Chapter 54. The uncooperative or violent patient
Ambulance crews are frequently exposed to violent situations and threatening behaviour from patients and bystanders. Ambulance control should communicate to crews any factors that may increase their risk when attending a scene. Factors suggesting the possibility of violence include:
• Location – such as night-club, party, rave, etc
• Historical – are violent incidents known to have happened at this location in the past?
• Type of call – fighting, stabbing, domestic violence
• Illness related – head injury, pain, delusions.
Police support should be requested early.
Prior to arrival
It is important to think about equipment that may be used against personnel, e.g.:
• Equipment bags
• Scissors, pens, pencils
• Stethoscopes.
All communication equipment, including hand-held devices, must be checked to avoid communications breakdown when help is needed in a violent or potentially violent situation.
On arrival
On arrival, initial considerations must include:
• Protective clothing – is there a need for a helmet and eye protection? Should high-visibility clothing be worn?
• Vehicle positioning – position safely with an easily accessible exit
• Survey the scene
• Establish if there are other services present. Who is in charge?
• Determine whether support (ambulance officer, police, fire brigade) will be needed
• Clear bystanders.
Systematic approach to the uncooperative or violent patient
• Maintain safety
• Introduce yourself
• Establish a rapport
• Set the ground rules
• Seek a history
• Seek clarification.
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