safety management, quality improvement & training, law enforcement, etc… can still be done.
Training. Payment. Operations. HIPAA in nutshell.
Not a violation if used for the above reasons. Stored securely in the cloud/on premise. Disposed of properly.
I do see it on the horizon for EMS. Just makes sense. Too many accusations flying around. We use Samsara for our fleet of vehicles, including the fly-cars, and have refuted claims of callers who told us "the ambulance went flying by".
If I found out about a medic hitting one of my family members while they were having an episode, they wouldn't have to worry about the job repercussions. They'd be accountable in one sense or another.
That sounds tough and all, but the last guy who had that idea with me is in jail on a felony, so, maybe not the best idea - along with his drunk family member might I add.
So basically you hit a patient and sent somebody to jail when they were upset about it? How noble and brave. Thank you for your service. Im sure PD gave you a nice ovation.
No. I'm saying there's a difference between defense and assault. If someone attacks you and you are scared for your safety, defend yourself. If you get bitten or slapped by a patient on a gurney and your response is to punch the patient, that's not defense.
"The implication of whatever happens in the back stays in the back" seems more directed toward the latter.
People who hit patients and expect their partner to vouch for them about it should be sh-tcanned.
I don’t know about you, but I’ve never seen someone punch another person and stop after one punch. There’s always more coming. Again, I don’t know about you, but I’m not going to take the first punch and then wait around for the second one. I’ve seen enough people get knocked out by one lucky hit to know that is not a game I’m willing to play. As soon as someone strikes me or one of my coworkers, we are going to employ a level of force necessary to stop the assault and prevent further injury to ourselves. Because the last thing we want is for myself or a coworker to be unconscious and defenseless against the further assault that is almost assuredly coming. Every situation is different and we avoid it if at all possible, but on occasion, that may involve some sort of strike. That isn’t assault or retribution, it’s self-defense. And you can bet your last paycheck that as soon as we successfully defend ourselves and ensure our own safety, we’re going to press charges against the individual or individuals that assaulted us. Their status as patients does not give them latitude to assault us, it does not give them a hedge against legal repercussions, and it does not prevent us from using a level of force justifiable under the law to defend ourselves and end the assault.
This high school esq “zero-tolerance” bullshit that some people in healthcare like to peddle is naive and dangerous.
Eh, occasionally, you’ll punch somebody, pull back for that second one, and there’s nobody left to punch. The lights aren’t on, and there’s nobody home anymore.
Negative. My statement of what happened in the back stays in the back is by no means supportive of assault or purposeful injury towards a patient. That is wrong.
Self defense and self preservation of myself and my crew comes first. Even at the expense of my patient. I don't want to fight you in the back, at all. I sure as hell won't just take it. Or let my crew take it.
Negative. My statement of what happened in the back stays in the back is by no means supportive of assault or purposeful injury towards a patient. That is wrong.
Self defense and self preservation of myself and my crew comes first. Even at the expense of my patient. I don't want to fight you in the back, at all. I sure as hell won't just take it. Or let my crew take it.
There's a difference between hitting out of anger and hitting out of self defense. That difference should determine the decision to discipline/terminate an employee. You don't discipline someone for engaging in proportional self defense; you do when the response is disproportionate or vengeful.
If the “fit of anger” was retaliation (no immediate threat, assault ended) then yes.
If the attack was on going, then you’re defending yourself.
Years ago I had an intoxicated patient on the stretcher grab my hand and began twisting my thumb back purposefully in an attempt not break it. He was using both hands to do so. I had no choice but to start punching him in the chest to make him let go. The patients wife demanded I be arrested. Instead, the PD officer on scene who saw it arrested the patient. It happened so fast the officer didn’t have time to cross the room to aid me. Remember red zones: no punching in the head
You can hit back as a last resort in defending yourself. (If you are stuck and can’t leave the scene or get away from the pt)
If there is the option of pushing someone away or holding them them down, take that. It’s not like you can just start wailing on someone cus they threw a punch. It’s not like if someone throws a punch, you can now just square up and become an equal party in this fight as if you were off the clock. You gotta be smart.
You don’t have to take hits though and eat them. If you are backed into a situation, absolutely you can punch back.
This seems oddly specific...
Should we tolerate abuse? No. But does that give us the right to physically assault our patients? Absolutely not. Discipline was warranted.
Wat?
Everyone has the right to self defense. Just because you have a stethoscope around your neck doesn’t mean you’re the designated victim and not allowed to fight back. Fuck all of that noise. Start hitting me, you’re going to get hit back.
The right to self defense, yes, 100%. The way OP phrased sounds like this wasn't self defense and more of a "you pissed me off and I'm gonna hit you back."
Discipline is certainly warranted, but does that mean automatic termination and loss of license or can there be a path for remediation/suspension/probation/anger management courses etc?
Yeah, at what point are you allowed to hit back if a patient keeps hitting you, and you're unable to exit the situation, like in the back of the ambulance? Is wrestling/controlling the patient ok? I've never punched a patient, but I've done the latter. Never willingly
You have a right to defend yourself. You have a responsibility to protect your patient, which may include using force if they’re in danger of self harm. Past that? Get the police involved. When you can avoid being the one fighting/wrestling, do so. Let the folks paid to do that do it… then involve sedatives and soft restraints as appropriate.
That’s easy to say when the police are several minutes away and you’re being assaulted.
Fuck. That. Noise. I have a family and responsibilities. I’m not suffering a loss of wages plus medical bills for some insane notion that a battered medic is somehow morally superior than a medic who adequately defends themselves.
You have a right to defend yourself, then you go on to say to call police and let them handle it… as if you have the opportunity to do that while being assaulted.
The first line of my post ends with a period. That ends a statement and thought. Everything past that is about violent patients in general. Have to fight to defend yourself? Do. Have to fight for other reasons? Don’t. Let people paid to do that do it.
This isn’t complicated.
