Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Violent Patient Tries to Jump From S.C. Chopper

This is wrong on so many levels. I hope that the biggest problem is the accuracy of the reporting.

A patient who leapt from a moving car on an interstate later tried the same thing from a helicopter.[1]

Simple EMS history taking is the best way to prevent bad outcomes. My favorite question is, Has this ever happened before? A positive response to that question results in my second favorite question – What helped make things better, last time?

Reports indicated the man suffered a head injury in a fall from a vehicle traveling about 70 mph.[1]

This isn’t rocket surgery. If someone jumped from a moving vehicle before he had a head injury, why should we assume that this will improve his thinking? This is what is known as a clue. Maybe he didn’t jump. Maybe he was pushed, but the tie goes to assuming the worst, protecting the patient, and protecting the crew.

About five minutes into the flight, he started struggling with medics, the newspaper reported.[1]

Surprising.

I’m shocked, shocked to find that predictable behavior is going on in here!

I thought we would just put the patient in the helicopter and have an uneventful flight, but No, the patient actually needs medical attention.

Deputies said Altoro Alveriz attempted to jump out of the helicopter, which promptly landed at Lowcountry Regional Airport.

Alveriz was then placed in a sleeve that prevented him from moving his arms and legs.[1]

When using RSI (Rapid Sequence Induction/Intubation) for head injured patients, many doctors recommend using lidocaine to protect against increased intracranial pressure from the intubation. With head injuries, increased intracranial pressure and hypoxia are the worst things we can cause.

The best way to increase intracranial pressure may be to restrain the patient without any sedation.

According to the article, what did they do for this patient?

Physical restraint without chemical restraint.

Why?

Maybe they were trying to punish the patient for being combative.[2]

Maybe they do not have standing orders for chemical restraint for these patients.[3]

Maybe they mistakenly assumed that nobody can get out of a Reeve’s sleeve.


Image credit.

Who knows? Maybe they did also chemically restrained him, but it was just not reported.

Violent patients should be chemically restrained for the safety of everyone. The patient, the crew, the people on the ground.

The same is true with ground transport. Violent patients should be chemically restrained for the safety of everyone. The patient, the crew, the other people on the road.

Generally, flight crews are appropriately aggressive about chemically restraining potentially combative patients before placing them anywhere near a helicopter. Why was this time different?

Droperidol, ketamine, midazolam, lorazepam, diazepam, et cetera. There are plenty of drugs that can be used to sedate patients to protect the patient from his own potential violence and from possible worsening intracranial pressure.

Footnotes:

[1] Violent Patient Tries to Jump From S.C. Chopper
EMSWorld.com News
Article

[2] They can’t help it
Captain Chair Confessions
January 5, 2012
Article

[3] There are doctors who think that protecting a patient with sedation is somehow more dangerous than allowing their unstable medical condition to progress without treatment directly causing the condition to get worse by only using physical restraints. The only appropriate word for these doctors is defendants, but too often, the bad outcomes are assumed to be inevitable. There is no good reason to believe that these bad outcomes are inevitable.

[4] [youtube]mUbytEgTXZQ[/youtube]
No, it isn’t a Reeve’s, but does anyone really believe that Houdini would not have been able to escape from a Reeve’s sleeve.

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Comments

  1. I’m glad I’m not the only one who was thinking all this. Also it’s only about an hour drive by ground to the nearest level 1 trauma center (I mapped it out) He probably could’ve gone by ground.

    • @in_the_city,

      I’m glad I’m not the only one who was thinking all this. Also it’s only about an hour drive by ground to the nearest level 1 trauma center (I mapped it out) He probably could’ve gone by ground.

      That depends. If the patient is actually showing signs of increased intracranial pressure, then a flight is probably the right means of transport.

      If the flight crew is just going to physically restrain the patient without any chemical sedation, thus raising the patient’s intracranial pressure, then a flight is definitely not appropriate.

      It is difficult to tell from the article.

      .

  2. Looks like a kidnapping to me 🙂

  3. A Reeves sleeve would dramatically improve my dating prospects.

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