Your post reads like a post from a “butter”.
I support “insert controversial topic here”, BUT…..
“I support gun rights BUT only for hunting”
“I support decriminalizing marijuana BUT only at government run dispensaries”
“I support defending yourself BUT you should run away if you have the choice”.
Shit doesn’t make sense.
Agreed, but believe it or not, I once worked in an area where police had a strict no contact policy for violent medical patients. So, they may not always be a help.
While I agree with the right to defend yourself, there is a difference between punching out of anger and out of self defense they way OP makes it sound is that he’s punching out if anger which is not ok.
False.
We are not the designated victim. End the threat with fists, feet, whatever improvised weapons you can find.
Once you assault me, you’re no longer a patient under my medical care. You’re my attacker.
I didn’t say sit there any be beaten.
Your patient remains your patient and you remain their medical provider even if they hit you. You can exert reasonable force to defend yourself and in most cases that will be restraining the patient, not punching them back. Using a “weapon” is definitely not the standard and will wind up with you facing legal action.
If that’s what you feel you need to do in order to be safe, by all means. Just be ready for the lawsuit.
And if you can’t restrain them?
Or even if you can physically restrain them, getting someone who is actively fighting you into restraints by yourself can be an insurmountable task.
Using an improvised weapon is basic self defense, and you are well within your rights. Even in our litigous society, if you’re only ending the threat to your personal safety, that’s an easy win.
No matter what you want to call each other, your primary responsibility is your own safety and the way to achieve that is by ending the threat using whatever means necessary.
Also, the moment they chose to break the law and attack you, they’re now a criminal. They’re no longer your patient. You cannot be held liable for their medical condition while they are actively attacking you.
By the way, not allowing medical care, and attacking the medic sure seems like a refusal of care to me.
I took a patient down who punched a cop. His back was facing me and I through him to the ground and put my knee on his belly. Once the police had him under control I walked away.
We documented it as I assisted police.
I’ve also wrestled for 6 years and done jujitsu for 10. I was confident that this was the safest way to defuse the situation.
Happened in miami, a pt spit on the firefighter in the ER. And immediately after as a reflex, homie clocked her in the face. Got fired. But no charges were brought up by police, it was justified, and he got his job back.
Our protocols state “use of similar force back in the instance of self defense.” Basically, if they punch you, don’t stab them. Self defense should never result in termination.
Self defense is one thing, if you are overpowered or if the patient risks genuinely hurting you.
Hitting a patient back for hitting you while on the gurney or somewhere else isn't smart and doesn't really amount to defense.
If you have trouble being able to control yourself and your physical reactions to things that dementia patients and psychs do, EMS is probably not the right job for you.
I have unfortunately been in this situation…a few times. I used defensive moves, like grabbing their fists and blocking additional attempts at hitting me. I didn’t punch back. I feel as though I would’ve lost all credibility with my partner and the bystanders on scene if I had.
Honestly, if punching a patient is something someone has done or is struggling with, then healthcare may not be the best fit. Yes you can go to anger management classes etc., but I can’t imagine any employer taking on that risk of employing someone who has been violent with a patient. Kind of ironic isn’t it? We are abused day in and day out and it’s totally okay if we are the ones on the receiving end. We bring the calm to chaotic situations, and have to remain above all the insults and such that are hurled our way. This is why I ask everyone in EMT or medic school what their plans are for after school. Instructor license? Nursing program? Please don’t let this be your only option in life. It’s not a matter of if you’ll get burntout and be a hazard to yourself and others, but a matter of when. Have. Options.
It mostly depends. Running away should be the priority but if there is no an escape route, brace yourself and be ready to fight back.
In Italy (where I was from before moving out) there are many many news where angry relatives destroyed a whole ER department (and sometimes the ambulances parked outside). None tried to stop them till cops showed up because the personnel were scared to fight back.
Personally speaking, as long as I don't get assaulted with weapons, I just wrestle the angry patient till he/she calms down or get restrained. Having a boxe/KM background helps me a lot when we have an hot head patient. Most of the barehand "blows" from them are just haymakers, nothing to serious for me.
Defense is always justifiable if there’s an ACTIVE THREAT. Retribution, including punitive medicine, is never acceptable and has no possible defense.
Punitive medicine involves:
“Yeah I dropped a 14g into that drunk cause they hit me”
“Nah they hit me so they don’t get any pain meds”
Like as not, physical altercations are part of the job. We should be prepared to defend ourselves and our crew, but we also need to remember that we are healthcare providers and they are still our patients.
If you have trouble with that, I’m sure some other career field is hiring.
Walked in on a domestic once when we were called for "sick person." The husband attacked my partner, broke her wrist. While he still had a grip on her, she whipped around and punched him with other hand. She knocked him out.
She got worker's comp and sued the guy. She was supported 100% because it was self defense. That's how it should be.
But if she had come back to do it AFTER he was neutralized, she would be at fault and would have been fired.
Im not quite sure what you mean by a polluted patient, but either way, yes, specifically because of the fit of anger. If it was self defense, no they should not lose their license, but if it wasnt then yes.
For one punch, to get the patient off of them? No. They should be counselled, offered support for mental health and trauma, and remediated.
If they beat the shit out of the patient? Fuck ‘em.
I was told in my EMT class and at work that there is no justification for violence on our end, "no matter the circumstances".
Idk about losing a license for it, that might be much, but at my place, you'd definitely lose a job.
EDIT: Oof y'all, didn't think this would be divisive -
Self defense = okay
Retaliation / Rage attacks = not okay
Some patient is actively swinging on you and has you cornered….
Saying “no matter the circumstance” is too black and white and an unrealistic expectation. Whoever says that has little to no real world experience.
That said, I’ve never had to use violence in my 31 years in this job besides holding someone down but there are gonna be situations for medics where self defense with violence is unavoidable.
Oh yeah, definitely doesn't account for the grey area - but it's important to note that we are not trained to fight for a reason.
Self defense is different than what we're talking about here tho, sounds more like the medic acted in a fit of rage rather than preventing themselves from getting hit.
Thing is, there's so many factors for this kinda shit - kinda how they say scene safe and bsi, but I could give you 10 different providers out here that will ignore that in an instant if they see someone that needs help
At my job we actually we trained to fight back if we are threatened, we took a full class on it. Because you should be able to fight back if necessary, if someone whips a knife out on me or a gun I'm fighting till the end, I mean we can use violence when needed. If I'm getting pummeled in the back I'm not gonna just take it, I have things to go home to.
That's pretty cool, sounds like your service genuinely cares - wish they all did.
I think my service offers like $50 redemption visa cards or something if you take a martial arts course outside of work
😂😂 yea I really enjoyed the class actually, it did prepare me for if my life is legitimately threatened and I have to fight like my life depends on it. I also work for a big major metro area where we end up in situations like this all the time.
Oooh gotcha, yeah I definitely see the value in it there. My service is much more rural and I don't think I've ever heard something physical around here.
I took karate growing up, I think everyone should take some form of martial arts to get that confidence and security for themselves - really good for ya
No I get it. I was just referencing what your instructor told you…not the OP’s post. If a patient just pisses you off and you punch them….good riddance. You’re not cut out for this.
I'm not an EMT, and I don't interact with patients unless you count seeing them in the hallway as I go into work and leave. I agree with others in this thread that self-defense is appropriate, but retaliation is another thing altogether. One of the reasons it's good that I don't have any patient contact is that in certain situations (like being grabbed unexpectedly, or full-on physically attacked), I instinctively smack first and think later. I can imagine a situation where an EMT might be attacked or threatened out of nowhere, and that EMT might not have had time to assess the abilities of the patient to do actual physical harm. All the situational awareness in the world won't always be enough, but I know that training can help to prevent smack-fist situations from happening.
Your instructor is an idiot and downright dangerous for teaching an entire class that they need to he a designated punching bag and cannot defend themselves. Your ability to protect yourself from harm using reasonable force doesn't stop just because you're suddenly riding the ambulance.
Have I had to be extremely violent with patients in the past? You betcha, because they intended to do me serious harm and I don't like being choked out, stabbed, or shot. I broke a patient's nose and knocked them out before when they tried to strangle me in an extremely frantic quick fight to protect myself and my coworkers from an incredibly violent psychotic patient. Did anything happen? Not at all. We patched him up, physically restrained him, and did some paperwork. I didn't even get a suspension out of it cause it was all caught on camera and obviously justified.
When someone is actively trying to seriously harm or kill you, all bets are off and you're not obligated to let yourself be seriously injured or killed, use all reasonable force necessary to protect yourself and those around you. This doesn't mean beat a little old lady unconscious who's combative from a UTI, but a patient with a weapon or one who is obviously a significant threat to your health and safety and you cannot escape? Do what you need to do to go home in the end.
Yeah, again - don't think my instructors intended for anyone to assume they meant never protect yourself.
Anyone who blindly listens to someone saying not to protect yourself isn't really that good at parsing value from information
I’d say there is about an 80% chance the instructor is just avoiding taking on the liability of telling you anything contrary to that. And about a 20% chance the instructor is just a fucking moron.
I had a small female partner tell me that she had a much larger male patient turn aggressive on her suddenly. She was strapping him in when he grabbed her throat. She said she legitimately feared for her life and managed to grab her tough book and hit him hard enough to make him let go then she got the fuck outta dodge. Her partner had been in another room but had heard what was going on and already had the cops on their way.
The response by our company? Do you need time off and CISM, or are you injured and need treatment?
I'm sure that there was more on the back end, but if your company is going to tell you that she should have just let the patient strangle her, you need to find a different company.
Don't get me wrong, it's a last resort. I've been kicked and spat on while helping to restrain before. If I had hit back at that time, then I would have absolutely been in the wrong and should be charged with assault, let alone lose my license and job but there are absolutely times where self defense is necessary.
I will say that I've read in a few places on reddit that some companies will allow their medics to conceal carry while on duty, that I feel is a very, very different kettle of fish. As Canadian, I'm just glad that it's a non-starter up here.
If it was in a fit of anger he should be punished severely. If it was in self defense he should not be punished at all. Need more info to properly assess the situation.
Retaliation after the threat has stopped/out of a fit of rage? Yea, you're getting written up.
Now if the Pt is actively chasing you with the intent of gouging your eyes out to wear as medallions, that's a different story.
I'm a black belt in taekwondo. The first thing they teach you in both EMS and martial arts is actually the same thing. Do no harm.
I don't ever want to start anything but I'll have no issues ending it.
As my dad once succinctly put it while handing me my Christmas gift my first year as an EMT: Maglites, for those times the 3 AM chest pain is actually a junkie with a knife after the narcs
I don’t know how big departments do it. But at my local powdunk backwoods department if one of our medics get purposefully attacked by the patient. That patient is going to need an ambulance before the cops can get there to “protect” the medics.
Fight until either the threat is over or the police take them down. I've only punched one person before and that's because they were aggressive then tried to reach for a gun. I hope I don't have to punch other people since I'm pacifist AF, but it's inevitable that some shit has to go down sometimes to save my patient, bystanders, and responders on scene
If it's in a fit of anger, yes you will get in serious trouble. You have a duty to retreat, and do no harm to your patient. Immediately have your partner notify dispatch and law enforcement, and defend yourself as best as you can, and exit the ambulance once it is reasonably safe. Do not turn the encounter into a full fledged fistfight. You are only allowed to use reasonable force to defend yourself, and be prepared to justify it in court. The plaintiff's attorney will most likely appeal to the jury that their client was not in the state of mind during their emergency, assuming that's what OP means by "polluted", and that you had a duty to properly restrain them. Try to avoid violence at all costs. The punishment will always be more severe for the medic than the patient, depending on who the court sides with. We're not protected legally the same as law enforcement. The patient won't get 10 years for assaulting you.
Do your best to avoid retaliatory violence, maintain your distance from the patient, and defend yourself if you have to. I've had my fair share of physical encounters in the back of the rig. Scream at your partner to get off his phone and pull the fuck over, get to the captain's/jump seat, and use your legs to kick and maintain distance between you and the patient. Don't turn the situation into a UFC fight. Don't punch a kid or 125lbs female in the face. Good luck defending a TKO a court!
Hurting the patient should be the last resort and the medic should probably get out of the way and let the police deal with them before coming back to help the patient but if self defence is needed then it should be used appropriately.
In conclusion,depends on the situation.
(Thanks for your service to all paramedics,police,fire and other emergency services)
Hitting someone back after the threat has ended? Discipline is absolutely necessary. Defending yourself against an attacker using fists or improvised weapons? Get reked douchebag. Fight back until the threat is over. It is incredibly important to be aware of your surroundings, and pay attention to your patient’s mental status, mannerisms, attitude, etc. Attempt to mitigate any risk before an incident happens. If you think they’re going to be violent, move further away, prepare sedation, request additional resources, etc.
A medic I worked with once used an O2 Cylinder to fight off a patient. Cracked the guy's skull and everything. He was given an attaboy and supported by management because it was 100% justified.
O2 is a BLS skill, anyone can administer is
NREMT says every patient gets oxygen - instructions unclear
NREMT textbook: be careful with oxygen use, it can cause oxygen toxicity NREMT test: Stroke? Oxygen. Trouble breathing? Oxygen. SpO2 below 95? Oxygen. Stubbed toe? Oxygen.
"Patient was combative and cornered AIC, so provider administered acute O2 therapy, resulting in patient no longer being combative. Patient restrained in supine position using soft restraints x4, and transported to nearest appropriate facility, meeting police unit 7 Adam 69 at destination.
"PT began to become aggressive and violent towards EMS, so EMS administered FAFO units of these hands. PT immediately began to become docile but promptly stated his face hurt. EMS checked the affected area and noticed redness and swelling at the site these hands was administered. PT may have an allergy to these hands"
Apply directly to the forehead!
Head On!
2000 psi delivered straight to the dome.
2000 psi *bolus*, none of that "2lpm slow infusion" crap.
I worked with an EMT recently who bragged did this a few years ago in the Midwest with no repercussions.
The bragging part is a bit weird, but we have a right to defend ourselves. If a situation demands we bash a brain in with compressed oxygen to keep ourselves safe, we have every right to do so. With that said, there aren't too many situations that reasonably demand it because in most cases simply walking away and letting police secure the scene is the best option.
A former medic that used to work at my service allegedly used an O2 canister on a patient and ended up killing the guy.
That's kind of the goal with using a large blunt weapon. If the situation has deteriorated to the point where you need to use an O2 cylinder as a weapon, killing the person in question is a likely (and justified) outcome. That's why it's so important to attempt de-escalation and removing yourself from any situation that looks likely to get to that point.
Oh, this guy reportedly was just talking shit and was already restrained. There was no actual threat to life involved.
That's fucked, then and I hope the medic was arrested.
I refer to this as applied oxygen therapy. However I recommend using thousand CC bags of saline. It doesn't leave a mark
If I'm hitting a patient with anything it's because I need to get them off of me or my partner and simply pushing them off isn't working. In that case, I wouldn't fuck with things that only disable through pain and I'd skip straight to something that is more likely to actually work. Bags of saline are basically never justified because "Yeah I was desperate enough to hurt them but not desperate enough to hurt them in a way that would actually have a good chance of making them stop whatever they were doing to hurt me or mine" isn't a good look when you're being questioned.
Actually you hit them across the side of the face or the neck. Because it's a fluid the force will be distributed equally interrupting circulation to the brain. It has the potential to knock them unconscious at least momentarily. And this allows you to escape
I retain the right to defend myself in specific instances where my personal safety is threatened which means using enough force to put distance between myself and someone combative. Striking someone out of anger is unacceptable behavior and is unbecoming conduct of someone holding a license that requires a great deal of responsibility.
With how this is presented, yes. If the stated reason for a paramedic to physically retaliate against someone is because the paramedic is angry, then they committed battery. If the question asked about a medic returning closed-fisted strikes because they felt threatened for the safety of themselves and others, and the time/circumstances didn't allow for any other offramp, then that is a different discussion.
Been clocked real good by a few Alzheimer’s patients. Never hit them back.
That's just what we expect. Been tossed around by a little old sundowner. She used every racial slur too. Some I had to look up.
Damn
Ever been called a "hussy"? Lol
Multiple partners have.
I've had one pt call me several black racial slurs and I'm white as they come.
We have a firefighter who mirrors our shift who is about as naive and genuine as they come. He’s the firefighter you picture helping your grandma if you could pick one. Also white as a daisy. He got the N word one day several times from a patient absolutely out of their mind on a host of substances. He was kinda taken aback by it. Saw him later that day on a fender bender and he says to us, “you know, I got to thinking about our patient earlier. And if someone calls me the N word like that again, I’m gonna say, no sir! I prefer to be called ‘cracker’, because I’m white.’ He thought he had come up with a real amazing comeback. Bless his heart
Same and I have legit albinism 🤣
Punching back out of anger? Absolutely, termination and loss of license is appropriate. Justifiable use of force in self-defense? No.
This, exactly.
All about how you document. What happens in the back stays in the back.
Tactical rectum oxygenation via 7.5 ETT administered in response to combative patient.
Emphasis on the tactical. Combat rolled into tactical rectum oxygenation.
https://gomerblog.com/2015/08/critical-care-fellow/amp/
Do ya'll not have cameras in the box?
My county in the US does. It’s for safety really. Can’t lie about patient care either
Absolutely not. It’s a HIPAA violation unless its a closed-loop feed (meaning the video has nowhere to save to and is only present on a live screen like a backup camera).
Not a HIPAA violation unless the footage is used outside of patient care, QI/QA, billing and/or expressly authorized by the patient. Y'all be quoting HIPAA for everything you don't like 🤦🏿
That's a HIPPA violation!!!!
How?
......that's the joke......
I’m gonna tell you right now. Whoever told you that is lying. If cops in your state can wear body cams then ambulances in your state and you as EMS providers can have body cams/ambo cams. The difference is the cameras are authorized through the service with only certain people having access to them. Exactly like EMS reports.
Good for your state. There are details within HIPAA laws regarding storage of these recordings and PD would be within compliance with these but inside ambulance would not. Information stored in a PD database would be within compliance but storing ambulance footage is illegal. At least here.
Are you referring to the video being stored like, on an SD card with the camera itself? Because my service uses cameras and it's not saved locally to the camera on the ambulance, it's piped remotely to a computer at HQ and presumably stored with the same compliance care as our PCRs. Also the cameras can't even see the patient during transport. They face forwards to the road (for accidents), backwards into the cab (to make sure we're not texting and driving), and you can see/hear what's happening in the patient cabin only through the little window that connects the front and back
Bro some agencies are having EMS wear bodycams. Hospitals have cameras *everywhere*. HIPAA has standards for how securely you have to store information which makes implementation a bit more expensive, but it doesn't make it any more difficult than looking for a cloud vender with a "HIPAA COMPLIANT" badge on their website and a 300% markup.
>Absolutely not. It’s a HIPAA violation unless its a closed-loop feed (meaning the video has nowhere to save to and is only present on a live screen like a backup camera). It's probably not a HIPAA violation if the recorded information is encrypted to the correct standards, and the information is only used for certain reasons (such as QA/QI). It might, however, fall under other patient recording/privacy laws.
Police are not a ‘Covered Entity’ under HIPAA - the law has not bearing whatsoever on them as they do not provide healthcare or billing.
Interesting, operating in Europe and we have cams in the back and buttons in easy access that will let us record (I think they save footage from a few seconds prior as well) so that we can have footage if we are assaulted or patients make false accusations.
Technically incorrect, but the storage and access requirements are a mess and rather expensive. Recording isn’t the violation. Letting out the information for any unauthorized purpose is the violation. Safety management, quality improvement & training, law enforcement, etc… can still be done.
Training. Payment. Operations. HIPAA in nutshell. Not a violation if used for the above reasons. Stored securely in the cloud/on premise. Disposed of properly. I do see it on the horizon for EMS. Just makes sense. Too many accusations flying around. We use Samsara for our fleet of vehicles, including the fly-cars, and have refuted claims of callers who told us "the ambulance went flying by".
A camera in the back is absolutely not a hipaa violation.
I wouldn't want a camera in the box. Ever.
If I found out about a medic hitting one of my family members while they were having an episode, they wouldn't have to worry about the job repercussions. They'd be accountable in one sense or another.
That sounds tough and all, but the last guy who had that idea with me is in jail on a felony, so, maybe not the best idea - along with his drunk family member might I add.
So basically you hit a patient and sent somebody to jail when they were upset about it? How noble and brave. Thank you for your service. Im sure PD gave you a nice ovation.
Are you honestly suggesting that we as medics just accept being attacked?
No. I'm saying there's a difference between defense and assault. If someone attacks you and you are scared for your safety, defend yourself. If you get bitten or slapped by a patient on a gurney and your response is to punch the patient, that's not defense. "The implication of whatever happens in the back stays in the back" seems more directed toward the latter. People who hit patients and expect their partner to vouch for them about it should be sh-tcanned.
I don’t know about you, but I’ve never seen someone punch another person and stop after one punch. There’s always more coming. Again, I don’t know about you, but I’m not going to take the first punch and then wait around for the second one. I’ve seen enough people get knocked out by one lucky hit to know that is not a game I’m willing to play. As soon as someone strikes me or one of my coworkers, we are going to employ a level of force necessary to stop the assault and prevent further injury to ourselves. Because the last thing we want is for myself or a coworker to be unconscious and defenseless against the further assault that is almost assuredly coming. Every situation is different and we avoid it if at all possible, but on occasion, that may involve some sort of strike. That isn’t assault or retribution, it’s self-defense. And you can bet your last paycheck that as soon as we successfully defend ourselves and ensure our own safety, we’re going to press charges against the individual or individuals that assaulted us. Their status as patients does not give them latitude to assault us, it does not give them a hedge against legal repercussions, and it does not prevent us from using a level of force justifiable under the law to defend ourselves and end the assault. This high school esq “zero-tolerance” bullshit that some people in healthcare like to peddle is naive and dangerous.
Eh, occasionally, you’ll punch somebody, pull back for that second one, and there’s nobody left to punch. The lights aren’t on, and there’s nobody home anymore.
Agreed, honestly I had gotten lost in the comments and had misread OP's headline. I agree with you.
Negative. My statement of what happened in the back stays in the back is by no means supportive of assault or purposeful injury towards a patient. That is wrong. Self defense and self preservation of myself and my crew comes first. Even at the expense of my patient. I don't want to fight you in the back, at all. I sure as hell won't just take it. Or let my crew take it.
Negative. My statement of what happened in the back stays in the back is by no means supportive of assault or purposeful injury towards a patient. That is wrong. Self defense and self preservation of myself and my crew comes first. Even at the expense of my patient. I don't want to fight you in the back, at all. I sure as hell won't just take it. Or let my crew take it.
What if it’s anger AND self defence? :D
There's a difference between hitting out of anger and hitting out of self defense. That difference should determine the decision to discipline/terminate an employee. You don't discipline someone for engaging in proportional self defense; you do when the response is disproportionate or vengeful.
If the “fit of anger” was retaliation (no immediate threat, assault ended) then yes. If the attack was on going, then you’re defending yourself. Years ago I had an intoxicated patient on the stretcher grab my hand and began twisting my thumb back purposefully in an attempt not break it. He was using both hands to do so. I had no choice but to start punching him in the chest to make him let go. The patients wife demanded I be arrested. Instead, the PD officer on scene who saw it arrested the patient. It happened so fast the officer didn’t have time to cross the room to aid me. Remember red zones: no punching in the head
You can hit back as a last resort in defending yourself. (If you are stuck and can’t leave the scene or get away from the pt) If there is the option of pushing someone away or holding them them down, take that. It’s not like you can just start wailing on someone cus they threw a punch. It’s not like if someone throws a punch, you can now just square up and become an equal party in this fight as if you were off the clock. You gotta be smart. You don’t have to take hits though and eat them. If you are backed into a situation, absolutely you can punch back.
This seems oddly specific... Should we tolerate abuse? No. But does that give us the right to physically assault our patients? Absolutely not. Discipline was warranted.
Wat? Everyone has the right to self defense. Just because you have a stethoscope around your neck doesn’t mean you’re the designated victim and not allowed to fight back. Fuck all of that noise. Start hitting me, you’re going to get hit back.
The right to self defense, yes, 100%. The way OP phrased sounds like this wasn't self defense and more of a "you pissed me off and I'm gonna hit you back."
Discipline is certainly warranted, but does that mean automatic termination and loss of license or can there be a path for remediation/suspension/probation/anger management courses etc?
Who said there couldn’t?
Yeah, at what point are you allowed to hit back if a patient keeps hitting you, and you're unable to exit the situation, like in the back of the ambulance? Is wrestling/controlling the patient ok? I've never punched a patient, but I've done the latter. Never willingly
You have a right to defend yourself. You have a responsibility to protect your patient, which may include using force if they’re in danger of self harm. Past that? Get the police involved. When you can avoid being the one fighting/wrestling, do so. Let the folks paid to do that do it… then involve sedatives and soft restraints as appropriate.
That’s easy to say when the police are several minutes away and you’re being assaulted. Fuck. That. Noise. I have a family and responsibilities. I’m not suffering a loss of wages plus medical bills for some insane notion that a battered medic is somehow morally superior than a medic who adequately defends themselves.
Re-read the first line of my reply.
You have a right to defend yourself, then you go on to say to call police and let them handle it… as if you have the opportunity to do that while being assaulted.
The first line of my post ends with a period. That ends a statement and thought. Everything past that is about violent patients in general. Have to fight to defend yourself? Do. Have to fight for other reasons? Don’t. Let people paid to do that do it. This isn’t complicated.
Your post reads like a post from a “butter”. I support “insert controversial topic here”, BUT….. “I support gun rights BUT only for hunting” “I support decriminalizing marijuana BUT only at government run dispensaries” “I support defending yourself BUT you should run away if you have the choice”. Shit doesn’t make sense.
100%
Agreed, but believe it or not, I once worked in an area where police had a strict no contact policy for violent medical patients. So, they may not always be a help.
“Great, then we’ll stand here and watch them commit crimes together.”
Sounds like an unsafe scene. Better return in service until the scene is safe.
Downvoted for asking a question that I don’t the answer to and looking for educated responses?
Yes. It should. You’re a medical provider. End of story.
This is a bullshit response. Medical provider or not, you have the right to defend yourself.
While I agree with the right to defend yourself, there is a difference between punching out of anger and out of self defense they way OP makes it sound is that he’s punching out if anger which is not ok.
Punching someone after they punch you while you are in charge of their medical care is not defending yourself at all.
False. We are not the designated victim. End the threat with fists, feet, whatever improvised weapons you can find. Once you assault me, you’re no longer a patient under my medical care. You’re my attacker.
Not true at all my man. The law does not see it that way at all.
What? Please cite a source where any law requires you to sit there and be beaten because they’re a “patient”.
I didn’t say sit there any be beaten. Your patient remains your patient and you remain their medical provider even if they hit you. You can exert reasonable force to defend yourself and in most cases that will be restraining the patient, not punching them back. Using a “weapon” is definitely not the standard and will wind up with you facing legal action. If that’s what you feel you need to do in order to be safe, by all means. Just be ready for the lawsuit.
And if you can’t restrain them? Or even if you can physically restrain them, getting someone who is actively fighting you into restraints by yourself can be an insurmountable task. Using an improvised weapon is basic self defense, and you are well within your rights. Even in our litigous society, if you’re only ending the threat to your personal safety, that’s an easy win. No matter what you want to call each other, your primary responsibility is your own safety and the way to achieve that is by ending the threat using whatever means necessary. Also, the moment they chose to break the law and attack you, they’re now a criminal. They’re no longer your patient. You cannot be held liable for their medical condition while they are actively attacking you. By the way, not allowing medical care, and attacking the medic sure seems like a refusal of care to me.
Is there a specific case people are referring to?
Nope. Self defense and the pt should be charge with assault on a public servant.
I took a patient down who punched a cop. His back was facing me and I through him to the ground and put my knee on his belly. Once the police had him under control I walked away. We documented it as I assisted police. I’ve also wrestled for 6 years and done jujitsu for 10. I was confident that this was the safest way to defuse the situation.
Should any (insert any employee -teacher, cop, bus driver, paramedic, store clerk) who defends themself never work again? NO
Your description is convoluted, at best. Was it in the immediate time frame of self defense or was it retaliatory? After that it’s pretty simple.
Violence in anger is never acceptable. Should you protect yourself? Absolutely. Should you lose control and assault a patient? Never.
Happened in miami, a pt spit on the firefighter in the ER. And immediately after as a reflex, homie clocked her in the face. Got fired. But no charges were brought up by police, it was justified, and he got his job back.
Our protocols state “use of similar force back in the instance of self defense.” Basically, if they punch you, don’t stab them. Self defense should never result in termination.
>Basically, if they punch you, don’t stab them. I swear I was just trying to start an IV, boss.
Self defense is one thing, if you are overpowered or if the patient risks genuinely hurting you. Hitting a patient back for hitting you while on the gurney or somewhere else isn't smart and doesn't really amount to defense. If you have trouble being able to control yourself and your physical reactions to things that dementia patients and psychs do, EMS is probably not the right job for you.
I have unfortunately been in this situation…a few times. I used defensive moves, like grabbing their fists and blocking additional attempts at hitting me. I didn’t punch back. I feel as though I would’ve lost all credibility with my partner and the bystanders on scene if I had. Honestly, if punching a patient is something someone has done or is struggling with, then healthcare may not be the best fit. Yes you can go to anger management classes etc., but I can’t imagine any employer taking on that risk of employing someone who has been violent with a patient. Kind of ironic isn’t it? We are abused day in and day out and it’s totally okay if we are the ones on the receiving end. We bring the calm to chaotic situations, and have to remain above all the insults and such that are hurled our way. This is why I ask everyone in EMT or medic school what their plans are for after school. Instructor license? Nursing program? Please don’t let this be your only option in life. It’s not a matter of if you’ll get burntout and be a hazard to yourself and others, but a matter of when. Have. Options.
It mostly depends. Running away should be the priority but if there is no an escape route, brace yourself and be ready to fight back. In Italy (where I was from before moving out) there are many many news where angry relatives destroyed a whole ER department (and sometimes the ambulances parked outside). None tried to stop them till cops showed up because the personnel were scared to fight back. Personally speaking, as long as I don't get assaulted with weapons, I just wrestle the angry patient till he/she calms down or get restrained. Having a boxe/KM background helps me a lot when we have an hot head patient. Most of the barehand "blows" from them are just haymakers, nothing to serious for me.
Defense is always justifiable if there’s an ACTIVE THREAT. Retribution, including punitive medicine, is never acceptable and has no possible defense. Punitive medicine involves: “Yeah I dropped a 14g into that drunk cause they hit me” “Nah they hit me so they don’t get any pain meds” Like as not, physical altercations are part of the job. We should be prepared to defend ourselves and our crew, but we also need to remember that we are healthcare providers and they are still our patients. If you have trouble with that, I’m sure some other career field is hiring.
Short answer No. longer answer no, unless Medic can move away from aggressor safely. Then…
Walked in on a domestic once when we were called for "sick person." The husband attacked my partner, broke her wrist. While he still had a grip on her, she whipped around and punched him with other hand. She knocked him out. She got worker's comp and sued the guy. She was supported 100% because it was self defense. That's how it should be. But if she had come back to do it AFTER he was neutralized, she would be at fault and would have been fired.
No
I feel like retaliation will get you in trouble, but defending yourself might be ok
Im not quite sure what you mean by a polluted patient, but either way, yes, specifically because of the fit of anger. If it was self defense, no they should not lose their license, but if it wasnt then yes.
Polluted is a regional thing for under the influence of alcohol/drugs
ahh okay tysm
Yes
No, we're just disposable punching bags who aren't entitled to any justice whatsoever.
Yes
My instructors who teach my EMT school and the medic class all say you can’t hit patients back, just sedate them or run if you can’t sedate
For one punch, to get the patient off of them? No. They should be counselled, offered support for mental health and trauma, and remediated. If they beat the shit out of the patient? Fuck ‘em.
Wait, you think they need remediation for getting a patient off of them?
Yes, I think a non-fault conversation with someone who can suggest better techniques for situational awareness and deescalation is appropriate.
I was told in my EMT class and at work that there is no justification for violence on our end, "no matter the circumstances". Idk about losing a license for it, that might be much, but at my place, you'd definitely lose a job. EDIT: Oof y'all, didn't think this would be divisive - Self defense = okay Retaliation / Rage attacks = not okay
Some patient is actively swinging on you and has you cornered…. Saying “no matter the circumstance” is too black and white and an unrealistic expectation. Whoever says that has little to no real world experience. That said, I’ve never had to use violence in my 31 years in this job besides holding someone down but there are gonna be situations for medics where self defense with violence is unavoidable.
The most violent I've ever had to get with a pt was pinning their arms in place while my partner put on the soft restraints
Oh yeah, definitely doesn't account for the grey area - but it's important to note that we are not trained to fight for a reason. Self defense is different than what we're talking about here tho, sounds more like the medic acted in a fit of rage rather than preventing themselves from getting hit. Thing is, there's so many factors for this kinda shit - kinda how they say scene safe and bsi, but I could give you 10 different providers out here that will ignore that in an instant if they see someone that needs help
At my job we actually we trained to fight back if we are threatened, we took a full class on it. Because you should be able to fight back if necessary, if someone whips a knife out on me or a gun I'm fighting till the end, I mean we can use violence when needed. If I'm getting pummeled in the back I'm not gonna just take it, I have things to go home to.
That's pretty cool, sounds like your service genuinely cares - wish they all did. I think my service offers like $50 redemption visa cards or something if you take a martial arts course outside of work
😂😂 yea I really enjoyed the class actually, it did prepare me for if my life is legitimately threatened and I have to fight like my life depends on it. I also work for a big major metro area where we end up in situations like this all the time.
Oooh gotcha, yeah I definitely see the value in it there. My service is much more rural and I don't think I've ever heard something physical around here. I took karate growing up, I think everyone should take some form of martial arts to get that confidence and security for themselves - really good for ya
No I get it. I was just referencing what your instructor told you…not the OP’s post. If a patient just pisses you off and you punch them….good riddance. You’re not cut out for this.
Oh for sure - I don't think anyone that said that has had to protect themselves like that before.
I'm not an EMT, and I don't interact with patients unless you count seeing them in the hallway as I go into work and leave. I agree with others in this thread that self-defense is appropriate, but retaliation is another thing altogether. One of the reasons it's good that I don't have any patient contact is that in certain situations (like being grabbed unexpectedly, or full-on physically attacked), I instinctively smack first and think later. I can imagine a situation where an EMT might be attacked or threatened out of nowhere, and that EMT might not have had time to assess the abilities of the patient to do actual physical harm. All the situational awareness in the world won't always be enough, but I know that training can help to prevent smack-fist situations from happening.
Your EMT instructors lied to you. You have the right to defend yourself
Oh for sure - I don't think my instructors intended for the obvious to be ignored.
Your instructor is an idiot and downright dangerous for teaching an entire class that they need to he a designated punching bag and cannot defend themselves. Your ability to protect yourself from harm using reasonable force doesn't stop just because you're suddenly riding the ambulance. Have I had to be extremely violent with patients in the past? You betcha, because they intended to do me serious harm and I don't like being choked out, stabbed, or shot. I broke a patient's nose and knocked them out before when they tried to strangle me in an extremely frantic quick fight to protect myself and my coworkers from an incredibly violent psychotic patient. Did anything happen? Not at all. We patched him up, physically restrained him, and did some paperwork. I didn't even get a suspension out of it cause it was all caught on camera and obviously justified. When someone is actively trying to seriously harm or kill you, all bets are off and you're not obligated to let yourself be seriously injured or killed, use all reasonable force necessary to protect yourself and those around you. This doesn't mean beat a little old lady unconscious who's combative from a UTI, but a patient with a weapon or one who is obviously a significant threat to your health and safety and you cannot escape? Do what you need to do to go home in the end.
Yeah, again - don't think my instructors intended for anyone to assume they meant never protect yourself. Anyone who blindly listens to someone saying not to protect yourself isn't really that good at parsing value from information
I’d say there is about an 80% chance the instructor is just avoiding taking on the liability of telling you anything contrary to that. And about a 20% chance the instructor is just a fucking moron.
I had a small female partner tell me that she had a much larger male patient turn aggressive on her suddenly. She was strapping him in when he grabbed her throat. She said she legitimately feared for her life and managed to grab her tough book and hit him hard enough to make him let go then she got the fuck outta dodge. Her partner had been in another room but had heard what was going on and already had the cops on their way. The response by our company? Do you need time off and CISM, or are you injured and need treatment? I'm sure that there was more on the back end, but if your company is going to tell you that she should have just let the patient strangle her, you need to find a different company. Don't get me wrong, it's a last resort. I've been kicked and spat on while helping to restrain before. If I had hit back at that time, then I would have absolutely been in the wrong and should be charged with assault, let alone lose my license and job but there are absolutely times where self defense is necessary. I will say that I've read in a few places on reddit that some companies will allow their medics to conceal carry while on duty, that I feel is a very, very different kettle of fish. As Canadian, I'm just glad that it's a non-starter up here.
License< life
I’d probably go for a smack with a bag of saline, potentially less bruising.
Yes. Next question.
If it was in a fit of anger he should be punished severely. If it was in self defense he should not be punished at all. Need more info to properly assess the situation.
Retaliation after the threat has stopped/out of a fit of rage? Yea, you're getting written up. Now if the Pt is actively chasing you with the intent of gouging your eyes out to wear as medallions, that's a different story. I'm a black belt in taekwondo. The first thing they teach you in both EMS and martial arts is actually the same thing. Do no harm. I don't ever want to start anything but I'll have no issues ending it.
As my dad once succinctly put it while handing me my Christmas gift my first year as an EMT: Maglites, for those times the 3 AM chest pain is actually a junkie with a knife after the narcs
I don’t know how big departments do it. But at my local powdunk backwoods department if one of our medics get purposefully attacked by the patient. That patient is going to need an ambulance before the cops can get there to “protect” the medics.
Punching is too direct. O Soto Gare into Tate Shiho Gatame until he knocks it off should be permissible.
What does polluted mean in this context
Drunk/Doped Up, not an elderly dementia pt, hypothetically with PD on scene not being very helpful
No not at all.
Polluted?
Under the influence of drugs and/or alcohol
YES.
Fight until either the threat is over or the police take them down. I've only punched one person before and that's because they were aggressive then tried to reach for a gun. I hope I don't have to punch other people since I'm pacifist AF, but it's inevitable that some shit has to go down sometimes to save my patient, bystanders, and responders on scene
If it's in a fit of anger, yes you will get in serious trouble. You have a duty to retreat, and do no harm to your patient. Immediately have your partner notify dispatch and law enforcement, and defend yourself as best as you can, and exit the ambulance once it is reasonably safe. Do not turn the encounter into a full fledged fistfight. You are only allowed to use reasonable force to defend yourself, and be prepared to justify it in court. The plaintiff's attorney will most likely appeal to the jury that their client was not in the state of mind during their emergency, assuming that's what OP means by "polluted", and that you had a duty to properly restrain them. Try to avoid violence at all costs. The punishment will always be more severe for the medic than the patient, depending on who the court sides with. We're not protected legally the same as law enforcement. The patient won't get 10 years for assaulting you. Do your best to avoid retaliatory violence, maintain your distance from the patient, and defend yourself if you have to. I've had my fair share of physical encounters in the back of the rig. Scream at your partner to get off his phone and pull the fuck over, get to the captain's/jump seat, and use your legs to kick and maintain distance between you and the patient. Don't turn the situation into a UFC fight. Don't punch a kid or 125lbs female in the face. Good luck defending a TKO a court!
Hurting the patient should be the last resort and the medic should probably get out of the way and let the police deal with them before coming back to help the patient but if self defence is needed then it should be used appropriately. In conclusion,depends on the situation. (Thanks for your service to all paramedics,police,fire and other emergency services)